Tingling and numbness in fingers or arms

Introduction Patients with cervical spinal stenosis complained that there are fingers (mostly at the fingertips) or pain and numbness in the arm when the disease is first developed, especially tingling. Feeling cold, chills, warmth, although the pain can be temporarily relieved, over time, the pain, cold feeling is still. Due to severe pain, it often affects the patient's sleep, diet and normal work. Mainly due to the sensory disturbance caused by the involvement of the spinal thalamus bundle and other sensory nerve fiber bundles. The course of the disease is short, the degree of pain is also mild, and the nature of the pain is dull or dull, and does not affect the functional activities of the upper limb.

Cause

Mainly due to the sensory disturbance caused by the involvement of the spinal thalamus bundle and other sensory nerve fiber bundles. The course of the disease is short, the degree of pain is also mild, and the nature of the pain is dull or dull, and does not affect the functional activities of the upper limb. The range of pain is either limited to the shoulder, or affects the back of the shoulder and the back of the shoulder, or affects the upper arm at the front of the shoulder, often with a sense of urgency on the back or upper arm. The shoulders feel cool, and the pain is relieved by warming or rubbing.

an examination

Related inspection

Spinal MRI examination of bone and joint soft tissue CT examination of arterial patency test of the supinator muscle strength test of the supinator muscle strength test

1. Sensory Disorder: The vast majority, even more than 95% of cases have this group of symptoms. Mainly manifested as numbness of the limbs, skin allergies or sensory separation, which is mainly due to the involvement of the spinal thalamus bundle and other sensory nerve fiber bundles. Its characteristics are:

(1) Occurrence earlier: Most of the symptoms of this group of symptoms appear first in the early stage of the disease, which is significantly different from cervical spondylosis, especially cervical spondylotic myelopathy. The symptoms of the latter are late.

(2) Upper limbs: More than 90% of the cases begin with the upper limbs, especially in the arms, or from the shoulders.

(3) Mainly for hemp and pain: The patient complained that there were fingers (mostly at the fingertips) or pain and numbness in the arm when the disease was first developed, especially tingling.

(4) Symptoms persistence: When the sensory disorder occurs, it usually lasts for a long time, and may have paroxysmal aggravation, which is related to various predisposing factors. A remission period can occur after treatment with non-surgical therapy.

2. Movement disorders: Many weeks or months after the onset of sensory symptoms, most of which are found during the examination. The main manifestation is the pyramidal tract sign. The patients start from the symptoms of heavy gait, weakness of the lower limbs, difficulty in lifting, easy to trip and banding, and the symptoms become more and more aggravated with the development of the disease course.

3. Muscle atrophy: The symptoms of muscle atrophy in patients with simple cervical spinal stenosis are generally later than those in patients with cervical spondylotic myelopathy. However, when combined with cervical spondylotic myelopathy, the symptoms of this group are not only early, but also Obviously, the scope is also extensive. The reason is mainly due to the multi-segment of the developmental spinal stenosis, so once the various factors cause the spinal cord to be involved, it is often the simultaneous emergence of several segments. At the time of examination, the plane generally does not exceed the innervation area of the highest segment of the spinal canal stenosis, which is significantly different from the level of muscle atrophy in the lateral sclerosis of the spinal cord to above the level of the neck 2 . At the same time, attention should be paid to cases involving the combined neck and neck deformity.

4. Reflection disorder

(1) Deep reflex: more hyperthyroidism, including: biceps reflex of upper limbs, triceps reflex and periosteal reflex of the tibia; lower limbs are mainly knee reflexes and tendon reflexes, mostly symmetrical or hyperactive.

(2) Shallow reflex: It also appears to be weakened or disappeared. Clinically, it is mainly abdominal wall reflex, cremaster reflex and anal reflex.

(3) Pathological reflex: more positive, with Hoffmann sign, palmar reflex and Babinski sign positive.

5. Other performance

(1) dysfunction of the stool: more in the middle and late stages, frequent urination, urgency and constipation; late can cause urinary retention, and even incontinence, but the latter is rare in the clinic.

(2) Autonomic symptoms: Most of the gastrointestinal and cardiovascular symptoms, accounting for about 30% of all cases (not easy to be detected and diagnosed before surgery, most of which were confirmed to be due to this after healing or significant improvement).

(3) Neck defense: These patients often keep the neck in a natural position (function position), which can be flexed and afraid of stretching. However, if the patient is accompanied by a significant degenerative change and a spur is formed at the posterior edge of the vertebral joint, it is also afraid of flexion.

Auxiliary inspection

Film degree exam

(1) X-ray plain film examination: conventional X-ray film, mainly on the lateral position, can clearly show the sagittal diameter of the cervical spine. Anyone who has a sagittal diameter of less than 12 mm on a flat lens with a standard projection distance of 180 cm has diagnostic value; when it is 12 to 14 mm, it has diagnostic reference significance; and when it is less than 10 mm, it can be completely diagnosed. In addition, it can be judged according to the ratio of the sagittal diameter of the vertebral body to the spinal canal. It is abnormal if it is less than 1:0.75, and has diagnostic significance when it is less than 1:0.6. The ratio can be completely diagnosed when the ratio is less than 1:0.5.

(2) CT or CTM and MRI examination: can clearly show the size and shape of the sagittal diameter of the spinal canal and its relationship with spinal cord compression. CT examination mainly shows bone tissue, while MRI examination is more clear on soft tissue imaging. Therefore, the combination of the two is ideal, which is not only conducive to diagnosis, but also conducive to the determination of the state of the spinal canal tissue to determine the treatment plan and operation. s Choice.

(3) Exclusion diagnosis may exclude other similar lesions of the cervical vertebra according to the results of clinical examination and imaging examination.

Differential diagnosis

Cervical disc herniation is lateral to the lateral side, and the posterior margin of the vertebral body, especially the hyperplasia of the hook vertebrae, can protrude into the intervertebral foramen, which can compress the nerve roots and invade the lower cervical vertebrae. Therefore, there are many arm pains or finger numbness, 30 years old or older. The low-head workers are prone to hair. It is a more common type of cervical spondylosis.

In the early stage of hand, foot and ankle, there was only paresthesia, tingling in the limbs, numbness, hand and foot spasms, and stiffness.

An arm muscle strain is a type of muscle strain, which is caused by a sharp contraction or excessive pulling of the muscle during exercise. Muscle strain is a damage caused by a sharp contraction or excessive pulling of muscles during exercise. This is easy to happen in long squats, pull-ups and sit-ups. After the muscle strain, the painful part of the strained area can be touched by the muscles of the muscles, and the pain is obvious. The local swelling or subcutaneous hemorrhage is obviously restricted.

Carpal tunnel syndrome is due to compression of the median nerve, pain, and numbness in the thumb, food, and middle finger. In the early stage, it often manifests as sensory dysfunction at the fingertips. It often wakes up due to numbness or burning pain several hours after falling asleep, and relieves after the activity.

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