Nerve Issues: Frequent Left Upper Back and Limb Numbness

Frequent numbness in the upper left back and numbness in the limbs while sleeping?

Hello, doctor.
I have the following main symptoms and I'm not sure if they are related:
1.
I have frequent numbness in the upper left back area, which started about three years ago.
X-rays are normal, and a cervical MRI shows slight degeneration, but it shouldn't cause severe compression.
I have a long-standing habit of resting my left elbow on the table while working, and using a fascia ball on the affected area provides slight relief when numbness occurs.

2.
I often experience numbness in my entire arm while sleeping.

3.
There are small, non-fixed muscle twitches throughout my body that are visible to the naked eye, which have persisted for about eight months, but I have not experienced any falls or significant weakness.

4.
I had electromyography (EMG) tests done on the thenar eminence of both hands and the left shoulder at the back of my neck.
The doctor indicated that my left hand is functioning at about 40% and my right hand at 60%, while the neck results were normal.

5.
I frequently experience numbness in my legs and lower back while sitting on the subway.

6.
Recently, when sleeping in a slightly left-side position, I wake up due to numbness in my left hand and left foot.

Last year, I frequently visited neurology and orthopedics for examinations, but I was prescribed Methylcobalamin, and I have taken a lot of it.
I would like to ask if this could be due to thoracic nerve compression or a brain issue? What direction should I take for further examination? Thank you.

Mr. Wu, 20~29 year old female. Ask Date: 2022/01/24

Dr. Jiang Junyi reply Neurology

Hello Mr.
Wu,
You mentioned, "Could the physician determine if the issue is due to thoracic nerve compression or a brain problem?" The symptoms include "involuntary muscle twitching in small, non-fixed areas of the body, visible to the naked eye, which has persisted for about 8 months, but there have been no falls or significant weakness...
Rolling the affected areas with a fascia ball provides slight relief." In addition to peripheral nerve compression, metabolic issues may need to be considered.
Muscle twitching is commonly seen in acute viral infections, anxiety, and medication use.
Prolonged physical activity is one of the main causes of muscle twitching.
Common medications that can cause this include corticosteroids, estrogens, and excessive caffeine intake.
If the symptoms worsen, it is advisable to consult a neurologist or a rehabilitation specialist for examinations (such as nerve conduction studies, electromyography, etc.) and treatment follow-up, and possibly arrange for brain imaging.
The physician will prescribe medication based on the condition.
Please ensure to practice self-protection, cleanliness, and disinfection before and after medical visits, and adhere to new pandemic prevention measures.
Thank you for your inquiry, and feel free to discuss any related questions!
Wishing you good health and peace,
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2022/01/24

More Info

Based on the symptoms you've described, it seems that you are experiencing a complex interplay of neurological issues that may involve both peripheral and central nervous system components. Your symptoms, including frequent numbness in the left upper back, hand numbness during sleep, muscle twitching, and varying degrees of strength in your hands, suggest that there could be multiple factors at play.

1. Nerve Compression or Irritation: The numbness in your left upper back and arm could be indicative of nerve compression or irritation, potentially from cervical spine issues. Although your cervical MRI showed only mild degeneration, even slight changes in the cervical spine can lead to nerve root compression, particularly if there is a herniated disc or osteophyte formation. The fact that you experience numbness when resting in certain positions (like sleeping on your side) supports the idea that your nerves may be sensitive to positional changes.

2. Peripheral Neuropathy: The muscle twitching you mentioned, which is visible and occurs in a non-specific manner, could be a sign of peripheral neuropathy. This condition can arise from various causes, including diabetes, vitamin deficiencies, or even idiopathic origins. The fact that your muscle strength is reduced in both hands, with the left hand showing more significant weakness, suggests that there may be a localized issue affecting the nerves that supply those muscles.

3. Thoracic Outlet Syndrome: Given your symptoms of numbness and tingling in the arm, particularly with certain postures, thoracic outlet syndrome could also be a consideration. This condition occurs when the blood vessels or nerves in the space between your collarbone and your first rib become compressed. This can lead to symptoms similar to what you are experiencing.

4. Cervical Radiculopathy: The results from your electromyography (EMG) showing reduced function in your left hand could indicate cervical radiculopathy, where nerve roots in the cervical spine are affected, leading to weakness and sensory changes in the upper extremities.

5. Potential Central Nervous System Issues: While your symptoms seem more peripheral, it is essential to rule out any central nervous system issues, especially if there are any additional neurological signs or symptoms. Conditions such as multiple sclerosis or other demyelinating diseases could present with similar symptoms, although they are less common.

Recommendations for Further Evaluation
1. Comprehensive Neurological Examination: A thorough neurological examination by a neurologist can help assess the extent of your symptoms and guide further testing.

2. Advanced Imaging: If not already done, consider an MRI of the thoracic spine in addition to the cervical spine. This can help identify any thoracic outlet issues or other compressive lesions.

3. Nerve Conduction Studies: If you haven't already, nerve conduction studies can provide more detailed information about the function of specific nerves and help pinpoint areas of dysfunction.

4. Physical Therapy: Engaging in physical therapy may help improve your posture and strengthen the muscles around your neck and upper back, potentially alleviating some of the nerve compression.

5. Lifestyle Modifications: Since you mentioned that certain positions exacerbate your symptoms, it may be beneficial to adjust your work and sleep posture. Ergonomic assessments can be helpful in reducing strain on your neck and upper back.

6. Follow-Up with Specialists: Given the complexity of your symptoms, it may be worthwhile to follow up with both a neurologist and an orthopedic specialist to explore all potential causes and treatment options.

In summary, while your symptoms may suggest peripheral nerve issues, it is crucial to consider both peripheral and central nervous system factors. A multidisciplinary approach involving neurologists, orthopedic specialists, and physical therapists will likely yield the best outcomes in diagnosing and managing your condition.

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