Arm Nerve Issues: Causes and Solutions for Weakness

Brachial plexus

Doctor, I have a question.
Since I was in the ninth grade, whenever I sleep on my left arm, it becomes completely numb, and the muscles in my arm feel completely soft.
Sometimes I experience weakness for over a week, while other times it resolves in just half an hour.
During the process of my muscles becoming tense, they twitch continuously.
I went to Kaohsiung Medical University for an MRI, which showed no issues.
However, during a nerve examination, there were some problems, but the doctor didn't provide further explanation and said there was nothing more he could do.
I feel very helpless.
Can you help me resolve this issue? Thank you.

Xiao Xi Xi, 10~19 year old female. Ask Date: 2015/09/15

Dr. Gao Chunde reply Neurology

This symptom and phenomenon are indeed quite rare.
To cause numbness and weakness, it could originate from the brain, brainstem, spinal nerves, the nerve roots exiting the spinal cord, or the brachial plexus.
If pressure is applied during sleep, one might consider whether there is an obstruction in the blood supply to the arm from the subclavian artery on the left side.
It raises the question of whether the brachial plexus is being compressed, leading to ischemia and damage, or if there is an injury related to ischemia, or even an unexplained inflammation of the plexus itself, which may take some time to recover on its own.
If the issue is central, then it would not be related to pressure on the arm, as localized ischemia or transient weakness following a discharge could present this way.
Periodic weakness is generally not limited to a single limb and is not associated with pressure.
The situation should still be evaluated by a neurologist in person to confirm the relationship between symptoms and clinical findings through a physical examination, and then consider what the underlying cause may be.

Reply Date: 2015/09/15

More Info

It sounds like you are experiencing a complex set of symptoms related to your left arm, including numbness, weakness, and muscle twitching. These issues can be quite concerning, especially when they persist over time. Let's break down the potential causes and solutions for your symptoms.

Possible Causes
1. Nerve Compression: One of the most common causes of numbness and weakness in the arms is nerve compression. This can occur due to various reasons, such as sleeping in an awkward position, which may compress the nerves in your arm or neck. Conditions like thoracic outlet syndrome or carpal tunnel syndrome can also lead to similar symptoms.

2. Peripheral Neuropathy: This condition involves damage to the peripheral nerves, which can cause weakness, numbness, and pain, typically in the hands and feet. Diabetes, vitamin deficiencies (especially B12), and certain medications can contribute to peripheral neuropathy.

3. Cervical Radiculopathy: If there is a problem in your cervical spine (neck), such as a herniated disc or degenerative changes, it can lead to nerve root compression. This can cause symptoms that radiate down the arm, including weakness and numbness.

4. Muscle Disorders: Conditions such as myopathy or inflammatory muscle diseases can lead to muscle weakness and twitching. These disorders affect the muscle fibers directly and can result in symptoms like those you are experiencing.

5. Anxiety and Stress: Sometimes, psychological factors can exacerbate physical symptoms. Anxiety can lead to muscle tension and twitching, which may contribute to your feelings of weakness.

Diagnostic Steps
Since you have already undergone MRI and nerve conduction studies, it’s essential to follow up with a neurologist or a specialist in neuromuscular disorders. They may recommend additional tests, such as:
- Electromyography (EMG): This test measures the electrical activity of muscles and can help identify issues with nerve-to-muscle transmission.

- Blood Tests: Checking for vitamin deficiencies, thyroid function, and autoimmune markers can provide insight into underlying conditions.

- Ultrasound: This can help visualize any structural abnormalities in the nerves or muscles.

Potential Solutions
1. Physical Therapy: Engaging in physical therapy can be beneficial. A physical therapist can design a program tailored to your needs, focusing on strengthening exercises, stretching, and improving your range of motion.

2. Ergonomic Adjustments: If your symptoms are exacerbated by certain activities or positions, consider making ergonomic adjustments to your workspace or sleeping position. Using supportive pillows or adjusting your chair height can help reduce nerve compression.

3. Medication: Depending on the underlying cause, medications such as anti-inflammatory drugs, muscle relaxants, or nerve pain medications (like gabapentin or pregabalin) may be prescribed to alleviate symptoms.

4. Lifestyle Changes: Incorporating regular exercise, a balanced diet rich in vitamins and minerals, and stress management techniques (like yoga or meditation) can improve overall health and potentially alleviate some symptoms.

5. Follow-Up with Specialists: If your current neurologist is unable to provide a solution, seeking a second opinion from another specialist, particularly one who focuses on neuromuscular disorders, may be beneficial.

Conclusion
Your symptoms of numbness, weakness, and muscle twitching in your left arm are concerning and warrant further investigation. While there are various potential causes, a thorough evaluation by a specialist is crucial for accurate diagnosis and effective treatment. In the meantime, consider physical therapy, ergonomic adjustments, and lifestyle changes to help manage your symptoms. Remember, you are not alone in this, and there are healthcare professionals who can help guide you through your recovery.

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