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Forum Name: Neurology Topics

Question: severe neuropathy both legs, ulnar transposition left arm no


 jackm - Thu Dec 25, 2008 4:06 am

I fell on a tower and after being pretty banged up I caught myself with my right hand. The men on the ground were worried about my right shoulder but that seems to be theonly thing not affected. This occurred in 2003. I had a heart attack 36 hours later-no heart damage. I immediately began feeling weakness and tingling in left hand. MRI showed cervical damage but not to the extent I was describing. In 2007 my left hand was much weaker and became permanently numb. I think possibly the dr didn't believe me. Sept 2008 ulnar transposition surgery and damage was 'severe' but I can move my fingers slow motion and drop things often. the entire arm aches very deep. In 2005 I had lumbar surgery because I could no longer walk and some kind of cysts were also removed there. I could walk for 2 more years then began falling and in 2009 was diagnosed severe neuropathy both legs. Now my right hand and arm have become permently numb and weak but the ulnar surgeon and nerve conduction tester told me to go again to the spine doctor before it becomes permanent.
When I turn my head to the right I can feel it cut off my right hand and arm. My neck is also very stiff. It hurts to type this and write and hold a phone.
Can they be missing something in the two mris that were done?
Also if my wife puts her hand on my back I over react like falling down. ? I am getting desparate because I am no longer working it is becoming increasingly difficult to wash some dishes and help with laudary etc.
 John Kenyon, CNA - Fri Feb 20, 2009 10:13 pm

User avatar Hello --

This is a very strange situation you describe, and what makes it "interesting" to me is that I'm familiar with at least one situation where things developed along similar lines, although there's no clear reason for it, following a physical trauma (although not as violent as the one you experienced).

Going top to bottom, what you describe about turning your head "cutting off your arm" (presumably both nerve conduction and maybe even circulation) strongly suggests thoracic outlet syndrome (TOS) on the right side. This can be caused by faulty posture or by trauma, the latter being more likely in your case. It also could be a distinctive feature of bilateral ulnar neuropathy (your left hand and arm definitely are having some of this).

What makes this particularly interesting is the similarity between cases of ulnar neuropathy by trauma followed some years later by idiopathic peripheral neuropathy in the lower extremities (including the falling tendency). While there is no logical connection between the two, there is also no other explanation, leading one to suspect there is some sort of occult cause-and-effect. I will refer this to the neurology team here in hopes someone may have some more useful insight into why this might happen. (It goes without saying this could be more directly related to the initial trauma, but even after removal of cysts the problem continues to progress).

I wish I could give you something more to go on. The ulnar neuropathy and possible TOS can be managed surgically and possibly via physical therapy respectively. The IPN is another story. It's that I'd like to get more input for.

Please stay in touch with us here and check back to see if anyone has anything to add in terms of the neuropathy in particular. Good luck to you.
 jboyer - Sat Feb 21, 2009 1:28 pm

Unfortunately ulnar neuropathy does have a notable failure rate with either transposition or decompression, If you did have severe damage with some axonal loss then complete recovery can only come after the nerve has had an opportunity to regenerate those axons that have died. This occurs at the rate of approximately one inch per month and therefore it may be 18 months before you are completely recovered. Nonetheless I usually expect some recovery within at least 3-6 months and if there is none I will generally repeat the EMG and nerve conduction studies to see if there has been any change. We don't necessarily expect improvement, but if they are worse that would indicate the nerve was inadequately decompressed.

Your history also suggests that some of your am symptoms are also coming from your cervical spine and I would suggest a cervical myelogram.

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