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Dr. Andrew Rynne

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What causes tingling and numbness in forearm post rotator cuff surgery?

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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 1755 Questions

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Posted on Fri, 16 Oct 2015 in Brain and Spine
Question: My husband had rotator cuff surgery 3 weeks ago and has had tingling and numbness in right forearm but has strong mobility of his hand and can move his arm up and down. Is this normal?
doctor
Answered by Dr. Dariush Saghafi 3 hours later
Brief Answer:
Nothing to worry about at this time

Detailed Answer:
Good evening. I am a neurologist and would like to comment on a couple of points regarding your question having to do with numbness and tingling the following rotator cuff surgery. because surgery necessarily involves the manipulation, cutting, sewing, and repair of tissues we know that the healing process after such a procedure normally can take anywhere from several weeks to several months to fully complete. of course, this is different from patient to patient depending upon their particular medical situation, any complications that may have occurred during surgery, as well as the extensiveness and complexity of the procedure.

after reading your question I am assuming that surgery was relatively uneventful and that your husband seems to be in otherwise good health. Therefore, the sensations he is feeling are quite normal and predictable much like sleeping on your arm and waking up the next morning with the arm feeling either very numb, very weak, or very tingly. Of course, in the case of sleeping on ones are usually symptoms resolve within several moments. In the case of surgery the timeframe but can be much longer because the healing process is not and overnight one as I'm sure you realize.

In my opinion, since he has good strength and no evidence of weakness in the arm, forearm, hand, or fingers then, the altered sensation's do not concern me at this point. aside from using warm compresses over the shoulder area that was surgery wise as well as the arm and forearm better feeling tingly there isn't very much more one can do to expedite the healing process. That pretty much has to occur at its own pace. I know that there are suggestions made regarding different types of medications such as anti-inflammatories and such and though I certainly would not oppose the use of simple analgesics or even stronger pain relievers if necessary since he is in A subacute phase of recovery in point of fact there are no studies that have proven definitively that additional medications will resolve the symptoms any faster than the natural healing process will accomplish on it's own given the time. One could talk about doing passive sorts of manipulations with the arm in order to facilitate circulation and flow into the muscle by both blood as well as lymphatic fluid, however, this is tempered by the extent to which the surgeon feels comfortable allowing him to move the shoulder about at this time. If he has been cleared for any type of physical or occupational therapy then, I would add that mild massage or range of motion from the elbow down may facilitate the exodus of additional inflammatory fluids that may be causing compressive symptoms but in all honesty woody be able to prove that to be true. other practitioners may also suggest the use of vitamin supplements and nutritional support in the form of vitamin B12, folate preparations, and other similar things but in point of fact those elements are best used and have shown to be optimally effective in cases where patients were actually deficient in those elements. Therefore, if your husband work to undergo any type of blood testing to find that he was deficient in B12, folate, even vitamin D then, I would wholeheartedly support a replacement therapy program but otherwise, you are likely not treating the problem any more directly than what I've already mentioned above.

I hope these suggestions satisfactorily address your question and give additional information you can discuss with your doctor for how to approach these concerns. If so, may I ask your favor of a high star rating with some written feedback? Also, if there are no other comments may I ask you not to forget to close this question on your end so it can be transacted an archived for further reference by colleagues as necessary?

you are invited to direct more comments or inquiries to meet in the future by going to my web address at: bit.ly/drdariushsaghafi

I would be honored to answer you quickly incomprehensibly. Please keep me informed as to the outcome of your husband's situation.

The square he has required a total of 65 minutes of position specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dariush Saghafi 23 hours later
I am overwhelmed that you have notified me with such detailed information and truly appreciate your time, expertise and comfort.

I will keep you posted about my husband's condition. I did but vitamin B12 meth
For healing purposes but if you think it won't help, perhaps he should stop.

Thank you for your time, again most appreciative. Have been extremely anxious about this situation and feel better.l

doctor
Answered by Dr. Dariush Saghafi 1 hour later
Brief Answer:
You are most welcome

Detailed Answer:
If you went to the trouble and expense of buying the methylcobalamin then, you may as well as him tested for Vitamin B12 levels. If his numbers come out to less than 350 then, I would ALSO have him get 2 more tests done. One is METHYLMALONIC ACID and the other HOMOCYSTEINE in serum (or urine). If either one of those labs is decidedly HIGH then, I would definitely go through a B12 replacement therapy program which would be 1 gram injectable B12 weekly for 4 weeks. Then, I would add an oral supplement for a few weeks and then, recheck his levels. If neither of those labs are high then, that means his B12 levels are likely normal and the use of B12 is really of no expected value....having said that....there's almost NO SIDE EFFECT to report for taking this medication under the circumstances therefore, in that setting I don't see the downside to his taking this medication and so it's good to easy.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dariush Saghafi 20 hours later
Do you think it is possible for the wrap they use in the shoulder surgery could have been too tight and caused the nerve inflamation in the forearm?

That is what his surgeon is saying but also said he feels the sensation will go away.
But if not within the next month to go to a Neurologist. Did say it was Neurapraxia, not sure of spelling.

Thank you again for your time.
doctor
Answered by Dr. Dariush Saghafi 25 hours later
Brief Answer:
Thank you for your return question AND COMPLIMENTS before!

Detailed Answer:
Good evening and thank you for your kind comments from the question before. They are very much appreciated and I'm happy that the information was of benefit.

With respect to the present questions- I wouldn't be able to give a fair answer to the first one since I wasn't there to witness how your husband's arm was wrapped nor examine him at the time he started having problems to determine whether excessive pressure from the wrap was the most likely cause of his problem. It simply wouldn't be fair for me to speculate on something so removed from my first hand knowledge.

What I will say (as I said in the other response) is that it is not unusual in my experience and practice of seeing patients post-surgically that sensations such as this should persist for up to several months simply based upon the injured area to that required surgery in the first place, the healing process, the surgical manipulation that took place during the process, anesthesia that was used, and possible metabolic deficiencies such as thyroid, adrenal, Vit. B12, folate, and Vit. D that could be even contributing to any issue of neurOpraxia (most common misspelling is neurApraxia--- Ha! You'll never forget that now I'll bet! LOL).

If in fact, he has neuropraxia then, the chance of full recovery is very good...but time frames vary from several weeks to several months. I've had patients that have last up to a couple of years to get fully back to normal. I would ask you have a bit more patience with the situation and participate in rehabilitation exercises and care to the extent permitted by your doctor or possible and see what develops.

I think it's worthwhile doing some laboratory testing to see what the levels of things such as TSH, FT4, serum cortisol, Vit. B12, Folate, and Vit. D might be and if on the low end of the spectrum of normal or if BELOW NORMAL then, boosting those levels up would be a very good thing.

Especially, Vitamin D....neurologists are more of the opinion that levels should be at least 60 if not closer to 70 or 80 and certainly in people with feelings of numbness and tingling. And so I would order the blood tests to see if anything comes back deficient so that it can be replaced. This will help recovery.

I agree that after another 4 weeks if there's been no significant recovery in the uncomfortable sensations that a neurology consult should be performed....SO I'LL BE WAITING FOR YOU HERE IN CLEVELAND! LOL!

Seriously, you're invited....Rock 'n Roll Hall of Fame, Great Lakes Science Museum, The XXXXXXX Orchestra, The Republican National Convention Summer 2016, The XXXXXXX Art Museum, and of course, The Browns, Cavaliers, and Indians (We LOVE the Yankees! HAHA! NOT!)

But I would just hang in a bit more and see how things develop, keep in touch with the surgeon, and I'm sure he'll guide you to next steps if they become necessary.

Remember, the key part of the puzzle here is that there is normal motor function of the limb....that is HUGE...or as XXXXXXX Trump might say, "UUUGE." If things were the other way around...in other words, perfect sensation and no motor function....that would be concerning to me...big time.....

But in the other direction? Just be calm....do some exercises, some labs, enjoy the beautiful fall weather....hope it stays just like this right through Halloween.....cuz then, maybe I'll even go out trick or treating! LOL....

I hope these suggestions satisfactorily address your questions and help give you a bit more ease of mind. If so, may I ask your favor of a high star rating with some written feedback?

Please send me more comments or inquiries in the future by going to my web address at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively. Please keep me informed as to the outcome of your husband's situation.

This query has required a total of 121 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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