Advice for another tennis player
I am another tennis player and I developed tingling in my left hand last February. It was quite severe and I would wake up at night due to it. It was very strong when I was driving, trying to sleep and holding a book or newspaper. I tried diuretics from my GP and it did not work. It has taken (in the place where I live) about 4 months to finally do the EMG test and get a diagnosis that I did indeed have CTS. However, my symptoms have become much less severe. I play tennis about three times a week, and this does not seem to increase the tingling (it still occurs on days when I haven't played). At the moment I experience mild wrist pain during the day from time to time and some tingling. What I am wondering is, whether it is necessary to splint at night in order for the symptoms to disappear completely? I am a patient of an orthopedic surgeon here who treated a tennis related shoulder injury I had, and without any face to face consultation he suggested either an injection or surgery. I had 4 cortisone injections to my shoulder in the past and I felt they did not work at all, so I am reluctant to go down that route. The CTS I am experiencing is very mild so obviously there is no need to do anything invasive in my opinion.
Because I had a long term shoulder injury which eventually needed surgery I am very aware of the wrist situation and wondering if I can get rid of the CTS altogether or will it just be intermittent. I do feel that increased tennis causes a little bit of the pain....
Thanks very much for the quick reply. I will try it. Would you suggest continuous use at night for a certain number of weeks or until symptoms disappear?
Most people settle on night time use only. There are no evidence based guides on how long to persist but personally I think 4 weeks should be long enough to arrive at a decision on whether it is producing adequate relief of symptoms or not - and also for some transient cases of CTS to resolve by themselves anyway. JB
I have been using the splint now for just 2 weeks (I don't know if that is long enough- I found it hard to start at night with the heatwave we had here) but haven't noticed a consistent result yet. Also I requested a copy of the letter from the neurophysiologist who did the nerve conduction test. I just wanted to judge whether what I have is very mild or moderate, would it improve, or remain the same or whether or not I should progress with an injection if the splint doesn't work. Literally, what he said in his letter was "her nerve conduction studies show slowing of median sensory conduction across the left wrist with sensory axonal loss, this implies moderate (grade 4/6) left carpal tunnel syndrome". I couldn't match that very well to the scale shown on your website- my symptoms aren't that severe although they are present very often.
The 'grade 4/6' comment suggests that he is using my severity scale anyway. If he is interpreting it correctly grade 4 would imply no recordable sensory conduction and some motor delay at the carpal tunnel, On the other hand that letter also mentions slowing of sensory conduction and if the sensory potential was recordable (in order to be able to measure slowing) then it could not have been grade 4 - more likely grade 2. If the report did not include the actual measured numbers then we can't check that - but it is a pretty poor report which does not show the measurements - all our standards demand that these are included in reports. If it is grade 4 then it may well not respond to a splint. JB
Thanks very much for looking at my reply. I will persist with the splint for now (I can't take ibuprofen as I have exercise induced asthma and it does make my chest a bit tight) and see where I am at in a few weeks time. I have found your website very helpful and appreciate your suggestions. (Just for your reference, I am a private patient located in Republic of Ireland).
I wonder if your NCS were done by Dr Connolly - I think he uses my grading and there aren't many neurophysiologists in Eire. JB
The NCS was done by Dr Brian McNamara, based at Cork University Hospital (in his private clinic), his letter quoted above was then referred to Consultant Pat Fleming (who did the subacromial decompression for my shoulder). He suggested the injection and possibly surgery if my symptoms did not go away. I wonder if it would be useful for me to request the report with the actual figures from Dr McNamara's office, or to take a wait and see approach.
Ah yes... I know Brian too. His formal report will undoubtedly include the measurements. JB
I have requested the report so I will be interested to see how it looks on your scale with the measurements...
I have the report but I am not sure how to use it with your scale.
The sensory NCS numbers are as follows:
Nerve/Sites Rec site onset peak NPAmp PP Amp Dist Vel
ms ms cm m/s
L. Median-Dig II
Wrist II 2.40 2.90 6.5 12.5 10.5 43.7
Palm II 3.15 5.30 29.4 40.8 10.5 33.3
L. Ulnar-Dig V
Wrist 1.70 2.15 15.2 15.9 9 52.9
Motor NCS
Nerve/sites Rec. Site Lat ms AMP 2-4 Rel Amp Dist Vel
L. Median
Wrist APB 3.75 10.6 100
Elbow APB 7.50 11.5 110 22 58.7
I am sorry for the typed in appearance of the figures I wasn't sure how to paste it in. I guess from my letter he had said 4/6 so I am just wondering what the actual test results mean?
Thanks.
It's not quite possible to make sense of the sensory studies unless there is a mistyping - the distance measurement for both wrist and palm recordings is given as 10.5cm and I would expect them to be different. However, it is possible to say that on my scale, these probably represent grade 1 or grade 2 CTS. Whether it is 1 or 2 will depend on what Brian's normal range is for digit to wrist sensory conduction velocity. JB
Just to follow up, I think the splint has been working as my symptoms are very very mild at this point in time. I only notice the tingling when using my computer and strangely enough when I wake up first thing in the morning I am getting the same in my right hand but then it goes away for the rest of the day. Possibly there was a small typo in the report but I would concur that the CTS is very mild. So, I will keep using the splint when needed until it either disappears completely or if it ever worsened I would go back to my consultant for an injection. Again, I really found the website helpful and thank you for all the useful advice.
Thankyou for the update. It was obviously worth trying the splint then, though to be fair it might just be that it was destined to get better by itself anyway. Transient symptoms first thing in the morning are quite common. Tingling on keyboard use would prompt me to look a little at things like wrist angle when typing and whether the heel of the hand, where the carpal tunnel lies is being used to rest upon. I have to say that the evidence that 'ergonomic' keyboad interventions help CTS is rather poor quality but it doesn't hurt to take a look at your typing position. JB
If you have not tried a splint then it is a harmless experiment and a few patients do seem to be effectively cured of CTS just by night splinting. Steroid injection at the wrist is completely different to injection of the shoulder (or any other joint for that matter) so I would not pay too much attention to the shoulder history but in this case I would certainly give it a try with a splint before anythng else. JB