I'm new and could use some input about my doctors report
I have had symptoms of CT for as long as I can remember and finally went to my doc about it. He referred me to a neurosurgeon. I had my appointment last week and had an EMG done to both arms, and also a needle evaluation to my right arm (the one that bothers me the most). I didn't actually see the doctor that day, but I was given a copy of the report that the specialist will review. Besides being filled with lots of strange to me jargon and figures, there is a spot for "preliminary findings". The technician wrote that I have bilateral severe carpal tunnel and moderate left ulnar nerve entrapment. The needle evaluation showed decreased interference pattern in my right tricep (50%). What does that mean? Left & Right Median Nerve - reduced amplitude, L4.7, R4.5 mV. Left Ulnar decreased conduction velocity (A Elbow-B Elbow, 36 m/s) Left median anti sensory and right median anti sensory nerves showed prolonged distal peak latency (L4.1, R4.1 ms) and decreased conduction velocity (Wrist 2nd digit, L34, R34 m/s) Left Ulnar Anti Sensory nerve showed prolonged distal peak latency (3.8 ms) and decreased conduction velocity (Wrist-5th digit, 37 m/s). All remaining nerves tested were within normal limits. All F Wave latencies were within normal limits. Also the results included it a complicated looking table of different readings and levels, but I think the summary above covers most of what the graph shows. Based on those figures, can anyone tell me - is that a "severe" case of CT? I know everyones perception of pain/sensation is different, but I'm just curious.
No, I'm not in England. I'm in Canada. I wish I could upload a picture of my test results.
It appears that I was given the first two pages of a longer report.
There is a large table called Motor Summary.
For the Left Median Motor (Abd Poll Brev) at the wrist:
Onset: 3.8ms Norm Onset: <4.2
O-P Amp: 4.7 mV Norm O-P >5
Site 1, Elbow Site 2, Wrist.
Delta-0 ms, 3.6 Dist(cm) 20.5 Vel(m/s) 57 Norm Vel(m/s) >50
Right Median Motor (Abd Poll Brev) at the wrist:
Onset: 3.8ms Norm Onset: <4.2
O-P Amp: 4.5 mV Norm O-P >5
Site 1, Elbow Site 2, Wrist.
Delta-0 ms, 3.8 Dist(cm) 21 Vel(m/s) 55 Norm Vel(m/s) >50
Then there is:
Left Ulnar Motor (Abd Dig Minimi)
B Elbow:
Onset: 6.2ms O-P Amp: 8.6 mV Norm O-P >5
Site 1, A Elbow Site 2, B Elbow.
Delta-0 ms, 1.2 Dist(cm) 4.3 Vel(m/s) 36 Norm Vel(m/s) >53
Anyhow - that's as much info as I got. I guess the entire report will be evaluated by the neurosurgeon and I"ll just wait to see what happens.
I really appreciate you taking the time to reply.
Well just taking those median nerve values in isolation, your CTS would be grade 2 out of 6 on my neurophysiological severity scale - which I usually phrase in English as 'mild'. However, it is important to realise that other diseases can also produce a set of median nerve results that look like this and the overall interpretation of the results depends on the other measurements made and your clinical presentation. I see you have a moderately high score on the diagnostic questionnaire so taken with those results it is likely that at least part of your problem is indeed CTS but I would be a little concerned about the ulnar nerve studies also being abnormal so your case certainly deserves some thought from your neurosurgeon who will try to tie everything together into an overall diagnosis. JB
Thank you so much for your thoughtful responses.
In all honesty - while my symptoms of CT are bothersome and becoming worse as the months roll by; it just didn't/doesn't feel severe to me. So, I was surprised to see that on the report.
I was told that it could take the neurosurgeon up to 6 weeks to evaluate my results, so now I just wait.
Thanks again.
Frozenmama
It's unusual for needle EMG to be done by a technician rather than a doctor. I guess we are not talking about the UK here.
Decreased interference pattern in the right triceps is hard to interpret - it might mean nothing more than you not making enough effort to contract the muscle to generate a full interference pattern. If they didn't provide any interpretation of that then it is effectively a meaningless comment by itself.
To grade the severity of your CTS in my terms we would need the measurements of median distal motor latency to abductor pollicis brevis (usually indicated as wrist to APB) - these figures should be recorded along with the amplitudes you have given (4.7 and 4.5 mV) and with luck they should have the lab's normal range for that measurment recorded with them.
Your ulnar nerve seems to show conduction abnormalities at both wrist and elbow from those results alone - trouble with this nerve at the wrist is rare. I think one would want to see the entire table of results to come to any firm conclusions as the interpretation of some of those results will depend on exactly what was measured to be normal. JB