Question
QUESTION: Hello. I am a single mom w no fam in the area. My job involves heavy lifting. I felt pain in upper back but it was more like a pinching. I woke up two weeks ago with severe pain shooting down ARM. Next day my thumb got numb. Then index fngr. Had an MRI. Some disc herniation c4. They want me to get EMG. Am terrified. The doc hasn't even seen me yet.

ANSWER: Hi Tina,
I am sorry you are hurting. The symptoms you describe sound more like a C6 radiculopathy, and definitely not a C4 level problem.  Is the disc herniation large?  The diagnostic question is why are the MRI findings are not in agreement with the signs you are describing.   The MRI may be of poor quality?  The MRI was read incorrectly?  Is it a bone spur, or is it another problem causing your numbness?

EMG requires a small needle to be placed in various muscles of your arm, forearm and hand. It may be slightly uncomfortable but an experienced neurologist or clinician will stop if its too painful.  This test may be necessary if symptoms are progressing or to help localize the cause of the numbness.

There is is a strong possibility that the pain and numbness has an inflammatory origin. This would explain the lack of correlation from the MRI.
The EMG in this case would also be relatively useless.

There is also a possibility that you have a thoracic outlet type syndrome causing a neurogenic compression of the brachial plexus.

If the condition is inflammatory or a disc bulge, treatment with a chiropractor plus antioxidant vitamins such as turmeric extract would be very helpful to quickly reduce your symptoms.  If you do not have any weakness in the arm, you could delay testing to see if a conservative treatment approach could be successful.  Unless you have intensifying pain, intensifying numbness or weakness in the arm an EMG may be unnecessary.

Let me know how you are doing.
All the best,

---------- FOLLOW-UP ----------

QUESTION: Hello Dr. True. Thanku so kindly for getting back with me. How do I find out if I have a bone spur? It has been four weeks and I still have numbness mostly in thumb, some loss of muscle tone, some weakness and soreness of muscles down the ARM. I am going to see a chiropractor and have been doing an over the door traction therapy. What would u do? Thanku so much for your gift of expertise.

Answer
Good morning,
A bone spur is diagnosed by x-ray.  Sometimes an osteophytic spur is difficult to see on x-ray unless the film angle or positioning is perfect. Traction is beneficial as well as class IV laser therapy. The inflatable collar home traction units may work slightly better than the over the door device. This should be discussed with your doctor.  I have had a lot of success treating patients with Class IV laser therapy.  Maybe there is a doctor in your geographic area with a high power laser therapy device.  It is important to have an MRI if symptoms do not improve with 3-4 weeks.