AANEM Connect

I have a complicated patient, 54 y/o male, diabetic currently under good control. h/o C5/6 ACDF August 2021 with some residual right hand numbness in the thumb/index which interstingly completely resolved following right rotator cuff repair in January 2023.  Shortly after the surgery, he started to have left arm and hand paresthesias and subjective numbness radiating from the L neck and shoulder. This was intermittent for a few months but then progressed to both arms and hands, all fingers. constant.  Cervical MRI did not show correlating findings but was technically limited from the hardware.

I did EMG LUE in May:

-Absent median sensory studies to index and middle

-normal ulnar and superficial radial sensory

-Median motor, 8 cm, latency 9.5 ms, amplitude 5.6 mv, CV 46 m/s

-ulnar motor, 8 cm, normal except mild decreased CV across elbow 46 m/s

-EMG:  ABP with decreased recruitment but no spontaneous activity

CTR done in June with no change in symptoms.

Spine surgery obtained CT myelogram and concluded that neck not causing the bilateral symptoms

Brain MRI was also obtained in May due to these symptoms and development of motion sickness following the shoulder surgery in January 2023 and was read as unremarkable.

Spine surgeon referred him to neurology, who saw him August 31 and did bilateral UE EMG:

LUE:

-absent median transcarpal

-Median motor, 7 cm, latency 8.1ms, amplitude 3.8 mv, CV 46 m/s

Question:  Given the CTR was done 3rd week of June and new EMG 9+ weeks post op shows basically no change in motor latency, I can't help but wonder if the CTR was not complete and he still has focal compression. I realize that demyelinting issues can take up to 3 months to recover, but in general I expect the latency to look better this far after CTR. Does anyone have a take/suggestions on what to do with these data?