Nerve Issues: Upper Back and Limb Numbness Explained

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 frequently experience numbness in the upper left back, which started about three years ago.
X-rays are normal, and a cervical MRI shows slight degeneration, which should not cause significant compression.
I have a long-standing habit of resting my left elbow on the table while working, and using a fascia ball to roll over the affected area provides slight relief when numbness occurs.

2.
I often wake up with my entire arm numb.

3.
I have 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 underwent electromyography (EMG) for the thenar eminence of both hands and the left shoulder and 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-leaning 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 they only prescribed me medication for symptom relief.
I have taken a lot of medication and 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: 2022/08/05

Dr. Jiang Junyi reply Neurology

Dear Mr.
Wu,
You mentioned that "your long-standing habit of resting your left elbow on the desk causes numbness, which can be slightly relieved by rolling a fascia ball over the affected area." This may indicate symptoms of ulnar nerve injury.
Additionally, you noted that "while sitting on the MRT, you often experience numbness in your legs and lower back, and recently, sleeping in a slightly left-leaning position has caused numbness in your left hand and foot, waking you up." This also warrants consideration of peripheral nerve compression symptoms.
Symptoms of peripheral nerve compression include:
1.
Pain characterized by burning or electric sensations.
2.
Symptoms that have a specific band-like distribution, which can be triggered by touch or pressure.
3.
Accompanied by muscle soreness and weakness.
If peripheral nerve issues cannot explain your symptoms, it may be necessary to consider additional brain lesions.
Peripheral nerve examinations typically utilize electrophysiological methods to assist in diagnosis.

Nerve conduction studies assess the transmission speed and waveform of large fiber nerves.
Electromyography (EMG) evaluates the muscle response in the areas supplied by the nerves.
I recommend that you visit a neurology outpatient clinic for further examination and follow-up, along with rehabilitation treatment.
Thank you for your inquiry, and feel free to discuss any related questions!
Wishing you good health, peace, and joy.
Dr.
Jiang Junyi, Department of Neurology, Taoyuan Hospital

Reply Date: 2022/08/05

More Info

Based on the symptoms you've described, it appears that you may be experiencing a combination of nerve-related issues that could stem from various sources, including potential compression of the nerves in the cervical or thoracic spine, as well as possible peripheral nerve involvement. Let's break down your symptoms and explore the possible underlying causes.

1. Upper Back and Arm Numbness: The persistent numbness in your left upper back and arm, which has been ongoing for about three years, could be indicative of nerve compression or irritation. Given that your cervical MRI showed slight degeneration but no significant compression, it is possible that your symptoms are related to postural habits, such as leaning on your left elbow while working. This posture can lead to repetitive strain on the nerves and muscles in that area, potentially causing symptoms like numbness and tingling.

2. Sleep-Related Numbness: The numbness you experience in your hand while sleeping could be due to positional compression of the nerves, particularly if you sleep in a way that puts pressure on your arms or shoulders. This is often seen in conditions like thoracic outlet syndrome or carpal tunnel syndrome, where certain positions can exacerbate nerve compression.

3. Muscle Twitches: The involuntary muscle twitches you describe, which have persisted for about eight months, can be attributed to a variety of factors, including nerve irritation, muscle fatigue, or even anxiety. While these twitches are often benign, if they are accompanied by other concerning symptoms, further evaluation may be warranted.

4. Electromyography (EMG) Findings: The EMG results indicating that your left hand is functioning at about 40% and the right at 60% suggest some degree of nerve impairment, particularly on the left side. This could be due to cervical nerve root involvement or peripheral nerve issues. The fact that your neck was deemed normal on the EMG may point towards a more localized issue affecting the brachial plexus or peripheral nerves.

5. Lower Back and Leg Symptoms: The numbness in your legs and lower back while sitting could also be related to nerve compression, possibly from the lumbar spine or even the thoracic region. Prolonged sitting, especially in poor posture, can lead to compression of the nerves that innervate the lower extremities.

Given these symptoms, it would be prudent to consider further diagnostic imaging, such as an MRI of the thoracic spine, to assess for any potential nerve compression that may not have been evident in the cervical region. Additionally, a thorough evaluation by a neurologist or a spine specialist could provide more insight into whether your symptoms are due to cervical, thoracic, or peripheral nerve issues.

In terms of management, physical therapy focusing on posture correction, strengthening, and stretching exercises may be beneficial. Ergonomic adjustments to your workspace can also help alleviate some of the strain on your neck and upper back. If conservative measures do not provide relief, further interventions, such as nerve blocks or surgical options, may be considered depending on the underlying cause.

In summary, your symptoms could be related to nerve compression in the cervical or thoracic spine, exacerbated by posture and repetitive strain. A comprehensive evaluation and targeted treatment plan will be essential in addressing your concerns and improving your quality of life.

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