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Impaired hand post accident, get intermittent spasms, flexing in fingers. Neck MRI shows hypertrophy. Cause?

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Hi, I was in a car accident almost 6 months ago. I lost the function of my left hand completely. It is spasming all day and is contorted into a fixed fingers flexed position. the fingers do variate slightly in thier positions depending on what I am doin but not by much. My questions are 1. My neck MRI showed mild uncovertebral hypertrophy. Would this be the cause? 2. This to me seems like nerve compression but I had a normal EMG. 3. When I bend my neck to the right as far as it will go (my neck has to touch my ear my hand will start to open, then my fingers get stuck where they are currently in contracture. I have had Ct scan of neck and brain, EMG, MRI of neck and Brachial plexus. Everything but the neck MRI was normal. I don't know what to do, I have pain that is burning, shooting and aching, discolored skin on hand and arm which gets mottled and purple. Also severe tingling in wrist and hand. Bad spasms in hand and fingers. My hand and arm goes from hot to freezing cold. I don't want to be permantly stuck using one hand. I have heard multiple terms thrown around and I'm confused. Does this sound like nerve compression to you?
Posted Sat, 18 May 2013 in Bones, Muscles and Joints
Answered by Dr. Prasad Akole 23 minutes later
Dear friend, welcome to Healthcaremagic!
I am Dr. Prasad Akole (Critical Care Expert- and am glad to address to your query here.

It is saddening to know your loss of function in left hand.
Did you have a crush injury or a sharp cut to the left limb?
Your symptoms are typical of parasthesiae (which are abnormal sensations perceived due to nerve damage).

As your scans and brachial plexus are reportedly normal, it is not due to central nerve affection.
I feel it is post-traumatic local neuropathy- compression or blunt/ crush injury to the nerve at the upper limb level.

It can be assessed by doing a NCV (Nerve Conduction Velocity) and not EMG (which is for muscle function- unless these two were combined).

Vertebral hypertrophy is unlikely the cause. Temperature changes felt are due to autonomic neuropathy/ parasthesia.

I would advise you to see a good neurologist and get this worked up. He/ she can derive the exact location of nerve injury by clinical and electrical tests.
Mild to moderate nerve affections may improve.
Ask if TENS (transcutaneous electrical nerve stimulation) locally could help?

Neuropathic pain is helped by gabapentin, neurotonics etc.
Sometimes plastic surgery is needed to repair the nerves.

I hope to have answered your query satisfactorily. I would be glad to answer any further queries. Take care and please keep me informed of your progress at
Good Luck! Do not loose perseverant.

It helps us to improve continuously if you could please write a rating review before you ‘accept’ and ‘close’ the query.
Thank you!!
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Follow-up: Impaired hand post accident, get intermittent spasms, flexing in fingers. Neck MRI shows hypertrophy. Cause? 8 hours later
I did not cut my arm at all during the accident. I know it cant be a crush injury because nothing was crushed. The tractor trailer truck side swiped my car and knocked the mirror off. I was wearing a seat belt and I got jossled to the right.The fingers affected are all of them except my pinky. My thumb is clamped down on top of my bent first finger. I cannot lift my thumb or use it at all. My second (middle finger and third (ring) finger are bent as well. My hand has been in this claw position for so long it is in contracture. I have severe numbness and tingling in my thumb, first and second fingers, and my palm, with some tingling in the third finger. I believe I had both a nerve conduction and an EMG and the nerve conduction was normal. It was done 4 1/2 weeks after the accident. The EMG shows these results on the report.... "MOTOR NERVE CONDUCTION STUDIES OF THE LEFT MEDIAN AND ULNAR NERVES WERE NORMAL. RADIAL NERVE WAS NORMAL. SENSORY NCS'S WERE NORMAL OF LEFT MEDIAN, ULNAR AND RADIAL NERVES. CONCENTRIC NEEDLE ELECTROMYOGRAPHY (emg) OF SELECTED MUSCLES REPRESENTING THE LEFT C5-T1 MYOTOMES WAS PERFORMED. FIRST DORSAL INTEROSSEOUS (FDI) REVEALED INCREASED INSERTIONAL ACTIVITY AND POOR ACTIVATION. ABDUCTOR POLLIS BREVIS REVEALED POOR ACTIVATION, EXTENSOR DIGITORUM COMMUNIS REVEALED FAIR ACTIVATION. EMG OF C8 PARASPINAL MUSCLES, BICEPS, AND TRICEPS WERE NORMAL. IT SAYS THERE IS NO EVIDENCE OF BRACHIAL PLEXOPATHY OR CERVICAL RADICULOPATHY. IT DOES SAY THE NEEDLE EXAMINATION NOTABLE FOR SIGNIFICANTLY DECREASED ACTIVATION IN CLINICALLY INVOLVED MUSCLES. DECREASED ACTIVATION MAY REFLECT RECOMMENDED." You mentioned nerve compression at the upper limb level. Which nerve were you referring to and where is "upper limb level"? That is my question. Oh, can you please email me the answer. I have trouble opening the website up to confirm questions. THANK YOU!
Answered by Dr. Prasad Akole 4 hours later

Thanks for the details.
Your EMG is not normal as you mention.

Your tests exclude high lesions like cord or brachial plexus structurally.

Although the comment in the EMG says that there is possibility of upper motor neuron lesion (which is near the spinal cord segments).
This is little strange. Sudden jolting at the neck and shoulder causes brachial plexus stretch injury to various extent. MRI rules out structural damage. Functional deficit is indicated by tests.

You have sensory deficits and parasthesiae in the median nerve territory and weak activation of dorsal interosseous (on EMG) which is supplied by the ulnar nerve.

Initially I suspected lesion at the level lower than the elbow (? above the wrist). But actual detailed testing of muscle group by group is needed.
Mixed nerve injuries are possible.

Due to these confusing comments on the tests, I would advise you to get evaluated by an expert neurologist to find out the exact level of injury (near the hand or at the brachial plexus/ cord level). Results of the NCV/ EMG have to be interpreted in the light of clinical findings.

Online consultations have this limitation.
Treatment can be planned after accurate localization of the level of injury.

I hope you find this useful and get appropriate treatments.
Have a healthy life ahead !
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