Peripheral neuropathy

The patient presents with her daughter, a nurse, today self-referred for evaluation of suspected peripheral neuropathy. She states that she has constant numbness and tinging in her hands and feet and that she has been diagnosed with carpal tunnel syndrome bilaterally with an EMG study. She also states that she has a history of lumbar spinal stenosis, but that the diagnosis of peripheral neuropathy has been given to her recently. She states that she is easily fatigued when ambulating for any length of time and she also has significant restriction in her cervical range of motion. She complains of dizziness and heaviness in her arms and sensory decrement as well.

IMPRESSION:
1. History of pelvic fractures back in November 20, 2012 with CT conformation.
2. Suspected lumbar stenosis; query ligamentous flavum hypertrophy as the primary cause, but no MRI is available.
3. EMG confirmed bilateral carpal tunnel syndrome (per patient).
4. Suspected cervical radiculopathy secondary to cervical stenosis – I see no myelopathic sign today.

PLAN:
I had a nice visit with the patient and her daughter today. It is evident that MRIs of her lumbar and cervical spine are definitely warranted and I would like for her to forward to us a copy of her EMG study. We discussed taking wait and see approach versus medication management versus physical rehabilitation modalities versus surgical referral versus interventional pain treatments. I explained to them that the only way I could recommend therapy is if I knew the cause of her symptoms. I do feel that her carpal tunnel is overlapping with cervical radiculopathy pattern and we will assess the EMG that she recently had done.

I would like her to follow up with Dr. or physician assistant after her MRI to discuss appropriate treatment planning. I have given her prescriptions for the MRIs and we will see her back here in the office after MRIs for further treatment and planning.

They seem very happy with their visit today. I will look forward to work with them.

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