Enter page title here injections or surgery?
Dear Dr Bland, I had the tests last week with you (*****) my severity score was 3. I have an appointment with Mr Wetherel on Wednesday for surgery but am getting worried about the operation not being a success. I have read it could be worse. I wandered what your opinion would be regarding having an injection first to see if it would help and give me more time to try more natural ways of mending. My hand is still inflamed with pain and numb fingers all the time, but I also have restricted movements and cannot make a fist, is this another symptom of carpal tunnel? Mr Wetherel is away at the moment so he is not available to ask, and as the appointment has been made without him seeing the results, I could cancel. As my carpal tunnel was caused by trauma I also worry leaving it will cause permanent nerve damage. First time I have ever put anything on a forum I hope to hear from you.
Thank you very much for your prompt reply, I did have the operation and Mr W said it was very compressed and I really had no alternative. Sadly though everything is still just the same, I still have a swollen hand and nerve pain up to my elbow and neck. Mr W did say it would take some time to loose the numbness and I suppose it is early days for the nerve pains to go also. Do you think it would help if I had some massage of the spine, neck, shoulder, other areas where the median nerve originates? It is now nearly 4 months since I fractured my wrist. Look forward to hearing from you.
It's very soon after surgery to be evaluating the outcome when there is also the complicating factor of the fracture to contend with too. Mr W will have to allow me my slight scepticism about assessing the nerve at surgery - all surgeons seem to describe all median nerves as looking very compressed when they see them and I'm not convinced that the appearance is a very good guide to the amount of physiological impairment - but then I don't spend all my time looking at these at operation so perhaps I'm not in a good position to judge. I presume he is going to review you shortly so I would wait and see what he says about physiotherapy to begin with. If the CTS symptoms are still present about 4-6 weeks post surgery in this circumstance I might be inclined to check the nerve conduction studies to see if they are improving. JB
Thank you again for your quick reply and it did help a lot. My hand is so much better but I am so unhappy as the day I had the stitches out, in fact walking home from the surgery, I fell over crossing the road and split open the scar and fractured my other wrist. That was now a week ago, I am only just being able to stop crying when talking about it. Mr W had done such a lovely job, luckily it did not need any more stitches and is healing again but I am petrified I am going to have the same carpal tunnel problem with this left wrist. The fingers on the left feel ok at the moment but I wandered if you would know how soon will it start to show if I am going to have the same trouble ? I have another week to go before I see the orthopedist for this fracture and just over a week to see Mr W again for the check up on the carpal tunnel operation. I still have slightly numb fingers but the nerve pains have diminished greatly. At least that is good news. Thank you in anticipation. S
Sorry to hear about the fall and new fracture. As long as the re-opened incision on the first side does not get infected that should recover OK though you might guess that it will remain tender and a bit thickened for longer than it would have done without the new injury. For the second hand you are of course at considerable risk of getting CTS on that side but it is not inevitable, nor is it predictable when it might become a problem. You don't really need to worry about it until such time as you get symptoms and at least in this scenario you are in a good position to recognise the problem if it does occur. JB
Dear Dr Bland,
It is now almost 8 weeks since I fractured my left wrist, and I am getting numb fingers intermittently and the pains in the wrist and arm are still there. Is it still too soon to judge weather it is going to be an on going problem of the carpal tunnel? too soon to test? Also when I was tested for the right hand I paid privately, will I be able to be tested on NHS for the left hand, if necessary? and will I need a doctors referral?
My right hand is progressing nicely and though I am not without pain it is so much better after the operation.
Look forward to hearing from you,
S
I guess there are la few questions there. Firstly who is looking after the fracture and have they discharged you from their care? Secondly have you also been discharged by Mr Wetherell after the carpal tunnel decompression? If no-one else is still treating you then your GP can refer you back to me as a possible case of post-traumatic CTS either on the NHS or privately but I do try not to treat hands in parallel with other clinicians so if someone else is still treating you you should stick with them for the moment and they can also ask for further nerve conduction studies if necessary. I'm quite happy to provide advice via the website though. JB
Thank you Dr Bland. I have the go-ahead from Bennenden for tests for my left hand and an appointment with Mr W on the 5th November. I am away at the moment but I wandered if I could have a private apointment on Monday 3rd?, I believe it is Monday evenings for private appointments. I would be able to tell Mr W the results on Wednesday. I only have my iPad with me or I would phone. I am back in England on Saturday 1st.
Yours sincerely, susan117
Dear Dr Bland
I forgot to add my doctor did refer me for nerve induction tests but it went back to the surgery,
I am hoping it has been sorted out by now as I think he didn't add that I had fractured my left wrist, so naturally it was disputed whether I needed another test.
Susan117
At the moment I think the evening of 3rd November is looking pretty full but we might be abe to fit one more in and we often get last minute changes for these appointments anyway. I'll try to get the staff to check it out. JB
We are hoping to be able to fit you in on Monday and Sue - chief clinical neurophysiologist - will contact you via email. Can you confirm that you aer seeing Mr W privately on the 5th? is this at the Chaucer? EK
Grade 3 is a good point at which to operate on it and has the highest success rate overall but no operation is ever entirely risk free. As Mr W will be doing the operation that also takes inexperienced surgeons out of the equation so your chances of a successful result should be very good and my educated guess would be that you have about a 1-2% chance of a bad result.
The restricted movement is probably more likely to be continuing effects of the fracture.
CTS can get either better or worse if untreated and the history of fracture does not really help to predict which way it will go I am afraid. Steroid injection is always an option but opinions on the use of injection vary widely amongst surgeons.
Ultimately only you can decide whether to go ahead with the operation or not - everyone's attitude to risk varies. Hopefully you will be able to contact Mr W at the start of next week to discuss it further if you are having doubts. JB