After first appointment
Hello Dr Bland,
I had a first appointment on the 23rd of February and You gave me splints and asked me to contact after four weeks of wearing them to discuss progress in treatment if there is any.
Actually, i have been wearing splints for three weeks, but i would also like to ask You about something else. After nerve conduction test i have 3/6 degree of CTS on the left hand and 5/6 on the right. You also said that my CTS is unusual and we start treatment of CTS, but at the meantime You would like to do some other tests to exclude other diseases with simillar symptoms. But since our last appointment i did not receive any letters and nobody called me. Did You refer me and i have to wait patiently? Few days after our appointment i spoke with my GP about this and she said that it is up to You if You want to send me to do other tests, because You continue my treatment now and only You can do this. I am sorry if i misunderstood something,but I just want to make sure about this. And what about physiotherapy? Do i need to start it at this stage of treatment or it is only after surgery? Do i need referall from You?
And I would like to tell You something about splints You gave me. I would say that they are really helpful. I wear them while sleeping and sometimes during the day if i feel pain in wrist. At the beginning of using them numbness almost disappeared and did not wake me up at night, but i began to feel slight pain in wrist during the day. Generally it was better and better, but i have to mention that i had sick note from GP and did not work. Since i got back to work symptoms increased and it worsened, especially on the left hand. I would say that left hand has 5/6 degree now. Only left hand wakes me up at nights and there are pins and needles and numbness almost all day. I work outside and try to save my hands as much as possible, but i would say that any harder physical activity causes increasing of symptoms of CTS. So probably one more week of wearing splint will not help. What do You suggest to do next?
Best regards
Artur Bartlinski
All right, I will wait then.
I don't have any particular day, but I think that sooner the better, so I could even arrive on Monday.
Can I normally get back to work after steroid injections? Can I drive a car immediately after injection?
And there is one more thing i have almost forgotten. I have noticed that there is a swelling on the top of my right hand, which is sometimes bigger sometimes smaller, soft in touch and it moves a bit when i close or open my hand. GP suggested that it may be a small ganglion and gave me a referral.
If you come along about 4:00pm on Monday afternoon we should be able to inject for you. Unless you are very unlucky you will be able to drive home afterwards and be back at work the following morning but a small number of patients do get a few days of pain after injection. We can probably also take a look at your lump with the ultrasound scanner - though we don't guarantee to be able to identify it as lumps and bumps are not really our field of expertise - though we can usually spot a ganglion cyst! JB
It's been three weeks after steroid injections on my both wrists. Unfortunately my CTS symptoms returned very quickly. Next day after injections, symptoms of CTS almost dissapeared and small lump on the top of the right hand as well. It was better and better every day, but after two weeks it started again, especially on left hand. Right hand is quite all right at the moment. I still cannot close it and lump on the top also appeared but I don't feel numbness and tingling so far. I cannot say the same about left hand. I feel numbness and tingling almost all day, however it doesn't wake me up at nights. I would say that it slowly worsens. Obviously I use splints every night and sometimes during the day.
That's a tricky one overall and I think I would like to see you to discuss what we do next, probably with repeat neurophysiology and ultrasound. I'll arrange am appointment as soon as I can. JB
I have been able to book you in for an appointment in 2 weeks time. I'll send the details in the post today but also email you. Please let me know if you don't receive anything. EK
Hello and thank You for this information. I've already received an e-mail from You with details. The date suits me, so I'll be there on Monday, 27th of April.
Today, finally I received a letter from Neurology. Unfortunately I have to wait a long time for an appointment(6th October). I am not sure if my hands will be fine until that, because It's slowly getting worse. Last injection on left wrist hasn't had any influence(it's even worse than it was before). My CTS is still mild and I really have a feeling that improvement achieved since the beginning of my CTS is a result of lighter job and better weather in summer(splints and other supports I bought are helpful as well) than in winter when it started. I really believe that injections had very small influence in my CTS. I am very afraid that CTS will increase from September when my job starts to be really hard.
As I said my CTS remains mild(perhaps a little worse than mild) after last injection, but I can't close both hands now. I could close left hand before and right hand after it warmed up. As I almost didn't feel any numbness or tingling in right hand before, now I feel it sometimes. In left hand I feel it almost all day as it was before, but numbness is stronger and hand is weaker. I also feel stiffness in both hands all day, especially in fingers. It is very unpleasant feeling and because of that I have to be careful with moving my hands. If I move it suddenly and sharply I can feel pain like they are near to break(tendons?). Sometimes I wake up at nights because of numbness on my hands, but I think it happens rather because of improper position than because of CTS itself. Generally left hand is more painful and problematic than right.
The only other option specifically for the CTS element of the problem is surgery and last time we spoke you were not very enthusiastic about that - have you changed your mind? JB
I said I would like to avoid surgery, but if other options fail what I suppose to do?. I have to do something with my cts. I hoped for earlier appointment with neurologist. We can wait until October, but what if it will worsen in September as I predict? Will surgery be necessary then? What do you think about it, doctor? Could you give me any advice, please?
I would be inclined to operate on the grade 5 right side I think. I can arrange for you to see one of the hand surgeons to get this moving if you wish. JB
I would rather start on the grade 5 left side as I have more problems with that. OK, you can arrange an appointment with hand surgeon, please. Thank you very much. Regards.
My records show the left side as being grade 3, but we will set about organising a hand surgery opinion anyway. JB
Hello dr Bland,
Two years of treatment my CTS will pass in February next year. We have already tried splints, injections and physiotherapy. These methods did not help or helped incompletely. As far as I do not use my palms and wrists intensively, symptoms like numbness and tingling remain mild and appear only in a case of holding something firmly in a hand for few minutes(driving, eating, telephoning, writing etc.). Symptoms become more troublesome, if I work more intensively and my hands are slightly swollen, but after two days off everything returns to its previous state. I still cannot close right hand completely and feel stiffness in both hands, especially in fingers.
I was on holiday for few weeks, I did not work completely and It also did not help. Do You think that in these circumstances, an operation is the only option left and I should try it? What is Your opinion? If this is the only option, then I have decided to go ahead with it on right wrist. What the next step would be?
I thought we were going for surgery a while back - obviously that didn't happen. After this long a gap (now about 7 months) we should probably test it again and see what we are dealing with. I'll organise an appointment. JB
Yes, we were thinking about surgery and I even had an appointment with a hand surgeon Dr Smith on that time, but I refused surgery eventually. In the meantime, I had several appointments with physiotherapist and the last one was on the 6th of June, not so long ago. He recommended me a lot of different exercises(hand stretching, squeezing ball etc.) and I gave it a try. Anyway, it did not help, other methods as well, so surgery seems to be the last option.
OK, I will wait for further details.
Despite passionate belief in them by some therapists and patients there is no concrete evidence that any kind of exercise really helps CTS so I'm not too surprised at that report. We'll get on and organise an appointment. JB
Hello Doctor,
Could we arrange steroid injections for both hands, please? Symptoms like pain around wrists, weakness and stiffness have strongly increased recently, but I do not really see any changes in terms of numbness or tingling.
By the way, I am still waiting for any contact about surgery.
You can drop in this afternoon (Tuesday 20th Dec) if you like - 2:30 onwards. JB
Today and tomorrow I am unavailable. I can arrive on Thursday or Friday, if possible.
I won't be able to do the injection for you after tomorrow as I am on leave. I will be back on the 4.1.17 so I could see you after that date if that is better for you? EK
All right, then I am available on the 9th or 10th of January 2017 and round the clock. Choose the day and time that suits You, however I would prefer early hours.
I am here both of those days. I will email you with a specific time. EK
I'm arranging for one of the neurologists to see you for a further opinion and to arrange some further investigations but I'm afraid that will indeed take a few weeks. I think the next thing we will do by way of treatment is to try the effect of a steroid injection. We should probably see you next week to review the situation and inject - is there any particular day that suits you? JB