Diagnosis today
Dear Dr. Bland,
I hope you do not mind my contacting you via this site.
I have been off work since February. An MRI showed that I have a prolapse disc in my cervical spine (C5/C6). This did not explain the tingling and numbness in my hands at night which has been present on an increasing basis in the last few months, and nerve conduction tests today flagged up that I have 'mild' carpal tunnel in both hands. I have previously had pain and weakness in my left hand and wrist, but no symptoms in the right hand up until the current nocturnal numbness and tingling. . Both conditions are caused by excessive keyboard work. Given that I have rested and not used the keyboard for the past five months, I envisage that spontaneous healing is unlikely (I am aged 55). I am really upset by this diagnosis, particularly as I had hoped to return to my career (social work) at some point - which now seems an impossible dream, given the keyboard work
I live in Hastings, and had the tests at Haywards Heath hospital.
I would like to talk to a specialist, and wondered if I might make an appointment with you if I paid privately? I am medically insured, but this does not cover further outpatient appointments this year. If surgery was required (which would be covered by medical insurance), would it be possible for this to be carried out by you?
Sorry for this random e-mail, but I am feeling devastated by this additional diagnosis. I hate being unable to work in addition to household tasks, driving etc. being so limited, and just want to try to find a way through this.
Thank you for your reply Dr. Bland. I will ask for a copy of my results. I do feel that the cervical prolapse and CTS are due to excessive keyboard work and (re prolapse) poor posture. Up until yesterday, I thought the hand and wrist symptoms were due to the prolapse. When I searched 'CTS and the cervical spine' I read about something called double crush, which sounds important but I don't understand. Are you able to explain this please, or guide me to info. that I can understand? I expect this is what you mean about finding out whether the symptoms are coming from the neck or wrists. I don't know which type of specialist would have an overview on this - the orthopaedic specialist does not want to see me again unless I opt for injection or surgery to my neck.
I did the quiz, but it was difficult to answer accurately as whilst I used to get pain in my left hand, I haven't for several months as I haven't been driving or using the keyboard. The tingling has developed over the past few months, moving into my right hand which previously was symptom free.
Thank you for your reply Dr. Bland. I will ask for a copy of my results. I do feel that the cervical prolapse and CTS are due to excessive keyboard work and (re prolapse) poor posture. Up until yesterday, I thought the hand and wrist symptoms were due to the prolapse. When I searched 'CTS and the cervical spine' I read about something called double crush, which sounds important but I don't understand. Are you able to explain this please, or guide me to info. that I can understand? I expect this is what you mean about finding out whether the symptoms are coming from the neck or wrists. I don't know which type of specialist would have an overview on this - the orthopaedic specialist does not want to see me again unless I opt for injection or surgery to my neck.
I did the quiz, but it was difficult to answer accurately as whilst I used to get pain in my left hand, I haven't for several months as I haven't been driving or using the keyboard. The tingling has developed over the past few months, moving into my right hand which previously was symptom free.
Looking at those answers I would guess that a significant proportion of your symptoms are due to the CTS. There is a page of this site devoted to double crush syndrome so you should start by reading that - it's a rather contentious issue and my basic view is that when the question arises it usually makes more sense to treat the CTS and then worry about whether there is an additional problem in the neck afterwards if there are still problems. Let me know if you are able to make sense of the doublecrush page - I wrote it a long time ago. A good tactic to try and clarify how much of the problem is coming from the wrist would be to try local steroid injection as an initial treatment. JB
I don't mind anyone asking questions on here - that is what the site is for. I don't use it as an advert for private practice however - indeed I wish to keep the site as free of all financial bias as is humanly possible. I would therefore prefer that you don't consult me privately.
I think the first thing in your case should be to try and figure whether the symptoms are originating more in the neck or the wrist. If you run through the questionnaire on the site here that will give me a good idea of what your symptoms are. It's important to realise that having an abnormal test result, be it nerve conduction studies or MRI, does not necessarily mean that the abnormality which has been shown is actually causing any symptoms - one of the major bugbears of modern medicine is the fact that our tests are now so sophisticated that they can detect many 'abnormalities' which are simply innocent bystanders.
The second thing we need are your nerve conduction results so that we can figure out what 'mild' means - did you ask for a copy?
Keyboard work is not a major risk factor for getting either CTS or slipped discs in your neck and for the CTS in particular it is almost certainly irrelevant both in terms of causation and in relation to getting back to work. If it turns out that your symptoms are mostly due to CTS then it should be possible to treat it and for you to go back to doing whatever you want to with the hands in most cases.
If we can gather some of that information I can help you understand the options for tackling the problem. JB