Normal nerve conduction test results.

Thankyou for that - we don't hear enough from the patients who turn out to have normal nerve conduction studies so it's refreshing to have someone willing to keep in touch. JB

Have at last received physiotherapy appt. May 12th !
Meanwhile symptoms continue to worsen, notably tingling fingers both hands plus odd achy feeling in arms mostly 24/7.
Hoping physiotherapy can sort this out, will report further after appt.
Mike.

By my calculations by the time that physio appointment comes around you will have had symptoms for 6 months or so. If it's still worsening in might be interesting to re-test you and see if anything is developing. Let me know what physio think and if they don't have any very clear idea what they are treating we will organise a re-test. JB

Many thanks, will do.
Mike.

Had first appt. with physiotherapy yesterday.
They have taken a detailed history and have arranged another appt. next week for a physical examination and suggestion of possible MRI scan.
Meanwhile symptoms remain variable, but on the whole continue to worsen.
Will update after next appt.
Thank you for your interest and help.
Mike

Thanks for staying in touch - did they actually offer any suggestions as to possible diagnosis? JB

Not really at this stage except suggestion that might possibly be cervical spine issue.
Am hoping for more info after next Tuesday's physical exam appt.
Will report outcome.
Once again many thanks,
Mike Boniface

Follow on appt with Physiotherapy yesterday.
This time full physical exam with reflex tests etc.
Physio. not sure of a diagnosis at this stage and therefore not proposed any treatment. Is writing to GP with a suggestion of MRI.scan
Symptoms remain the same.
Mike Boniface

The next commonest cause of symptoms that can be mistaken for CTS is probably C6/7 radiculopathy in the neck so that may a fruitful avenue but MRI of the neck can be hard to interpret sometimes because almost everyone has some degenerative change in the neck on MRI. I remain curious about how things evolve and, from an organisational point of view, how efficient we (the NHS) are at arranging things for you so stay in touch please. JB

Thank you again. Will do.
Mike

Latest update :
GP Appt. last Wednesday as follow up to written report received by doctor from physiotherapy.
GP organised blood tests and writing to Neurology ( bloods booked 05 June)
MRI not arranged at this stage.
Unfortunately symptoms continue unabated. However slightly less severe on Left but more severe R H S
Will report further development.
Thanks for interest.
Mike Boniface.

Sounds as though no-one is entirely sure of the diagnosis, in which case neurology is a reaasonable speciality to go to for a second/third opinion. The neurology waiting lists tend to be on the long side though. We'll see what they come up with. JB

Bloods all back, results normal NFA.
Currently awaiting response / appt. as a result of GP letter to Neurology. All symptoms remain.
Will continue to update in due course.

I can't say I'm surprised that the bloods are normal. I wonder how long the neurology queue is at present. JB

Received neurology appointment at last. Tuesday 8th September !!
Long anxious wait ahead.
Will update in due course.
Many thanks for your interest to date.
Mike Boniface.

Are the symptoms still worse on the little finger side of the hand? If so I might check your ulnar nerves at the elbow again and perhaps take a look at them with the ultrasound scanner while we're waiting for neurology. I guess that neurology referral was made about the start of June so a little over 3 months - they are probably operating to a 13 week target I suspect and I know the neurologists are under considerable strain because of of people leaving/retiring. JB

Thanks for reply,
I am very grateful for your continued interest.
Symptoms on right hand are currently variable, affecting both thumb side and little finger side to varying degrees.
From my point of view, your suggestion of a possible further look at the ulnar nerves seems like a very good idea and is much appreciated.
If you do consider that further testing might be helpful and is possible, would I need to consult my GP in order to arrange an appointment for your clinic ?
Many thanks,
Mike Boniface.

No need to see your GP again. I'll just take this as an extension of the original referral - take it as something we forgot to do first time around. JB

We have booked you an appointment in early August and will send the details in the post. EK

Thank you,
Very much obliged.
Mike.

Further update.
Seen by Prof Pullicino this week.
. - Suspects problem could be neck - arranging MRI..
Will report outcome in due course.
Thanks for interest and help.
Mike

It's taken us a long time to get to that hasn't it! I think the wait for MRI of the neck is at least relatively short though. JB

Had MRI Cervical Spine mid October
Report received a couple of weeks ago. . Scan shows moderate neural foraminal stenosis at C5/6.RHS and at C6/7 bilaterally. No spinal cord compression. Multi level cervical spondylosis.
All seem to confirm Prof P's diagnosis and your opinion of likely cause of symptoms when you saw me for nerve conduction tests and U/S back in August. ie. Cervical radiculopathy.
GP has suggested I try some Physiotherapy but long waiting times for NHS
.Therefore current plan is to seek out a private physiotherapist with experience of treating this condition
Thanks once again for your continued interest, help and support. Very much appreciated.

Mike Boniface.

Thanks for the update. It does sound as though the MRI findings might fit in with the symptoms to at least some extent, though the little finger side of the hand would classically be more C8. Unfortunately the neck is harder to treat than the wrist, or even the elbow.

At some point it would be interesting to study whether MRI of the neck or nerve conduction studies are the most cost effective first investigation for tingling upper limbs with normal physical examination findings. In my experience quite a lot of patients start with MRI and are only found to have something like carpal tunnel syndrome after a fruitless visit to the neurosurgeons. In your case it is exactly the opposite sequence but at least neurophysiology is available locally whereas the neurosurgeons are all in London.

I hope they manage to alleviate some of the symptoms when you eventually find someone to tackle it. Let me know how you get on please. JB