NCS says "severe" CTS, but symptoms have gone away?
Good morning Dr Bland
I am a man age 84 in good general health, not on any medication. In early November I had severe CTS symptoms in both hands confirmed by the GP who offered me steroid injections. I asked for a NCS first, but by the time this took place on 8 January, the NCS symptoms had become negligible. I was therefore surprised to see the report saying the "evidence was in keeping with a severe CTS in both hands".
This suggests to me the possibility of some form of neuropathy not caused by CTS. I have discussed this report with my GP who is noncommittal, but has offered to refer me to a neurologist if there is any sign of a degenerative condition. Meanwhile I have been sent for a thyroid test but I am not clear what that is intended to establish. I feel I would like to see a neurologist soon to find out what is going on, but I would first like to have any comment you feel you could make on this anomalous NCS result.
I should add that I have experienced hand numbness while driving for some years. Before and during the CTS episode I was experiencing considerable shoulder, neck and upper arm pain which is still present to a limited extend, for which I have been referred for physiotherapy. The GP ruled out PMR after testing for it.
Thank you.
The correlation between subjective severity of symptoms and severity of NCS results is pretty loose. If you can get hold of a copy of the actual NCS report we can take a look at it and see if there is any more to be gleaned by way of useful information. The thyroid test is being done because having an underactive thyroid is one of the known causes of secondary CTS. JB
Thank you. I have now sent the NCS report as you suggest by email. There was other material in the report which would not transmit, but I hope this will suffice.
I have noted what you say about the lack of correlation between perceived symptoms and test result which may explain the apparent anomaly. However I would like to know if your reading of these results might suggest a possible cause other than CTS, so that this could be investigated. Thank you for explaining about the thyroid test.
Michael
I've had two sets of NCS results from B2, and Kbeach87 but no others in the last 48h I'm afraid. JB
I have tried again to send by email. Please note that I am not expecting to gain your attention at the weekend, but wanted to send before leaving home until Wednesday next.
Michael
Still nothing. Weekends are when I have most time to think :-) Best email address to use is Jeremy [dot] Bland [at] nhs [dot] net JB
I've tried again. I appreciate your willingness to help at weekends. Michael
Got them now, they show grade 4 right and grade 3 left CTS (out of 6). The ulnar sensory potentials are also quite small but not necessarily abnormal for someone of 84. it might be worth checking the sensory potentials in your feet but they probably only help diagnsotically if they are clearly normal - which would help to exclude a serious generalised polyneuropathy. (Absent sensory potentials in the feet are considered aceptable at 84). If there are no other symptoms/signs to indicate more widespread problem then it is probably safe to await developments for a week or two - keeping a careful eye out for weakness or wasting of the muscles at the base of the thumb (Check out you-tube for videos of how to test the power of the abductor pollicis brevis muscle). As long as your symptoms remain in remission I would then be inclined to check the NCS after about 3 months to see which way it's going I think. JB
I have just noticed a mistake in my earlier post today. In line 3, I should have said "the CTS symptoms had become negligible"' not NCS.
Sorry about that.
Michael