Hand and Arm Numbness

      Hand and arm numbness is a common complaint . I would like to discuss the most common syndromes causing  these sorts of complaints. Specifically I am talking about more chronic or long-standing problems as opposed to something with sudden onset such as we may see in a stroke.

            The most common and perhaps least serious cause would be carpal tunnel syndrome. This syndrome is caused by compression of the median nerve as it travels through the wrist.  This usually develops slowly over time but can also be an acute problem brought on by significant repetitive activity of the hand and wrist over a short period of time. I've seen this occur quite frequently in patients who've spent the weekend painting a room for example. This typically will produce numbness, pain or tingling in the thumb, first and second fingers of the hand. All of these symptoms may exist together. Typically symptoms will get worse at night or with use of the hand. Usually carpal tunnel syndrome will develop first in the dominant hand but frequently involves both hands as it becomes more severe. In severe cases the pain may involve the entire arm.  We used to believe that carpal tunnel syndrome was entirely a result of repetitive motion. Now we know that some patients are predisposed to this based on the anatomy of the wrist.

            Frequently carpal tunnel syndrome can be treated conservatively when it is mild. Wrist splints, anti-inflammatory medications and B6 and B12 supplementation can sometimes be helpful. Frequently this is all that is necessary to alleviate symptoms. If a patient has weakness in the hand or aatrophy of the muscles of the thumb, surgery is recommended. Surgical decompression of the median nerve is a highly effective treatment in the majority of patients.  Cubital tunnel syndrome is a similar process however involves compression of the ulnar nerve at the elbow. Numbness and tingling in the fourth and fifth digit of the hand are typical.  This nerve supplies many of the muscles of the hand and therefore hand weakness and loss of dexterity or common and tend to occur early in the disease process. Progressive loss of nerve function can happen quite quickly and therefore weakness needs to be treated as a serious problem as a nerve recovers poorly if damage gets severe before surgical intervention.

            Radiculopathy or “pinched nerve” is also a fairly common cause of numbness in the hand and arm. The distribution of this numbness would depend on which nerve roots were actually involved. This is frequently caused by a bulging disc or bone spurs in the neck.  The most common level involved is between the fifth and sixth cervical vertebrae. This would also produce numbness in the thumb and first two fingers of the hand. Usually radiculopathy is accompanied by pain traveling down the arm, but occasionally numbness and/or tingling may be the only symptoms. Radiculopathy generally is a more serious problem than carpal tunnel syndrome and is more prone to produce nerve damage if left untreated.

            The majority of patients with radiculopathy will improve with conservative treatment such as physical therapy, anti-inflammatory medications, chiropractic treatment, acupuncture etc. Cervical epidural steroid injections can also be highly effective. For those patients who fail to respond to conservative therapy or who have significant neurologic deficits, surgical intervention is also highly effective. Because most disk problems in the cervical spine are degenerative in nature, symptoms may frequently recur even if they initially responded conservative treatment.

            Cervical myelopathy is the most significant problem causing numbness in the arms or hands. This commonly results from spinal cord compression from bulging discs or bone spurs. Symptoms may be on both sides and typically are accompanied by difficulty walking, loss of balance or bladder control problems. There may not be significant pain involved.  Involvement of the legs with weakness or balance problems suggested myelopathy may be present and prompt surgical attention is generally necessary.

            There are many causes of numbness in the arms and hands. Frequently the symptoms of several different disorders can overlap in several different disorders may exist in the same patient. Frequently consultation with a neurologist or neurological surgeon is necessary to make the correct diagnosis

Jerrel Boyer DO

Neurological Surgeon

Chicago Back Institute

"My Doctor Told Me I Have a Slipped Disk. What Does This Mean?"

     I would like to address what it means to have disk herniation in your lumbar spine. It seems that many patients may have been given this diagnosis but have never really had it fully explained to them if they have never been to our practice. Hopefully I can give you a better understanding of what this means and when to seek consultation with a spine specialist at the Chicago back Institute.

         Our spine is made up of individual bones called vertebrae, which stack vertically, to make up our spinal column. Between each vertebra there is an inter-vertebral disc.  These are present throughout the cervical spine with the exception of between the first and second cervical vertebrae. They are also present between each thoracic and lumbar vertebra.   The purpose of the disc is to act as a cushion between the vertebrae, but also to allow motion between vertebrae while providing some stability. The outermost portion of the disc is a ligament like structure called the annulus. The central portion of the disc is called the nucleus pulposis. This is often viewed as a jellylike substance, however the consistency is much more like crabmeat.

         The first thing to consider is that abnormalities of the disc can be fairly common even in people who have no symptoms whatsoever. Therefore your herniated disc may have nothing to do with your symptoms. While lumbar disc herniations can cause back pain, more frequently they will produce symptoms into the leg. Lumbar disc herniation typically causes symptoms by pressing upon or inflaming one or multiple lumbar nerve roots. These lumbar nerve roots exit the spine and travel to the legs. Therefore numbness, tingling, weakness or pain into the legs would be more typical if symptoms are related to the disk herniation.  The simple fact of having a bulging disc or a herniated disc does not mean that this is the cause or certainly the only cause of someone's symptoms. Our job as neurosurgeons is to correlate what we see on a patient's films to their specific symptoms and physical examination.

         The fact that you may have a lumbar disk herniation does not mean that surgery will always be required. As a matter of fact most patients can improve without surgical intervention. Approximately 90% of patients can improve or eliminate their symptoms without the need for surgical intervention if this is their first time with this problem, however sometimes this may take weeks or months. Our sophisticated knowledge, and experience with all types of spine disorders allows us to direct our patients to the appropriate conservative care that will produce the most expeditious and cost-effective resolution to the problem.  Initial non-surgical care may involve over-the-counter non-steroidal anti-inflammatory medicines, prescription non-steroidal anti-inflammatory medicines, oral steroids, physical therapy or possibly epidural steroid injections. In some cases we may feel surgical intervention is likely to be the only resolution to the problem based on our experience and occasionally will recommend this is the initial treatment. This saves valuable time and resources in those cases where we feel conservative treatments are not likely to be of value.

         Many patients may be anxious or nervous about seeing a spine surgeon after they have been diagnosed with a lumbar disc herniation because they may fear surgery. However as discussed above the majority of these cases can be alleviated without surgical intervention, and we are in a position to help direct the most appropriate conservative care when indicated in cooperation with your primary care physician or chiropractic physician.

Dr. Jerrel Boyer

When To Seek Medical Care for your Back Pain

Most of us experience back pain at some point in our lives. While most of these episodes resolve spontaneously without medical treatment, there are times when seeking the advice of a health care professional is appropriate. This question has been raised many times during our community education seminars so I would like to cover some of these important points. While most episodes of back pain that we see in the clinic do not require surgical intervention to resolve, prompt medical attention in certain instances can lead to a quicker, more complete recovery by allowing us to direct the patient to the most appropriate conservative care.

I would like to talk primarily about back pain and neurologic symptoms arising without any sort of trauma. While most episodes of this sort of back pain resolve spontaneously within 4 to 6 weeks, there are certain symptoms that should prompt medical attention. Back pain can come from the muscles of the spine only, and that type of back pain usually represents a sprain type injury and very often will resolve spontaneously. However in some instances symptoms can be caused by pressure on the neurologic structures of the spine, particularly the nerve roots that exit between each vertebrae in the spine. The symptoms that are commonly associated with this sort of problem include pain in one or both legs; numbness or tingling in the legs, groin, or buttocks; weakness of the legs; loss of control of the bowels or bladder or difficulty emptying the bladder. Any of these symptoms suggest that nerve compression or irritation may be occurring and should be evaluated by your healthcare provider. if you have weakness of your legs or bladder difficulties mentioned above, you may have a potentially serious problem and should be evaluated urgently. Less serious nerve compression or irritation very often can be treated without surgery, however an evaluation by an experienced physician with expertise in spinal disorders will help get your conservative treatment headed in the right direction.

The second category of back pain that should be evaluated, is any episode of back pain that persists longer than three months, even if it is not accompanied by the neurologic symptoms mentioned above. Very often this sort of back pain is caused by degenerative changes of the spine, and while surgery likely will not be necessary, well directed conservative care and lifestyle modifications can be tailored specifically to the particular problem. It is also important to exclude much more serious problems such as spinal tumors as a cause of back pain if it has been present for this period of time. Evaluation is especially important in those patients who have a prior history of cancer anywhere in their body.

Dr. Jerrel Boyer

Introduction

I would like to take a few moments to introduce myself and discuss what I would like to achieve with this blog. I am a neurosurgeon at the Chicago back Institute, affiliated with Swedish covenant Hospital in Chicago Illinois. The formation of the Chicago back Institute was a product of the desire of myself, Dr Daniel Laich and Dr. Fred Geisler to unite to form a destination for the most advanced spinal care available.

I have a keen interest in minimally invasive spine surgery, complex spine surgery as well as brain tumor surgery. Dr. Laich brings advanced skills in minimally invasive spine surgery and performs certain minimally invasive procedures only available in a few locations in the United States. Dr. Geisler brings years of experience in spine surgery, particularly complex spine reconstructions. He also has extensive research experience. I'm honored to partner with such talented neurosurgeons.

Although we perform a vast array of surgical procedures, we all share a conservative approach to the treatment of spinal disorders. We endeavor to alleviate patient symptoms without surgery if at all possible. A large part of this, is patient education. I hope to provide this, in part, through this blog. I hope you enjoy its content and find it informative.