Question
I have been having a problem with numbness in hands and arms during sleeping. It could be either one arm or the other, or both at the same time. It generally happens in the early morning hours. It is quite extreme and takes several minutes to regain feeling and strength. I have no pain in fingers or wrists just numbness. this happens several times and is disruptive and uncomfortable. A particularly bad night may be followed by some slight pain or I might say weakness in arms for a few hours. I am a strong healthy 42 year old female. I have noticed that heavy lifting in the gym, or at work makes this problem much much worse. I took a one month vacation and had no symptoms, and slept well. I do have some pain, slight tingling, and stiffness in my neck, this also coincides with how much lifting I have been doing. I feel that I may be doing some kind of nerve damage, but also feel that I am not lifting or working out any harder then any other 42 year old. I did have some adjustments for the pain in neck/sublexations? but it never did seem to help that much. Any ideas if where I should turn for help? I cant imagine giving up my gym time, but also have to sleep.  This has been an on again off again problem for two years. I quit a job because of this and had reduction of symtoms, they have come back now as I have been spending more time working out at the gym.
Thank you in advance for any suggestions about where I should turn for help.

Answer
Dear Lynn,

The first thing I would do is get a new functional examination of the neck and upper arm vasculature.  The chiropractor you were seeing should have performed a good orthopedic examination of the neck and associated structures, but a new look can sometimes yield a more complete diagnostic impression.  Concerning subluxations, this can mean just about anything...the term does not have an agreed upon specific definition in chiropractic circles, therefore I assume you are referring to joint fixation or abnormal joint motion.

The symptoms you are describing can be due to compression in the cord, nerve irritation, a disk problem, or vascular compression of the arteries that supply the arm.  Syrinx formation (like a fluid filled cyst in the spinal cord), and tumors are always possible, but not common problems.

Thoracic Outlet Syndrome (TOS) immediately comes to mind from what you have described, and is a compression/irritation of the brachial plexus nerves and the vascular bundle that supplies blood to the arm.  The diagnosis of TOS has been criticized in the past as unsubsatntiated by some and non-specific, but patients with these types of problems can be helped with cervical adjustments and soft tissue work. The soft tissue component (myofascial work and stretching) may be of greater benefit to you than the adjustment.  The scalene muscles in the neck are frequently indicated as one source of the problem...more so than the bony boundaries of the area- ribs, clavicle, vertebra.  You can easily google TOS for more comprehensive information and anatomical pictures.

These possibilities can be narrowed down with orthopedic tests that have been designed to stress individual parts of the anatomy, and this should be correlated with the initial history of complaint.  After an examination, if disk or cord compromise is suspected, an MRI would be appropriate, and it would pick up a tumor if present as well.  This is the gold standard for diagnostic testing concerning cord or disk problems...sometimes a myelogram is necessary, but this will usually be suggested by the radiologist if they feel it is necessary.

If going to the gym is compounding the problem, then you need to let your doctor know about this, and try to figure out which exercises are problematic.  Over-training of the pec minor, pec major, and overhead shoulder presses can cause muscle imbalances which may contribute to the problem.  I would suggest you limit your gym activities until the actual source of the problem has been located.

Hope this helps Lynn, bottom line get another opinion if you need to and make sure the area of complain is examined properly.  Treatment plans should only be initiated with a working knowledge of the anatomy as it applies to each case.  Thorough examination and diagnostic tests when warranted are the ways to arrive at understanding.  Also make sure your doctors explain the information they gather on examination to you.

Respectfully,
Dr. J. Shawn Leatherman