I don't appear to have CTS. Is my appointment wasting time?

That sensory distribution would suggest an ulnar nerve lesion, probably at the elbow. We can test that for you to see if there is any measurable damage to the nerve but we don't treat that condition - my clinic is very specifically for CTS - so if we do find evidence of ulnar nerve problems all we can do is offer some advice on conservative management. Overall I would be inclined to keep the appointment - it only takes us a couple of minutes extra to check the ulnar nerve too. JB

Dear Dr Bland
Thank you for your prompt reply. ( on a Sunday evening!)
I will keep the appointment but will investigate the probable condition before then.
I will add that this is an extremely impressive communication tool. The NHS should take a long hard look at it.
Regards
Adrian.

Thankyou for the comments. I find this works well for comunicating with patients but I can see that some of my colleagues might not wish to work this way. It helps that we are dealing with a single, fairly minor, condition that people are generally quite happy to talk about in public. JB

Dear Dr Bland

I came in yesterday for tests and it appears I have problems with both arms, although my left is considerably worse. It is the ulnar nerve in both cases, I believe. As I have lost a great deal of confidence in my GP who thought it was carpal tunnel syndrome. I went to see her today to ensure she would be referring me for treatment once your report reaches her. I also asked about excercises in the meanwhile.

I am now told that she will not be referring me because your department will be doing this. I was told yesterday that it would be my GP. Would you please confirm who will be referring me? Also, should I be doing any particular tasks with my hands and arm to keep them functioning? My GP won't comment until she sees the report.

Very many thanks.

I'm afraid my clinic is only set up to deal with carpal tunnel syndrome, not ulnar nerve lesions at the elbows (your problem) and administratively the system makes it your GPs responsibility to do something about this, either herself or by referring you to someone who does deal with ulnar nerve problems at the elbows. It's reassuring to find that the online questionnaire was right about it not being CTS and also that it did turn out to be what it sounded like in our earlier discussion so at least we have a diagnosis. If it's of interest I have recently added a page to the site specifically about ulnar neuropathy. I thought it was worth providing something for this group of patients without CTS as there do seem to be a small but significant group of you who get referred to the CTS clinic. I'm sorry we didn't send your report with you - had we known you were going to go back to the surgery immediately we could have given you a copy. JB

I have just been given an appointment to see Dr Smith for an initial consultation at QEQM Margate on 22nd September. I have tried to explain that the problem is identified and asked if there is any way of getting treatment earlier.
To start with I have been told that I have been sent an appointment with the wrong hospital. It should be at Canterbury. Then after phoning round I have been told that there seems to be no way of anything happening quicker.
May I ask if another 12 week delay (6 weeks to the appoinment then a probable 6 weeks to treatment) will be detrimental to me? My left hand is bad and I gather my right is also affected by cubital tunnel syndrome.
Again, very many thanks for help with my problem which is not your area after all.

It is a long wait to deal with a problem where we have a clear-cut diagnosis and I can only apologise for the system in this case. The sad fact is that, if we want the NHS to be able to deliver the sort of care that those of us working in it would like to deliver then, as a nation, we have to spend more money on it. I'm not going to say any more than that about the politics of healthcare as that is not what this site is for. Andrew Smith has clinics in both Margate and Canterbury so I would guess they have just slotted you into whichever has the earliest vacancy but I don't control that clinic booking system of course. I know the orthopaedic clinics are substantially overloaded with referrals so I can't say I'm surprised by the delay - my own queue is also longer than I wish it to be at the moment, just barely within the mandatory target set for us. I'm hoping to use the online questionnaire to divert patients to the right clinic more reliably in the future and your case is a good example - had we been using it in the way I wish, your first port of call after GP referral would probably have been direct to Andrew Smith's clinic, or at least to the clinic which the hand therapists run in association with him and I think that would almost certainly have saved you at least 6 weeks. We might well still have ended up testing you, but not in the CTS clinic.

All that is very depressing. What about your ulnar nerve problem? The news there is a bit mixed. Self help measures are well worth trying and can be summed up as don't bend the elbow and don't lean on it. There's a much longer explanation in the ulnar neuropathy page (please read this and tell me what you think - it is very new and I could use the feedback). The success rate of such methods is limited but they are at least risk free and something you can be getting on with. If it continues to worsen despite this then the only other real option is surgery which is also not a guaranteed solution but does work for a reasonable number of patients. We don't know much about the rate of progression of ulnar nerve problems because there are no decent studies of the natural history of untreated ulnar neuropathy so it's impossible to say whether a six of 12 week delay is likely to be significantly detrimental.

If you are curious and want to try to make a quantitative assessment of how much your nerve has changed over a few weeks we can arrange to re-test them in a few weeks - just before your appointment with Andrew would probably make sense. Ideally one would like to do this with a sample of 50 or so patients with ulnar neuropathy with perhaps three tests spread over a 6 or twelve month period of non-treatment (or perhaps conservative treatment only). It would however be difficult to get this past an ethics committee, hard to recruit patients willing to try it, and hugely expensive - a formal trial set up like that would probably cost at least 50k, possibly quite a bit more. We could also take a look at your ulnar nerves with the ultrasound scanner - there is some evidence that the appearance of the nerve has some predictive value for treatment response but this is a bit experimental. JB

I am extremely grateful for your interest and involvement in my case. It would seem to be the reasonable course to have direct communication with a specialist but you are very much the exception, unfortunately.
I have looked at your new page along with other websites that deal with ulnar nerve problems. It all appears quite straightforward but vague as to the effectiveness of treatment. This I would imagine to be due to the lack of trials or studies as you mention. I have already been attempting to keep my arm straight and not lean on it. I am also flexing and moving my fingers, especially the numb little finger to keep the muscles functioning. At the moment I don't feel my role as my wife's carer is compromised and I intend to do all I can to keep it that way. Having said that, I would welcome the opportunity to revisit your clinic closer to September 22nd to try and quantify any degradation. Do I need to involve my GP, or are you able to set an appointment direct?
With my profound thanks
Adrian.

There do indeed need to be some good quality studies of ulnar nerve treatment. If your appointment on 22nd is late in the day I'll see you that morning and send the results with you - otherwise I can probably fit it in on the Monday. No need for further GP intervention at present - I'll take it as a referral from Mr Smith. JB

Fantastic! My appointment is for 14:15 on 22nd Sept, unless I can change it.

I'll see you at the start of the Tuesday morning clinic then and you can take your results on to see Andrew in the afternoon. That should give you long enough to get from Canterbury to Margate. I'll send out an appointment letter. JB

The appointment is for Canterbury. I was told Margate but it now transpires all of Dr Smith's clinics will change to Canterbury after Sept 1st. My wife will enjoy a look around the shops!

I guess that makes it a bit easier. I can move the slot with me a bit later if that's more convenient. There's nothing else booked that morning yet. JB

Sorry I missed your last post. Anytime that is convenient for you is OK with me. As my wife and I don't get out as much as we did, any reason for a trip to Canterbury is welcome. If Carole is not up to travelling then obviously I will come alone. I will try anything to get back to functioning properly, my confidence in treatment having increased with the success of the pain blockers in my spine. I know the arm is a different problem but I am sure it will respond well.
Best regards.
Adrian.

I'll leave it set at 10:00 then. See you then. JB

Hi Dr Bland
I have just been told that Dr Smith's clinic on 22nd has been cancelled and there are currently no plans for an alternative.
May I assume I can still see you at 10:00 on that day? It would seem to be a good idea to at least have some more information for whenever I finally get to see somebody.
Many thanks
Adrian

No problem, keep the appointment with me and we'll have a look at the ultrasound imaging as well as the NCS. JB

OK. Will see you then.

I can't say thanks enough for your help, especially as my injury doesn't really come under your clinic.
I have an appointment now with Dr Smith next Tuesday 29th, which is better than I imagined. I can attend with no false hopes and can live with this problem provided it can stabilise.
Hope you liked the cake!
Warm regards
Adrian.

It turn's out that the reason Andrew Smith's Tuesday afternoon clinic was cancelled was so that we could both, along with most of the rest of the consultant body from East Kent, attend a meeting discussing the future options for the organisation of East Kent healthcare. I saw him there and then passed on your details to try and get things moving. I was in London yesterday but I'm told the cake was much appreciated by the department :-) Let me know what you decide to do with the elbow and how it turns out please. One of the technical staff is interesting in following up ulnar nerve problems and we may try to do something a bit like out carpal tunnel work with ulnar neuropathy. JB

I saw Dr Smith yesterday, an hour early as Carole had radiotherapy at 5 so I called into his clinic just in case. He was kind enough to see me and we agreed on day surgery for the problem. I am confident I will regain strength and lose the numbness in my hand.
I will report on the procedure for your technician once it is completed.
I must say that both you and Dr Smith have been most pleasant and supportive. Clearly you are both passionate about your chosen disciplines despite the frustrations of working within the NHS. ( no comments on this expected!)
Best regards
Adrian.

I thought that surgery was going to be the only option for this. it will be interesting to see how successful it is. JB