Symptoms improved, no surgery?
Hello, I have had the symptoms of carpal tunnel since last April 2014, but the symptoms have changed and I'd like to not have surgery though I've been advised to have it by a friend who is an orthopaedic surgeon. Last year I had very bad numbness and tingling especially through the night which would wake me up and hurt a lot. I saw a physiotherapist but it didn't help. Now almost a year later, I don't get any numbness, only a bit of tingling when I've used it a lot, but it does ache a lot. It hardly ever keeps me awake at night, and the worst time is morning when the wrist feels swollen, painful, and sometimes I can hardly open my hand. I've started wearing a splint at night which helps a little, and I try not to use the hand as much (I am a fitness trainer). The hand is definitely weaker, I have pain up my arm and struggle with writing etc.(It's my dominant hand) but as I don't have much tingling or numbness perhaps it is getting better and I should not have surgery? My GP said the first thing is to try the injection, but what time frame? If things get worse? Any advice would be gratefully received.
Thank you, Miranda
Thank you for your reply Jeremy, it was very helpful. I had a nerve conduction test done in February and the results say 'abnormal and consistent with a moderately severe median nerve lesion in the right carpal tunnel'. I saw my gp yesterday to discuss the results and the plan is I take anti inflammatory tablets three times a day for a month, wear the splint at night, and try to not use the hand too much with the hope that it may correct itself. If things don't improve then look at getting a steroid injection. The morning stiffness starts getting better within an hour of getting up and having a shower (I run it under the hot water which helps a lot) and the swelling has usually gone down a bit by lunchtime. I shared my concerns with her about the possibility that it feels better only because of deterioration in nerve function and she has agreed to refer me to see a specialist to discuss this matter. I guess I'll wait and see what happens.
See if you can get hold of the actual nerve conduction results. I'm afraid we are not very consistent in the way we use terms like 'moderately severe' so that could cover a wide range of actual findings. Anti-inflammatory tablets have not been clearly shown to benefit CTS, though they may have a nonspecific pain relieving effect if you have pain as a symptom and they may of course benefit other things. That morning stiffness and swelling sounds quite significant to me and should probably not just be assumed to be due to CTS. JB
I do have a copy of the nerve conduction results, this is what is recorded under sensory.
Latency msec: R median nerve 3.0, L median nerve 1.8, R ulnar nerve 1.8, L ulnar nerve 1.7, right F4 double peak, left F4 single peak.
Amplitude microvolts: R median nerve 8, L median nerve 22, R ulnar nerve 11, L ulnar nerve 13.
Distance cm: R median nerve 11.5, L median nerve 11.0, R ulnar nerve 9.0, L ulnar nerve 9.0.
Velocity m/sec: R median nerve 39, L median nerve 61, R ulnar nerve 50, L ulnar nerve 53.
I hope this makes more sense to you than it does to me! Yes I'm not terribly keen on taking pain killers that frequently and for that length of time...but if it helps. The hand is definitely at its worse in the morning; it's as if the tendons are pulling really tight closing the hand. I do get pain and swelling at my Humero-ulnar joint which I have had for at least four years before the carpal tunnel symptoms. My GP sent me for an xray for arthritis but it was clear and no further treatment was suggested. I went privately for physiotherapy, she didn't know what was causing it, probably just wear and tear, but said it isn't connected to the carpal tunnel. I don't know what to think anymore.
They look like sensory nerve conduction studies only and are most likely to be grade 2 out of 6 on my severity scale (where 6 is the worst), though it is hard to be sure without a motor study - is there also a measurement on there labelled 'distal motor latency - median nerve'? You can look at the outcomes for surgery on grade 2 CTS here on the website - there does not seem to be any desperate urgency to operate on that from a physiological point of view - though a lot will depend on how much of a nuisance the symptoms are overall. JB
There is a section called Motor and one of the headings is 'Latency msec' but there is no information in any of the Motor columns. It is good news to hear my hand isn't too bad, I'll definitely have a look on the website. I intend to avoid surgery if possible; I know what to do to manage the symptoms. Thank you so much for your help, I have had so many conflicting views from health professionals, it is a relief to speak to someone who can advise with authority on the subject.
So they either didn't do the motor study or it is missing from that report. If you remember the tests, the motor study is the one in which a small shock administered to the wrist makes your thumb twitch. Remember to be wary of 'authority' - I can be as wrong as the next man and when all I have to go on is postings on a web forum I am working from very limited information. The evidence summarised here on the web site is the best I can find though. Hopefully you will continue improving. JB
I don't think they did the motor test because I don't remember them shocking the wrist. They just put rings on my fingers and shocked them. The symptoms have changed again, my hand hasn't been difficult to open on a morning recently, possibly due to the splint at night? Let's hope it is progress. I have read about the work you are doing at the clinic, I wish it wasn't so far away!
It does sound like progress in the right direction and at least there are some nerve conduction results so it should be possible to repeat those at some point and see if there really is measurable improvement. JB
Usually the change in subjective severity of symptoms is a good guide as to whether the condition is getting physiologically worse or better but you can occasionally get caught out by cases in which a deterioration in nerve function is perceived as an improvement in symptoms by the patient, and vice versa. It sounds as though some of your symptoms are improving while others are worsening so this is a confusing scenario and, I would have thought, a prime indication for getting some tests done, preferably both nerve conduction studies and ultrasound imaging, so that we can get an objective idea of what we are dealing with. How long does the morning stiffness and swelling last - that symptom might make you wonder about other problems, especially if prolonged. JB