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Neuro Doctor
Neuro Doctor, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5238
Experience:  American Board Certified Neurologist, Internal Medicine
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Looking for some input. For the past year or so I have been

Customer Question

Hi there. Looking for some input. For the past year or so I have been suffering from a range of issues that appear to be nerve/muscle related. The primary concern I have is what I describe as weakness in some of my hand/finger/arm muscle systems. I drop things, have some light trouble with dexterity, turning doorknobs is a clumsy action. Muscle fatigue in my arm tricep ( or what feels like it) when drying my hair or talking on the phone using my left arm. This has primarily been my left arm/hand - and initially was felt in my triceps, forearm and thumb/index pinching but I am also now having some bilateral weakness in my third and fourth fingers - more than thumb/index. No significant numbness and not significant pain though when I do have it it is with movement. On several occasions, I woke up in the middle of the night with screaming pain in my left arm in the general area just in front of the inside of the elbow and will periodically have a very dull and brief ache in that same area during the day. I have also been having what feels like a similar issue with a "weak" feeling in my left ankle area and at least a perceived periodic feeling of "muscle fatigue" in that area as well. And have periodically had some neck pain/ache/tightness that was generally one-sided with the tightness moving into whatever muscle is between the neck and shoulder at the top of my back.
I recently saw a neurologist and had a nerve test done - though no imaging. That neurologist said probably CTS - which is some ways made sense, but i some did not i.e. shoulder/neck/upper forearm pain etc - and asked me to try wrist splints at night. I have now done that for a month with no change.
I have not had any imaging done and the results of nerve test are below. By my understanding there were a few abnormal results though the neurologist I saw didn't really provide much explanation.
I am hoping someone can help me both understand the test results and if symptoms etc. really do point to a strange cast of bilateral CTS that is presenting a bit oddly and somehow has interplay with my shoulder etc. And provide some advice on next steps towards either treatment approach or continued diagnostics.
I will admit that the straight CTS seems odd to me, and I have some concern that these issues may be more aligned to potential nutritional based neuropathy ( I'm a vegan) or similar.
Here are the general notes from the testing
Borderline normal evoked response amplitude and normal conduction velocity with digit 2 stimulation.
Reduced evoked response amplitude and normal conduction velocity with digit 4 in right median
Evoked response amplitude and conduction velocity normal with digit 2 and digit forced diminished in the left median nerve.
Evoked response amplitude and conduction velocity normal in left sural, superficial, peroneal and bilateral ulnar nerves.
Motor nerve conduction shows normal distal motor latency evoked response amplitude and conduction velocity in the left tibial, peroneal and bilateral median and ulnar nerves.
F-wave minimal onset latency is normal in the left tibial and bilateral median and ulnar nerves.
F-wave responses are absent in the left peroneal nerve.
Latency difference between the second lumbrical and second dorsal interosseous muscles with stimulation of the median and ulnar nerves respectively is normal on the right and prolonged on the left.
Needle examination reveals no abnormal spontaneous activity, normal motor unit potential morphology and reduced recruitment with submaximal effort in all the muscles studied in the left upper and lower extremities. –**my note... this portion of the results shows a highlighted result of Full recruitment on maximal effort for the Left first Dorsal interosseous.
Conclusions: This study shows electrophysiologic findings suggestive of left median neuropathy at the wrist as may be seen with early mild CTS. Reduced evoked response amplitude in the right digital median sensory nerve (digit 4) cannot be further localized. There are no electrophysiologic findings suggestive of left cervical or lumbosacral radiculopathy.
Submitted: 6 months ago.
Category: Neurology
Expert:  Dr. Captain replied 6 months ago.

Hello!

Welcome to the JustAnswer.com question/answer interface.

I am a Family Medicine doctor, board certified with active licenses and certification in Internal Medicine, Pediatrics, Obstetrics and Gynecology, as well as Integrative Medicine & Naturopathy, with advanced training in Neurology, Cardiovascular Medicine, Gastroenterology, Endocrinology, and Psychiatry. I am also well-trained in Functional Medicine. For your review, here is my direct link with my current ratings: http://www.justanswer.com/medical/expert-familydoctor/

I have read your post and observations. Would you prefer a summary answer to your question, or would you prefer more back-and-forth, where there will be a series of more questions and more details clarified? There is no difference in charges for your preference. You can continue to ask questions and receive answers without additional charges.

Either way, the goal is for your satisfaction, and I’ll do my best to take the appropriate time to help you.

Customer: replied 6 months ago.
Hi there - It looks like you are a family practice MD? I was specifically looking fo a neurologist.
Expert:  Dr. Captain replied 6 months ago.

I have extensive training in neurology, but I'm surely happy to opt out if you prefer a Neurologist. I don't know how many are available online now.

Expert:  Dr. Captain replied 6 months ago.

More often than not, questions very much like your own, are ones that I have, and do, address regularly in my clinics. That said, I certainly understand if you'd rather a neurologist.

Customer: replied 6 months ago.
Thank you - and please don't take this wrong, but I would prefer a neurologist.Thanks
Expert:  Dr. Captain replied 6 months ago.

it won't cost you anything additional for me to opt out. No worries at all :)

Expert:  Dr. Captain replied 6 months ago.

Hi there - It looks like it has been about 4 hours since your post was listed, and no neurologists are available. Would you like to continue waiting?

Customer: replied 6 months ago.
waiting for neurologist.
Expert:  Neuro Doctor replied 6 months ago.

Hi, I am an American Board Certified Neurologist with vast experience in diagnosing & treating all types of neurological & other medical conditions including the concerns of “Multiple new symptoms & EMG test report interpretation” you have mentioned here and I am very glad to help you with your health concerns.

Your EMG test (EMG & Nerve Conduction Test) shows there are findings suggestive of median nerve involvement on the left side and this type of findings can be seen with CTS, especially early stages.

But please see this emg test has not helped much to explain your symptoms. You seem to have more diffuse symptoms, for example you also have some proximal upper limb symptoms and symptoms in the neck areas too and this test has not provided any explanation for these symptoms. You also have a finding of absent F response in the left peroneal nerve, this is one of the nerves in the leg and this also possibly points towards some more diffuse process rather than just some localized entrapment neuropathy of the hand like cts.

For example you may be suffering from radiculopathy which is pinched spinal nerve roots in the spine. This can occur due to varieties of spinal conditions including arthritis, discs etc. The pinching of the spinal nerves can explain your symptoms in the proximal upper limbs too along with the neck symptoms. The absent f response of peroneal nerve in the leg may be suspicious for pinched spinal nerve root at L 5 level in the lumbar spine. Based on this report although it seems this test has not identified any cervical radiculopathy but please see the emg test does not pick the radiculopathy always, it can miss this condition and an MRI of the spine is the best test to rule in or rule out radiculopathy (discussed again below later)

Although this emg/nerve conduction test has not revealed any definitive peripheral neuropathy findings however in early stages this test may show mild findings like this, which can be confused with entrapment neuropathies like cts, which means the emg findings themselves are not enough to confirm the diagnosis in the early stages of neuropathies so we need to explore further. Since you are vegan so there is possibility for nutritional neuropathy for example vit b12 deficiency can cause neuropathy and can produce the symptoms you are having. Although this emg test has not helped much in this regard however you need a blood test (if not already done) to look for vit b12 deficiency and in early stages of the neuropathy the emg test may not always reveal neuropathy whereas the blood vit b12 level can help in confidently ruling in or ruling out b12 deficiency.

You also need an MRI of the cervical spine to explain the upper limb symptoms as well as the emg test findings, and also an MRI of the lumbar spine to explain the emg test finding & the left leg symptoms, and this will help in ruling out any spinal conditions causing your symptoms. If you feel the symptoms are one sided, for example only on left sided then an MRI of the brain too is a consideration because such one sided symptoms require ruling out brain conditions too.

If not already done you also need blood tests to rule out thyroid disease, and autoimmune connective tissue disorder etc because these conditions too can present with the type of symptoms you are having. If you are having risk for lyme disease then you need lyme tests too (if not already tested).

As you see there are various possibilities and you certainly need further testing and we cannot really stop just with this emg test report because this emg test has really not helped much to explain your symptoms. You may be having some cts too but the point is your symptoms are not restricted just to the carpal tunnel syndrome area, rather the symptoms are more diffuse and outside the median nerve territory too (for example the proximal arm & the leg are certainly not supplied the carpal tunnel median nerve) - so further testing is necessary (MRI scans, additional blood testing etc) to ascertain the precise cause for your symptoms and then treated appropriately depending upon the test results.

Please let me know if you have any further questions, and please click a positive rating (preferably 5 Star/Excellent) to credit for the time & effort put by me in answering your health question, and this is the only way I will be credited for my service to you. If you have follow-up or additional questions you can ask them after the rating too.

Best regards,

Neuro Doctor

Expert:  Neuro Doctor replied 6 months ago.

Hi, Have I answered your questions & concerns related to your health & the emg test report? Do you have any additional questions? Do you want to discuss this further? Please let me know.

Best regards!

Neuro Doctor

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