Is mine severe enough to warrant surgery? Can my lifestyle be the cause? (21M)
Hello everyone,
I was seeing an Orthopaedic doctor for other reasons (shoulder/neck issues) and he took an EMG test to see if my shoulder instability/other problems and found I have bad CTS for being a 21M y/o male.
The test showed that my median nerve latency was 4.8 ms on the left and 4.9 ms on the right. He said 5.0 was the low-range they consider severe enough and tell people that they need shots and/or surgery with 3.2 being the average. Is this true? He said because I am young, it is likely genetic and likely my carpal tunnels being smaller. He said the only place the nerve can be crimped at is the wrist (but I briefly saw on wikipedia this is debated). He said it will only get worse until the point that my muscles will atrophy. Also, my hands are constantly freezing to the point of pain in the fingertips (they turn purple when extremely cold), is it possible this affected the EMG test? (and could it be indicative of circulation issues, maybe muscle imbalances as cause?)
I'm very hesitant to get surgery and want to be sure the cause is indeed genetic. The thing is that my other symptoms bother me more: constant neck tension/pain (pretty much always, leading to headaches everyday and sometimes migraines w/visual aura), shoulder instability (popping out, causing shocking sensation down arm when pushing, tingling/numbness painful pins/needles all over body, aches in joints). Also, my other outside two fingers (the joints in all of them) sometimes hurt more than the ones related to CTS. In fact, the severity test on this website said I didn't even have CTS (maybe from other fingers bothering me and fact that mine flare up with activities)?
Maybe I am just used to the tingling/numbness as normal sensations. The CTS I always figured was regular pain after doing activities too long. I can't do much with my hands more than an hour without pain, especially gaming or drawing (those kill my wrists, which deeply saddens me because I wanted to do art). It mainly bothers me at night time, but my wrists do constantly hurt now that I am noticing it more. I constantly have a pulsating sensation in wrist and fingers. Maybe the other symptoms just mask the CTS ones?
Is it possible my posture/lifestyle is causing CTS, despite that the doctor says it can't and has to be genetic (mainly because I'm young)? I grew up gaming heavily (handhelds since age 5) and not caring about my posture until the past few years. I'm on the computer 24/7. Some tests I've taken which rule other causes out (of other symptoms +CTS):
-Blood tests: regular deficiencies, B-vitamin and some auto-immune
-MRI (brain)
-EMG shoulder/arm
Idk. I am confused on what to do. I don't want to get surgery and hear a lot of negative things about it. Thanks in advance for reading this essay.
Hey, thanks so much for the reply.
The lab warmed my hands up in preparation for the test, but the person taking it did say that they got cold again. Also, I took the test when I was 16 and abnormally had mild symptoms for someone my age, so I don't know if that strengthens the diagnosis as my hands were likely cold then as well. Also, I guess cold hands themselves can be a symptom of CTS?
Unfortunately my mother was adopted and I'm unsure of her family history.
I do have a paper copy of the results that I could take a picture of. It looks like they measured
-a couple radial/ulnar/median anti-sensory nerves from the wrist to my palm
-a median and ulnar motor nerve
I don't think they measured much in my neck/shoulder though. Because my main reason to see the orthopaedic doctor was for shoulder instability and neck pain, I'm hoping that is the cause and it's not genetic. Despite the fact that the doctor warningly sounded like it was 99% chance genetic, that if I don't get surgery soon my hand is going to shrivel up and fall off, and that the only place it can be crimped is in the wrist, I think it's safe more me to work through shoulder physical therapy (working on a lot of trunk stability) and see how it plays out. I saw a video that said if the nerve is slightly pinched in the shoulder, then it becomes highly sensitive and amplifies the irritancy from bends in the wrist. I also seem to have ulnar nerve pinching through the elbow which feels like an electric shock when my shoulder does wonky stuff and I am pushing.
Also, I saw someone's post on Reddit who said doctors were telling them not to get surgery young if they can wait because the tendon grows back and will have to get surgery again?
Thanks for your time
You have picked up a lot of rumour and hearsay, most of which is unfounded in science. If you email me the nerve conduction results that would be a good start as they are at least concrete measurements. JB
Your diagnostic score here will be heavily downweighted because of your age but even so your symptoms are not that typical of CTS and in general one should not rush into surgery on the basis of just a lab result. It does sound as though you might have Raynaud's phenomenon and if your hands were very cold at the time of testing that can slow the nerves down and produce erroneous results. A decent lab however will have checked your hand temperature and also measured another nerve in the same hand for comparison - if they are all slow then that indicates a problem, either technical such as temperature, or in the patient. The obvious thing to ask about 'genetic' CTS is - are there any other affected family members. In all the families that have been written up with familial CTS there is a very obvious family history with almost everyone getting the disease by the age of 30. Do you have the full set of nerve conduction results? JB