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Pinched nerves/What can be done??

  Could not find just a neurology area to post in.
  So will try here. Had an EMG and NCV for carpal tunnel symptoms.The neurologist who did the test said I didn't have carpal tunnel. The orthopedic surgeon is going to perform the CT surgery anyway Jul 15. Whenever I do too much of a repetitive motion, like drying dishes, buttoning my shirt causes my forearm to go very weak and end up with pain in the forearm and shoulder. Have to rest several minutes for the pain and weakness to go away.If I concentrate too much on doing these certain tasks my hand shakes and if goes on for too long the whole arm shakes and hurts. I really have to hold on to it and try to relax and sometimes that helps. I take 1mg Ativan a day and that seems to slow down the tremors somewhat. I continually have a binding in my entire hand and a tingling in my entire forearm. I lose my grip when carrying anything.My hand is somewhat numb most of the time.
  This is the neuro's interpretation of the tests.
  Normal EMG  Left arm and shoulder girdle
  NCV shows mild electrical evidence of polyneuropathy. Electrical diagnosis of specific entrapement neuropathy is unreliable in presence of polyneuropathy. However, no disproportionate slowing is noted at any of the usual entrapment sites.
  This neuro says he can't be of any further help to me and to seek someone with more expertise for my problem. What kind of Dr. do we now look for and is there any other tests that could pinpoint the problem? If these test results mean compressed or pinched nerves in several areas then is there anything that can be done? Medication or otherwise?
  I feel that my arm is getting weaker and losing strength. Are there any exercises that I should not do that could aggravate my condition? What would be more beneficial--heat or cold-- on my arm/shoulder?
  Thanks for any help you can give, it will be appreciated. Sharon, John's wife
Dear Sharon,
Carpal tunnel syndrome is caused by entrapment of the median nerve. Symptoms include tinglinf, most frequently in the thumb, index and middle finger. Symptoms tend to be worse with extensive use of the wrist and at night.  Weakness of the hand muscles tend to occur with prolonged entrapment.  The most sensitive test to diagnose CTS is nerve conduction studies (usually part of routine emg exam) that show slowing in 70- 90% of patients with CTS.  From your report, it sounds as if these findings were not seen. In addition, the emg suggested a mild polyneuropathy. These findings suggest a more generalized process affecting several nerves rather than just one nerve.  There are several reasons such as diabetes and other metabolic reasons, infectious, and hereditary. Tremor is an unusual finding in polyneuropathy and CTS. If the weakness tends to develop after  repetitive use, this may be a sign of myesthenia gravis. Tests that may be helpful include blood work for specific antibodies and emg with repetivtive stimulation. I would recommend getting another evalutaion by a neurologist and a second opinion regarding the carpal tunnel prior to any surgical intervention.  If you are interested in getting an evaluation at CCF, cal 1-800-CCF-CARE. Good Luck

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