Update of symptoms

John Elliott
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Dear Dr Bland,
You/Emma sent me a letter requesting an update since the appointment last October. I have completed a symptoms severity questionnaire and the result reflects quite well how I would describe the current levels.

The answers to the letter are as follows (my patient number with you on the letter is 104369):

My overall opinion of the effect of the surgery: 3) Slight improvement. No pain but the complete numbness in left hand thumb (top joint) and first 2 fingers (top 2 joints) is a considerable inconvenience when trying to button clothes. Would I prefer the hand as before surgery or as now? Definitely as now because there is no pain, but the numbness is a real drag!

Days off work? Nil. I am retired

Physiotherapy? Dr Ponraja arranged it after my appointment at Canterbury in October. I go to WHH on 1 Feb - some 14 weeks after the October appt. I have continued with my own physiotherapy/steam room. There has been improvement but the finger joints are still stiff and restrictive near clenching my left fist. That is also where I have put on the questionnaire that I have mild pain.

Symptoms in the other hand. Very slightly worse - more tingling. But not a problem.

Emma wrote not to bother with the GP input but here is my view.
1) Scar fully healed? YES
2) Infection? NO
3) Scar tenderness? NONE
4) Wasting of thenar eminence. MILD (my opinion!)
5) Power in apb? Normal (I tested both hands with my wife opposing!)

Regards
John Elliott

jeremydpbland
Online

Thanks very much for the update. I'll add to the records tomorrow. I would expect slow progress from grade 6 so overall this sounds about as much can be expected at this point. If the numbness persists we may well test it again after a while to see whether there is a measurable improvement - some of the grade 6 cases do not change at all unfortunately. I'm a little surprised by the APB strength report as I would expect some weakness, especially if there is some visible wasting - it's a hard muscle to test though.JB

John Elliott
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Dear Dr Bland,
I have replied to your mail as it saves me repeating much of the history. I have had 6 sessions of physio at the William Harvey Hospital. The physio staff now need authorisation to continue. They assess that further sessions would help. So far, the ultra sound treatment has reduced the (previously small amount) of scar tissue to almost zero. The ultra sound has also helped the blood circulation to the fingers. However, the fingers still get cold. My personal physio efforts to improve movement in the finger joints shows a small but steady weekly improvement but the restriction in the joints is still significant. A major change is that I can feel within the affected fingers. I would describe it as like having my hand in hot water after playing snow balls! The internal feeling appeared intermittently after a few sessions of ultra sound but is now permanently present. The surface (skin) of the fingers is still completely numb to hot/cold and touch. The numbness is the most inconvenient aspect of the symptoms. The WHH physio did some touch/sensation tests (with my eyes shut) and that produced some very strange results; my nervous system made some very wrong conclusions. I have a physio regime to try to re-educate the nervous system. If you agree that continued physio is worthwhile, how do we go about authorisation? I said I would pass to you the information in the WHH physio dept letter. An e-mail response address is ekh-tr [dot] OPDAppointments [at] nhs [dot] net and ask to forward to Thomas [dot] Kenmir [at] nhs [dot] net (He is the physio man). I can of course come to your dept at Canterbury, or scan the letter to you. Please let me know. Regards. JE

jeremydpbland
Online

I'm sure we can request extended hand therapy if it seems to be helping. We're now about 7 months post-op and I suspect some of those sensory symptoms relate to regenerating nerve fibres. I think we mihght aim to test it again in midsummer if you can spare the time to visit us. IN the meantime we''ll try to contat physio about continuing for the moment. JB

John Elliott
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Dear Dr Bland, Thank you. I will make a note to contact your dept in mid summer for an appt. That would also allow time for any further physio to take effect. Regards. JE

John Elliott
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Dear Dr Bland,I have just returned from a physio session at William Harvey Hosp. They have not received any authorisation for further sessions. Have you been able to send authorisation to them? Do you need any additional information from me? I told them that I would send this note to you. Regards. JE

jeremydpbland
Online

I had an email exchange with the physio concerned who was confident they would be able to obtain further authorisation from your GP surgery. I'll drop him a note and ask how they are getting on with that. I still have the option of submitting a request from the CTS clinic but at that point they felt they didn't need one. JB

John Elliott
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Thank you. Whatever you did seems to have worked as I had a call this morning from the physio dept to arrange further treatment dates. Regards JE

John Elliott
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Dear Dr Bland, I have now progressed as far as both the WHH physio dept and I think is probable with the physio exercises. You suggested that I come to have the nerves checked again. I would like to do that. My right hand has remained the same during the past 6 months or so - slight tingling in the tips of thumb and 3 fingers but no pain and minimal interference with normal life. The left hand is fundamentally the same with numbness beyond the first joint of thumb and 3 fingers but the joint stiffness is a little reduced. The physio exercises have certainly guided my efforts but both the physio dept and I wonder if time would have brought me to the present level anyway. There has been slow but steady improvement since the operation. The numbness is still restricting but the sensations "inside" the fingers and recently the occasional shooting pain, also within the index and middle fingers, keep me positive about further progress. Regards JE.

jeremydpbland
Online

Sounds like a good time to re-test and take stock of where we are. I'll schedule an appointment - it will be in August sometime. JB

John Elliott
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Thank you. Probably unimportant but my last report to you was ambiguous regarding my left hand. It remains much the same as it (the left hand) had been for the previous 6 months and not as the right hand had been. Regards JE

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