Carpal Tunnel is affecting my career/job choice and I am despairing at what I can do for a job
Hi, I am copying over 2 posts from another forum, so please forgive the repetition from the two posts below:
Post 1 - I developed Carpal Tunnel syndrome 3 and a half years ago. I had my first operation 2 and a half years ago, and continued with my office based role with no problems for 18 months. However it came back with a vengeance. I had a second operation 4 months ago and I knew straight away it hadnt worked. The surgeon said that the scar tissue from the first operation was like someone had poured concrete in my hand.
It was recommended that I change careers to something else, which I did. I had started to get pain in my left hand as well and I wanted to at least "save" one of my hands. So I moved into a role organising activities for the elderly at people with Dementia. However because a lot of the role has manual handling, wheelchair pushing and basically a lot of work with my hands that I hadnt anticipated, I am now in agony constantly and my left hand has more prominent symptoms of carpal tunnel syndrome but not as bad as my right hand.
I am desperate to not be in a situation where I can no longer work because of the pain. My next consultant appointment is at the end of May and we will find out where we go from here.
The biggest problem facing me is what job I can actually do that wont aggravate my hands. I am well educated with qualifications in HR, Payroll etc and have always worked in an office up until my recent job in elderly care. Every job I look at seems to involve an element of computer work/lifting and other things which i know will hurt my hands. I cant even peel potatoes without pain. It's really depressing me and I think because I feel so low, I am not being very imaginative in what role I can do. I dont want to end up with permanent nerve damage to either of my hands and really dont want to be on disability benefits and in pain all the time. I love having a sense of purpose of working, but I just cant see what I can do. In my HR role, I have tried Smartnav and Dragon Naturally speaking but because I was working with HR systems and spreadsheets so much, Dragon was really awkward to use (even the professional edition) and it was taking forever to do something which would usually take me only an hour max. Smart nav gave me a massive neckache and subsequent headaches because of using my head as a mouse.
I really am in despair right now. I am only 34 years old and so have many years ahead of me for working but I just dont want to be in this pain all the time. Does anyone have any ideas of what job I can possibly do that wont affect my hands and cause me further pain and complications?
I would really appreciate some advice, because this is really getting me down and knocking my self confidence.
Post 2 - I first started suffering with Carpal Tunnel about 3 and a half years ago. I wore a wrist splint whilst I was working on the computer however it did nothing but make the pain worse. The company I worked for bought me various ergonomic keyboards and mice but they didnt help. One thing that I didnt really have was the pain waking me up on a night time. It was always within 20 - 30 mins of me starting work that it would kick off, then by the time I went to bed, it was still very painful and felt swollen, but I guess I must be a deep sleeper or just very tired, as it was very rare for the pain to wake me up during my sleep. I saw a consultant who did some tests by bending my hand etc and he diagnosed Carpal Tunnel and booked me in for an operation. Whilst on the operating table, he asked me how long I had had this and I said about a year at that point. He said the Carpal tunnel was really thick and him and the other Lady who was doing the operation were commenting about how thick it was to each other. After the operation and I regained feeling in my hand, I immediately knew it had worked and felt great about it.
Fast forward to the beginning of last year, the Carpal tunnel in my right hand had returned and I was getting niggles in my left hand as well. The Doctor referred me to the Consultant about my right hand. He also did some bending of my wrist then sent me for a nerve conduction test on both hands. My left hand was fine, and my right hand was also within the normal range but towards the cutoff for Carpal tunnel. I have no idea what the figures are though. The consultant decided to operate just before Christmas last year. When I was in the operation he asked me if I had had an infection last time, which I replied no. He said that there was a lot of scar tissue as if someone had opened up my hand and poured concrete in there. He removed the scar tissue. Once I had regained the feeling back in my hand, I knew this time that it hadnt worked as the pain was no different to before the operation. At my follow up, he said that on the second operation it can take longer for my hand to heal, and that it might be 8 months or so before we can be sure. I am due to see him at the end of May for another check up.
My doctor has run lots of blood tests on me to check for all the ususal culpits that can cause Carpal Tunnel (Diabetes, Thyroid, Arthritis, and a whole load of other hormal tests)
The pain in my right hand is typical of normal carpal tunnel symptoms however I have an achey sort of grinding feeling on the top of my pointing finger (for want of a better word) from the big knuckle bone to the middle bone of my finger. Although the pain in my left hand is a lot less, I also have the same pain in the top of that pointing finger.
I read something the other day about Vitamin B6 and B12 deficiencies possibly causing the lubricant in the carpal tunnel bones, but I assume if I was deficient in those, it would have been picked up from the numerous blood tests that I have had. I didnt fully understand the reasons behind why the inflammation occurs until I read this document, as it hadnt been explained to me before.
I dont want to go into a job that is going to make the situation worse, however Computers and Manual Handling etc from my previous jobs seem to be doing exactly that. I dont want to be unemployed and I simply cant afford to me. I would just like to do a job that utilises my brain but that doesnt affect my hand. It seems like a tall order, I know, but I just cant think what is out there where using your hands is a small part of a job.
I would appreciate any advice you can give me. Thank you
Hi Jeremy
I did the symptom checker and it said only 10% chance of CTS. Not sure if I am understating the pain/difficulty on the questionnaire. I guess its down to how you rate it. For example - severe pain for me would mean I would be off work in agony. Its painful but not enough for me to justify completely stopping working/being off sick, as I still work through the pain I have
OK so let’s have a think about this. We start with demographics – you are in an age group where CTS is relatively uncommon – not unknown but the disorder is much commoner in older individuals . In younger patients the first thing I look for is a family history as having a high genetic predisposition to CTS can be one of the reasons for seeing it at an early age – but you have no family history. Occupationally you were doing a lot of keyboard work before developing the symptoms – contrary to popular belief that is not a big risk factor for developing CTS. It is actually commoner in heavy industrial type occupations so I don’ t think your original occupation is especially helpful diagnostically.
Against that background we can then look at your original presentation and ask whether the initial diagnosis was right or not. From your second post we can start to analyse this. We do have some features in favour of CTS – you had a positive Phalen’s test (the hand bending thing) and if the symptom distribution then was the same as it is now then it was the right fingers for CTS. Most importantly it appeared to get much better immediately after surgery.
On the other side of the balance – your symptoms were daytime and use related rather than nocturnal. They did not respond to use of a splint (though I would wonder did you try wearing it at night rather than in the daytime? And was it well fitted?)
Unfortunately we are lacking a few things that would have greatly helped now because they were simply not done when you first presented. No-one took the trouble to perform any nerve conduction tests or ultrasound imaging and no-one thought to try treating it with local steroid injection first to see whether that made any difference. In the UK it is still considered acceptable practice to operate on CTS without carrying out nerve studies and provided the operation goes well this is not a big deal but the lack of pre-operative studies seriously hampers our ability to figure what has gone wrong in a case like this. I am afraid I put little store by what surgeons see during surgery so that does not help us much either.
If you did have CTS then the successful operation should have lasted a long time. Though we do see occasional true recurrences after successful surgery they tend to be 10-20 years after the original surgery whereas yours managed only about 2 years. This time we do have some NCS but the results are normal. “Towards the cut-off for CTS” – does not really mean anything, especially when there has been previous surgery. It is entirely possible that if you took a normal wrist and inflicted carpal tunnel surgery on it you could convert what had been normal nerve conduction into something that could be described like that.
At this point it is sounding less and less like CTS, we now have normal test results, no effect from re-do surgery and still a symptom pattern which is rather atypical. It’s worth noting at this point that, although some patients do get a lot of pain from CTS, in many people the symptoms are tingling and numbness rather than pain. The mere presence of pain in the hand does not make it CTS. It’s easy to say this with hindsight of course but I would not have rushed into revision surgery at this stage. Imaging studies, further nerve conduction studies after a gap to see if nerve function was deteriorating and possibly even a belated trial of steroid injection might all have been useful at this stage. We now have a situation where two operations have, ultimately, failed to solve the problem and have quite possibly added a good deal of scar tissue to your hand.
Although it is now rather late after two operations it would still be useful to carry out some of the investigations now. In particular at this point, if you are within reach of someone who is knowledgeable about ultrasound imaging in carpal tunnel syndrome, it may be possible to get a fair idea of whether your current accumulation of scar tissue is directly compromising the nerve by looking at the nerve in this way. The problem is that there are very few people in the UK who can do this for you. Another set of NCS would also be useful – ideally done at the same time as the imaging.
The Vitamin B6/B12 stuff is largely nonsense and irrelevant to CTS. There was a vogue for treating CTS with B6 a few years back but it does not have any effect in proper randomised controlled trials. B12 deficiency causes anaemia and widespread neurological disease before it causes CTS.
If you can, get yourself referred to a neurologist rather than a hand surgeon. They will come at the problem from a new angle and may come up with an alternative diagnosis. If you want to let me know roughly where you are by email I'll see if I know anyone local who could be recommended to give a second opinion. JB
Thank you for coming back to me. It has certainly made me think a lot about getting more tests done. I have health insurance so I will ask my Doctor to refer me to a Neurologist. I am in Coventry so if you know someone I can ask to be referred to them. Not sure how to send by private email though? Thank you for all your help
My email address is in the contacts page of the site here but for convenience it is Jeremy [dot] Bland [at] nhs [dot] net JB
Thanks for copying over. It's a bit easier for me to keep track of things here rather than on patient.co.uk as I only look at that now and again. I have a clinic this afternoon so I'll go over this story again later and tell you what I think. You might also find it useful to run through the symptom questionnaire and to read the section dealing with failed carpal tunnel surgery. JB