slipnslide
02-04-2007, 08:36 PM
To give a brief history, I had no pain till an MVA in 11/05. Went though conservative care prior to surgery then had ACDF C5-7 in 6/06. Woke up from that surgery with hernia next the the left hip graft site and had that repaired 3 weeks later. Continued pain in neck, shoulders, arms, butt bones, backs of thighs, and tingling of bilateral hands and feet (same as before surgery). Was told it's expected post-op and would subside, but it didn't. I went for 3 weeks of PT before the Physical therapist sent me back to my OSS because of increased pain. Also, during pre-op testing my WBC's were elevated and I was sent on to a Hema/onco who did extensive blood testing, bone marrow biopsy, and DNA test for Polycythemia Vera. I did not have the JAk2 (?) chromosome/gene to give a definite diagnosis of PV, so I go back to the Hema/Onco every 6 months for monitoring. At the last visit in 12/06 my WBC was 18.6. Oct. '06 hernia type pain returned and CT showed swelling around the nerve by hip and hernia repair and have had 2 RFA's done to try to allevaite the nerve pain.
I was sent for another EMG/NCS in 11/06 which stated:
Summary and Findings:
The bilateral median and ulnar sensory nerves revealed prolonged peak latency, normal amplitude and decreased conduction velocity. The bilateral radial sensory nerves revealed borderline prolonged peak latency, normal amplitude and normal conduction velocity.
The bilateral ulnar motor nerves revealed normal distal latency, normal amplitude and decreased conduction velocity across the cubital tunnel w/ a drop of > 10m/s.
To assess for polyneuropathy third limb sensory and motor nerve were tested (right peroneal motor and sural sensory). These were WNL.
Monopolar needle EMG was performed in selected bilateral upper extremities, innervated by C5-T1 nerve roots inclusive. No spontaneous activity was seen in any muscles tested in the form of fibrillations, positive sharp waves or fasciculations. Voluntary motor unit morphologies are otherwise normal.
Impression: Inconclusive study. There is new evidence of global sensory slowing in the upper extremities, however the slowing is more pronounced for the median and ulnar nerves and more likely related to CTS and potentially Ulnar Neuropathy at the elbows. The lack of slowing in a third limb (RLE) reduces the likelihood of polyneuropathy as a source. There is no evidence for acute cervical radiculopathy on EMG.
I was sent for new MRI of the neck in 12/06 which showed some uncinate hypertrophy at C3/4...MRI that was done back in 2/06 showed bulging disc at C3/4:confused: .
I was then sent to a hand/upper extremity surgeon who diagnosed me with bi-lateral carpal tunnel but believes the problems with the ulnar nerve were neuropathic and being caused by something between the neck and shoulder region. He sent me on to a Neurologist.
The Neurologist's report reads:
Physical Examination: Outwardly she doesn't appear to be in any significant discomfort. Mental status and cranial nerves are normal. She has a trigger point in the right cervical paraspinals. Gross strength and fine motor movements is normal throughout. There is no extension beyond the upright of her neck secondary to pain. Light touch sensation causes tingling all over both hands but is most significant in the thumb and 5th fingers. She has diminished left bicep and brachiordialis reflexes other wise symetrical. Gait is normal.
Significant laboratories have show normal B-12 levels and normal thyroid function.
I reviewed a repeat MRI of her neck from 12/15/06 which shows surgery as described. I don't take any significant foraminal stenosis or spinal stenosis.
Nerve conduction study is most recently done on 11/15/06. EMG of upper extremities was normal. Sensory nerves reportedly showed diffuse slowing.
PLAN: Check serum protein electrophoresis. Outside of that I don't have any recommendations.
The serum protein electrophoresis test came back within normal range. The Neuro suggested 5 different things it could be but was taking shots in the dark and told me he didn't know what to tell me or recommend.
Anyone have any clues, comments, or suggestions as to what any of this could be?
Thanks,
Kim
I was sent for another EMG/NCS in 11/06 which stated:
Summary and Findings:
The bilateral median and ulnar sensory nerves revealed prolonged peak latency, normal amplitude and decreased conduction velocity. The bilateral radial sensory nerves revealed borderline prolonged peak latency, normal amplitude and normal conduction velocity.
The bilateral ulnar motor nerves revealed normal distal latency, normal amplitude and decreased conduction velocity across the cubital tunnel w/ a drop of > 10m/s.
To assess for polyneuropathy third limb sensory and motor nerve were tested (right peroneal motor and sural sensory). These were WNL.
Monopolar needle EMG was performed in selected bilateral upper extremities, innervated by C5-T1 nerve roots inclusive. No spontaneous activity was seen in any muscles tested in the form of fibrillations, positive sharp waves or fasciculations. Voluntary motor unit morphologies are otherwise normal.
Impression: Inconclusive study. There is new evidence of global sensory slowing in the upper extremities, however the slowing is more pronounced for the median and ulnar nerves and more likely related to CTS and potentially Ulnar Neuropathy at the elbows. The lack of slowing in a third limb (RLE) reduces the likelihood of polyneuropathy as a source. There is no evidence for acute cervical radiculopathy on EMG.
I was sent for new MRI of the neck in 12/06 which showed some uncinate hypertrophy at C3/4...MRI that was done back in 2/06 showed bulging disc at C3/4:confused: .
I was then sent to a hand/upper extremity surgeon who diagnosed me with bi-lateral carpal tunnel but believes the problems with the ulnar nerve were neuropathic and being caused by something between the neck and shoulder region. He sent me on to a Neurologist.
The Neurologist's report reads:
Physical Examination: Outwardly she doesn't appear to be in any significant discomfort. Mental status and cranial nerves are normal. She has a trigger point in the right cervical paraspinals. Gross strength and fine motor movements is normal throughout. There is no extension beyond the upright of her neck secondary to pain. Light touch sensation causes tingling all over both hands but is most significant in the thumb and 5th fingers. She has diminished left bicep and brachiordialis reflexes other wise symetrical. Gait is normal.
Significant laboratories have show normal B-12 levels and normal thyroid function.
I reviewed a repeat MRI of her neck from 12/15/06 which shows surgery as described. I don't take any significant foraminal stenosis or spinal stenosis.
Nerve conduction study is most recently done on 11/15/06. EMG of upper extremities was normal. Sensory nerves reportedly showed diffuse slowing.
PLAN: Check serum protein electrophoresis. Outside of that I don't have any recommendations.
The serum protein electrophoresis test came back within normal range. The Neuro suggested 5 different things it could be but was taking shots in the dark and told me he didn't know what to tell me or recommend.
Anyone have any clues, comments, or suggestions as to what any of this could be?
Thanks,
Kim