4 failed operations - where from here?
Hello and thank you for a very informative and clear website. I would like advice. I'm 53 and female, in good health. I've had left-sided CTS for five years. I've also had four operations at a well-respected teaching hospital in the home counties of UK. My 'dead hand' has not improved at all, evidenced by conductivity tests, physio-administered sensation tests and my own experience. The constant numbness is increasing in density, and it impacts on my work and my semi-professional instrumental playing. Recent ultrasound scan (my first ever) showed the median nerve running apparently perfectly from shoulder to wrist-crease. At out-patients today I was frustrated that my own surgeon was not available, and (again!!) my test-results had been lost. I'm (again) awaiting an appointment with the surgeon. I would like a second opinion, and would even pay for a private consultation, but I don't know where to start. I'm not even sure if I should be looking for a plastic surgeon's opinion, or a neurologist, or another specialism. I would be very grateful for any helpful advice. Thank you.
Thank you for your quick response, Dr Bland. I will ask my GP about an NHS referral to you at King's College, and I have already made a request to see my medical notes. Even if it turns out that there are no more treatment options, I will feel easier in my mind if I understand the situation more clearly. Thank you for your advice.
OK. If your GP does want to arange this it is best to send a letter specifically addressed to me and marked for my attention to the neurophysiology department at Kings - otherwise it may get buried in the general mass of CTS referrals and seen by someone else (there are 7 of us, plus juniors at Kings). JB
Very many thanks for seeing me yesterday at Kings College Hospital, Dr Bland. I do appreciate the time which you and Dr Elias devoted to my left arm! It was so helpful to hear you unpick the facts of my five year nerve difficulty, and I look forward to further investigations with local neurologists. I will be sure to keep you informed. With best wishes.
(Edit by JB - I've taken the other doctors names out of this message now as there is no need for those to remain public)
Thankyou. I did manage to track down those names on the original referral paperwork in the end so copies of the report should have gone out to all concerned in today's post, including a copy to you. If you would not mind adding your email address to the registration on the site here I can then contact you directly if I discover anything else which may be of use. For a start it looks as though the most appropriate Oxford neurologist is probably David Bennett. JB
I received your report yesterday, for which many thanks. It's very detailed - much appreciated. I'll speak to my GP and surgeon about the next step, and I'll keep you informed. I've updated my website details as requested. Thanks again for all your help, and I'll keep in touch. Best wishes.
Four operations on the same hand is a lot of history - I've only met one patient who has had more than that and barely a handful of people who have had three. It's hard to know who would provide the best opinion as a lot depends on the details of the history so far and the nerve conduction results. You are probably within range for a referral to my King's College clinic which could be made on the NHS if your GP agrees (I don't do private work arising out of the website). I would want to see all your old neurophysiology results so we might have to contact wherever they were done. Failing that I guess the default option is probably to ask for a second opinion from a neurologist. That would be the speciality most likely to pick up any alternative reasons for a median neuropathy. JB