[charles78]

My diagnosis came about as a result from a gunshot wound through the left elbow. As time progressed and healing being slow, at the request of the the insurance company my Dr. ran a nerve conduction test. The results came back bilateral carpal tunnel and bilateral ulnar sensory neuropathy, which my pcp said was poly, or peripheral neuropathy. Blood work done, I was told normal, but my MPV low at 7.1, MO# high .9, MCH high 31.2, MCHC low 33.1, but looking at it there are some that are some just in borderline range(don't know if that means anything at all though). None of this was addressed in the "everything is normal" result I got from over the phone. So it was left at idiopathic peripheral neuropathy.
After doing some research and realizing that problems that I have been having for years that I had just chalked up to normal everyday pain/ (getting too old for that stuff lol) and even changed jobs because my back and legs couldn't handle the stress any longer. I wanted to know if this was the root and what I could do to feel my age of only 33 instead of 70. So I was referred to a neurologist who did another nerve conduction/EMG and 2 MRIs and blood and urine tests. (was told blood and urine both fine) I then was referred to a neuro surgeon because of severity of carpal tunnel and the MRI results. One thing I don't understand is I am being sent to have a ct scan, and to see a hemotologist for what I thought was just to get blood drawn but I found out that I'm doing another work up with them as a dr. and not just a stick and leave.
I know this is long and I apologize for that, I just wanted to give a little background information because sometimes little things make a difference. The results from the tests I have so far are listed bellow, I really appreciate any help I can get on breaking this down and then piecing it all together to figure out what it is I have if it still falls under neuropathy or if its changed into something else. Again thank you for taking the time and your input!


MRI of the cervical spine without contrast

Date of Exam: 6/2/2012

Technique:

Sagittal T1
Sagittal T2
Sagittal Stir
Axial T2
Axial gradient echo

Clinical Indication: Neck Pain

Findings: There is nonspecific decreased T1 signal intensity within marrow containing elements of the cervical spine. Please see comments below.

The included contents of the posterior cranial fossa are unremarkable. Cord signal intensity is normal. There is mild degeneration of the C1/C2 level and thickening of the transverse ligament. Cervical alignment is maintained. Negative for procervical soft tissue swelling. Multilevel uncovertebral spurring is present. There is a posterior bulge of disc at C5/C6. Mild canal stenosis and mild left and moderate preferential right foraminal stenosis is present. There is minimal posterior bulge of disc at C4/C5.

At remaining cervical levels, canal and foramina are patent. There is dorsal epidural lipomatosis in the upper thoracic spine. There is nonspecific mild T2 prolongation in the C4 vertebral body centrally.

Impression:
1. Disc disease, described above with greatest disc bulge at C5/C6
2. Diminished marrow signal intensity on T1-weighted imaging, nonspecific. Consider response to anemia/red marrow expansion, smoking if applicable to this patient, less likely other marrow infiltrative conditions. CBC correlation recommended.
3. Nonspecific T2 prolongation in the central substance of the C4 vertebral body. This does not extend into the posterior elements or to the endplates. Atypical hemangioma is one consideration. Dedicated CT imaging could further evaluate. If unrevealing by CT, bone scan would be of diagnostic value.

Exam: MRI of the lumbar spine without contrast.

Date of Exam: 6/2/2012

Clinical indication: Low back pain

Technique:

Sagittal T1
Sagittal T2
Sagittal Stir
Axial T1
Axial T2

Findings:

Dorsal epidural lipomatosis present throughout the lumbar spine. This contributes to mild narrowing of the thecal sac. There is Circumferential epidural lipomatosis at the S1 level. The conus is normal in size and signal intensity. Lumbar alignment is maintained. Multilevel mild facet arthrosis and ligamentum flavum thickening is present. Negative for vertebral body fracture.

There is nonspecific decreased T1 signal intensity within marrow containing elements of the lumbar spine.

The abdominal aorta tapers normally. Negative for paravertebral mass. Congenital pedicle foreshortening is present throughout.

Broad-based disc bulge at S5/S1 results in mild preferential stenosis of the left neural foramen and of the left lateral recess.
There is broad-based disc bulge at L4/L5 with mild flattening of the anterior thecal sac.

Negative for other notable abnormality.

Impression:
1. Epidural lipomatosis
2. Congenital pedicle foreshortening
3. Mild lower lumbar disc bulges.

Nerve conduction and EMG

Descriptions
-Motor nerve conduction-

the left median nerve, normal
the right median nerve: [*wrist] decreased amplitude (1.6mV)
the left ulnar nerve: [wrist] prolonged latency (3.4ms) and decreased amplitude (2.2mV)
the left peroneal nerve:normal
the left tibial nerve: [ankle] prolonged latency (6.2ms)
the left H-reflex nerve: normal

-sensory nerve conduction-

the left median nerve: [2nd digit] prolonged latency(3.9 ms) and decreased amplitude (13.0uV). [2nd digit]decreased conduction velocity (35.5m/s).

the right median nerve: [2nd digit] prolonged latency (4.1ms) and decreased amplitude (13.1uV) [2nd. digit] decreased conduction velocity (33.8m/s).

the left ulnar nerve: [wrist-5th dig] prolonged latencay (3.7ms) and decreased amplitude (5.0uV) [wrist-5th digit] decreased conduction velocity (37.9m/s)

the left radial nerve: [wrist-b 1st dig] Decreased amplitude (8.2uV)
the left sural nerve: [14 CM] decreased amplitude (1.3uV)
the left superficial peroneal nerve: [ant lat mall] decreased amplitude (2.4uV) [ant lat mall] decreased conduction velocity (34.9m/s)

-F-Wave-
the left median nerve: normal
the right median nerve: normal
the left ulnar nerve: normal
the left peroneal nerve: normal
the left tibial nerve: normal

-EMG Findings-
the right deltoid C5-6: all findings are normal
the right triceps C6-7-8: all findings are normal
the right brachioradalis C5-6:all findings are normal
the right flex.carpradi C6-7: all findings are normal
the right Biceps Brac C5-6: all findings are normal
the right 1st dorsal Int C8-T1: all findings are normal
the right Abduc.Pol.Brev C8-T1: abnormal findings: Fibs.
the left deltoid C5-6: all findings are normal
the left triceps C6-7-8: all findings are normal
the left Brachioradalis C5-6 abnormal findings: Fibs. , High Amp. , Dur..
the left bicep brac C5-6: all findings are normal
the left flex.CarpRadi C6-7: all findings are normal
The left 1st dorsal Int C8-T1:all findings are normal
the left Abduc.Pol.Brev C8-T1: all findings are normal
the both C5 Parasp: all findings are normal

summary/Interpretation

The patient has bilateral carpal tunnel syndrome, left worse than right, and also the patient has left C5 and C6 radiculopathy.

[mrsD]

Welcome to NeuroTalk:

I found a site which explains what blood tests mean...to help you understand that part of your testing.
It happens that the major topic at that site is for something else, but the explanations of the abbreviations etc are easy to understand:

http://www.hrpca.org/cbc.htm

As far as carpal tunnel goes, it can be from repetitive strain, from the neck compressed discs, or metabolic (like mine is) from low thyroid functions.

I am not very grounded in imaging test results, or the conduction studies, but others here, esp glenntaj, may be here tomorrow, or later today.

If you haven't had thyroid tests, I'd suggest them just to rule that out. Low thyroid deposits a form of mucin (tissue) under the skin and this can compress the nerves when they go under the ligaments in the hands and feet.

Getting that bone marrow looked at is important as some
marrow disorders make large proteins that clog up the blood.
Those can be tested for and one form is called MGUS for short.
If you have elevated monoclonal antibodies, this thickens the blood and slows circulation and the nerves then suffer with symptoms. Some forms of PN are caused by MGUS:
http://en.wikipedia.org/wiki/Monoclo...d_significance

So visiting the hematologist is probably a good idea for you.

[charles78]

Hi and thank you so much for your reply, that site eased my mind a little because from their chart most of mine or borderline to slightly out which from what I've read is not uncommon.
With the other showing radiculopathy I wasn't sure how I would be categorized.
I did have the thyroid and a bunch of others that all come back normal.
My neurologist and neuro surgeon keep playing ask the other when it comes to neuropathy.
I really appreciate those sites and your input really helped

[mrsD]

There is one simple mechanical test for nerve compression at the wrist and foot... It is called Tinel's sign.

If you don't have it strongly, you probably don't have compression at the wrist.

http://www.youtube.com/watch?v=XcDhqKRT2aU

I have carpal tunnel, which now after having my thyroid supplemented is much better, but not totally 100% gone.
There are times I can extend my fingers doing something and still a huge zing like an electric shock. If you've never had that
feeling either at the doctor's when tapped or when doing something, your nerve compression may be at the neck level.
Tinel's of ankle:
http://www.youtube.com/watch?v=s_-U4CyRiZs

You can also tap the top of the instep with a wooden spoon and
see if compression there (often from shoes tied too tightly) affects the toes.

For example I have minor Tinel's at the lateral ankle, but a strong one on the top of the instep. So I use an alternate shoe lacing pattern to take the pressure off at that location.

These examination may help locate where your nerve impact is located.