Wellgate perfect wrist support - left wrist

I haven't seen this particular splint 'in the flesh' but from online illustrations it does not look well suited to use for carpal tunnel syndrome. It appears to have the stiffener on the wrong side of the wrist? - hard to be sure without getting my hands on one. The ones we use are made by promedics but there are plenty of similar designs. Most of them need a bit of adjustment to fit properly. JB

I have had a look at Promedics, and there appear to be three choices for CTS - Procool Deluxe Wrist Thumb Brace; Procool Wrist Thumb Restriction; Procool D-ring Wrist Splint - I presume I choose the latter? I would need to order by post. Would I need professional help to adjust so it fits properly?

Having read through information today, it would appear that splints and other treatments may slow up the process, but surgery is generally always needed in the end for CTS even in cases that may be classified as currently mild? I have felt progressively more anxious and low as the day has gone on, and do not have any follow-up after nerve conduction tests yesterday. The tester will write to orthopaedic surgeon who has now signed me off re my cervical prolapse, and I will be notified in writing of results of tests - i.e. that I have CTS, which I was informed of yesterday following nerve conduction tests (I have also asked for a copy of test so I can quantify 'mild').

Re my symptoms: (following an acute RSI episode in left hand in September 2014) I first developed pain, weakness and tingling in left hand in January 2015, which gradually receded following my giving up my (computer) work, but have now proceeded to significant numbness and tingling at night in both hands. I have periodic low level tingling in my left wrist and some weakness e.g. when picking up something heavy with that hand, but no current day time symptoms in my right wrist/hand. Given this progression of symptoms and reading other cases, it would appear that this is more than 'mild' and will in all likelihood end in surgery? I also feel confused about when surgery should take place, as from my reading it would seem that leaving it too late when nerve damage has occurred is not a good thing, whereas surgery may not be agreed at my current stage. If it is inevitable that I will need surgery, then I would really wish to get on with it so as not to have this hanging over me and also to be able to go back to work at some stage. I am unsure who should carry this out - e.g. a neurologist or orthopaedic surgeon - or whether there is a particular specialism in arm/hand surgery. From the posts I have read, it is most evident that the skill and experience of the surgeon is key, but I would not know where to start in making this decision (I would be a private patient).

Prior to nerve conduction tests, I had a number of physical tests for CTS and none of these showed it up, so I do feel very disappointed and hadn't been expecting this result.

Sorry to ask so many questions, and for my anxiety.

The splint we used to illustrate on the site here (see the splinting section) is very simple and seems to work as well as any. You don't need to immobilise the thumb. You can also follow the instructions on here to adjust it to fit properly.

Though some surgeons give the impression that surgery is always needed I think this is based on their experience of patients who have been referred for surgery. When you look at the mass of patients who present in primary care the picture is rather different. There are only a few studies not carried out in surgical clinics but they suggest that only a minority of patients ever end up with surgery with a fair number improving spontaneously witout any treatment and others responding to splints or steroids. In a 2012 study from Scotland only one third of patients initially treated with injection had had surgery 5 years later. We are currently trying to find out what has happened to every patient who we started out treating with steroids in 2007 - we know that 16% of them have had surgery but we have lost touch with quite a few so we are currently trying to trace them to see if there are lots of operations we don't know about - I'll put the results on here once we have an answer.

The episode in September 2014 could have been an earlier self limiting attack of CTS - hard to tell for sure. 'RSI' is a rather poor term which hides a variety of real diagnoses including CTS but also various forms of tendonitis, several types arthritis and even odd things like writers cramp. Labelling them all 'RSI' is not a very useful way of deciding treatment.

It's very hard to judge how severe the nerve damage is from the symptoms. The subjective severity, character and timing of the symptoms is very loosely correlated with the severity as assessed by nerve conduction studies when you look at hundreds of patients but the correlation is so poor that you cannot reliably predict one thing from the other in the individual patient so the description of the symptoms you give there does not particularly mean that this is 'more than mild', nor have you mentioned anything which particularly predicts that surgery will be necessary.

There are some things which help to predict which patients will respond well to surgery and these are discussed in the surgical prognosis page. You will notice that the subjective severity of symptoms as experienced by the patient does not figure in this. One of the better predictors is the nerve conduction results but they have to be analysed in the correct way - just describing them as 'mild/moderate/severe' according to whatever whim strikes the person doing them is not good enough. Provided you know the detailed nerve conduction results there is an 'ideal' time for surgery - not too soon and not too late. One has to remember that a few people are permanently disabled by carpal tunnel surgery so there is a downside as well as a prospect of cure.

The major determinant of surgical expertise is the amount of practice the surgeon has had doing the particular operation you are thinking of having - you just want someone who does lots of carpal tunnel operations. Such people tend to be either specialist hand surgeons or plastic surgeons but there are GP surgeons who have made a speciality out carpal tunnel surgery and a variety of others.

The physical 'tests' for CTS are very unreliable. About the best of them is Phalen's sign - which again you can find described on the site here. It is not always done very well in clinic.

Questions are fine, and if we try to answer them here then the discussion is documented for others with the same problems so this forum builds up into a useful resource. Notwithstanding the fact that this site is part of internet I would caution against reading too much about CTS on the web. Patient forums are often dominated by people who have poor results of treatment because they have more incentive to search the net. This tends to give an unfairly pessimistic view of the outcome of treatment. (This is true of most diseases you look up on the web, not just CTS). If you stick to reputable sites such as NHS choices and remain wary of people touting for business you will get a fairly unbiased impression. JB