Have longstanding rheumatoid arthritis & am very weak in both arms with tingling and numbness in both hands esp.fingertips. c.t scan showed nothing & waiting for an MRI IN 3 Wks.any ideas anyone? doctor
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replied December 17th, 2012
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cookiegal,

One condition that is always of concern in patients with long standing RA, especially if the inflammation is under poor control, is atlanto-axial instability (C1-C2) in the neck.

In this condition, the transvers ligament, which holds the dens of C2 against the front of the ring of C1, because weak and stretched due to chronic synovitis (inflammation).

This can lead to problems with myelopathy. In many cases, the clue to a myelopathy is that the upper extremities are affected more that the lowere (as would usually be seen in most spinal cord problems).


But, usually, any significant movement of the dens can be picked up on plain lateral x-rays of the C spine (+/- flexion and extension views). Likewise, a CT would usually also pick this up.

It is possible that the patient might have a dynamic problem, where the dens is still in its usual position, but with movement, it can shift out of location. But, in these cases, usually patients only have neurological symptoms when they move their head in certain directions.


But, it is also possible that the problem is not comming from the neck, though the fact that it is bilateral leads one more to the spine.

You could have compression of some of the peripheral nerves, anywhere from the upper shoulder (brachial plexus), to the region of the shoulder and collar bone (thoracic outlet syndrome), to anywhere along the course of the nerve(s) as it(they) travel through the arm.

In this case, some electrical studies (EMG - electromyography and NCV - nerve conduction velocity) could help to determine where the nerve is being compressed.


So, guess you will have to wait to see if the MRI shows any thing going on in the cord. If not, then your physician may need to start looking at the peripheral nerves.

Good luck.
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replied December 18th, 2012
NUMB ARMS RHEUMATOID ARTHRITIS
DOES IT SOUND LIKE SURGERY MAY BE ONLY OPTION?
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replied December 19th, 2012
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cookiegal,

It depends upon what is causing the problems.


It it does turn out to be a problem with the upper vertebra of the spine shifting and putting pressure on the spinal cord, then a stabilizing surgery may be needed.


But, again, you have to find out what exactly is causing the problem first. Then, a treatment plan can be developed to address the underlying problem.

Good luck.
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