Nerve Compression: Left Upper Back and Limb Numbness Issues - Neurology

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Based on the symptoms you've described, it appears that you may be experiencing a combination of nerve compression and possibly other underlying issues that could be contributing to your discomfort. Let's break down your symptoms and explore potential causes and next steps for evaluation.

1. Left Upper Back Numbness: The numbness in your left upper back that has persisted for three years could be related to several factors. Given that your X-ray is normal and the MRI shows only mild degeneration, it is less likely that there is significant structural damage causing nerve compression. However, your long-standing posture, particularly resting your left elbow on the table, could lead to muscle tightness and nerve irritation, particularly of the brachial plexus or cervical nerves.

2. Hand Numbness During Sleep: Experiencing numbness in your hand while sleeping, especially if you sleep in a position that puts pressure on your arm, could suggest a condition known as thoracic outlet syndrome or even carpal tunnel syndrome, particularly if the numbness is localized to the thumb and first two fingers.

3. Muscle Twitches: The involuntary muscle twitches you describe, which have been ongoing for about eight months, can be benign fasciculations, often related to stress, fatigue, or even electrolyte imbalances. However, if they are persistent and widespread, it may warrant further investigation to rule out conditions such as benign fasciculation syndrome or even more serious neurological conditions.

4. Electromyography (EMG) Results: The EMG results indicating that your left hand has about 40% function compared to 60% on the right suggests some degree of nerve impairment on the left side. This could be due to compression or irritation of the nerves that innervate the hand and forearm. The fact that your neck MRI was normal is reassuring, but it does not completely rule out issues at the thoracic outlet or even at the level of the brachial plexus.

5. Lower Back and Leg Numbness: The numbness in your legs while sitting, particularly in a position that may compress the lower back, could indicate lumbar nerve root irritation or compression. This is often seen in conditions such as sciatica or lumbar radiculopathy, where a herniated disc or spinal stenosis can lead to symptoms in the legs.


Recommendations for Further Evaluation:
- Neurological Consultation: Given the complexity of your symptoms, a thorough evaluation by a neurologist would be beneficial. They may recommend additional imaging studies, such as an MRI of the thoracic spine, to assess for any potential nerve compression that may not have been evident in previous studies.

- Physical Therapy: Engaging in physical therapy can help address muscle imbalances and improve posture, which may alleviate some of the nerve compression symptoms. A physical therapist can provide exercises to strengthen the muscles around your neck and upper back, as well as stretching techniques to relieve tension.

- Lifestyle Modifications: Consider adjusting your work posture to reduce strain on your neck and upper back. Ergonomic assessments can help optimize your workspace to prevent further nerve irritation.

- Electrolyte and Nutritional Assessment: Since muscle twitches can be related to deficiencies, it may be worthwhile to evaluate your diet and consider supplementation if necessary.

- Follow-Up EMG: If symptoms persist or worsen, repeat EMG studies may be warranted to monitor any changes in nerve function over time.

In summary, while your symptoms could be indicative of nerve compression, particularly in the thoracic or cervical regions, they may also be influenced by lifestyle factors and muscle imbalances. A comprehensive approach involving further evaluation, physical therapy, and lifestyle adjustments may provide relief and improve your overall function.