Low score on Qustionnaire, but worrying symptoms
Hi everyone, I'm hoping someone might be able to provide some insight on my atypical case ....
I had a sprain injury to the thumb/palm/wrist area (not determined which tendons) and about a week after injury I started having numbness/loss of sensation/tingling in my thumb and first finger. At first it was transient, and as my pain in the area from injury resolved, so did the numbness/loss of sensation/tingling. But then I reinjured the tendons, and then the numbness etc. came back, and it's a little big worse now than it was the first time around.
I'm still trying to sort out the tendon injury with a physiotherapist, but it has been now 2 months of numbness etc. I don't get it at night, it feels best in the morning, and it feels better with heat applied to the hand area. In some wrist positions there is no tingling, but there is still loss of sensation, and in general the symptoms are continuous through the day, and worsened by doing anything that involves moving my hands a lot ....
My first question is: I'm wondering what kind of doctor to see ... if this is brought about by an acute injury, will it likely resolve, or should I be considering surgery given that I have numbness etc. almost all of the time? Is it clinically relevant that only the thumb and first finger are effected? Is it clinically relevant that I still have loss of hand function from the tendon injury (stiffness, less range of motion, physio determined), i.e., does that indicate more of transient mechanical situation rather than a more classic carpal tunnel syndrom? Furthermore, how frequently is CTS brought on by acute minor injuries to the hand/thumb/wrist, and does that have any bearing on success of the surgery? (i.e. Is it really caused by compression in the carpal tunnel area, or outside that region, and is there any way to know?) As a side note, I've tried two braces and the numbness is not notably better with braces, which I read were indicated in carpal tunnel. In fact, one brace (that my physio determined held the wrist in a good position) actually seemed to make the numbness worse (although having the wrist straight makes the numbness etc. less likely)
Thank you for your input!!
I was on a rolling chair and attempting to pull myself towards a desk by gripping the desk with thumb underneath and index finger on top. I felt a sharp ripping/spasm pain in my inner palm of both hands ... pain was brief, gone in half a second. Then, I developed pain in the forearm when gripping things at an angle where the wrist was not straight. Two physiotherapists, one a hand specialist, said injury was to a tendon that started inside at thumb joint (the part of the thumb you can bend 90 degrees), ran the course of the palm, and up to mid underside of forearm. Third physio was more interested in stiffness in palm at base of thumb. All said median nerve, but no doctor evaluation yet as I'm in the process of moving.
I generally only notice parathesia symptoms if I push on the tips of index and thumb, but sometimes when cold or with a lot of movement it becomes noticeable without pushing. I think numbness was more transient until a few weeks ago but Im not sure ... I have been avoiding fine finger use of those digits. I can definitely say its getting worse not even with a lot of rest I am doing ...
The splint holds the wrist straight but I think it is altering the dynamics of the hand in a way that because of the injury in turn bothers the nerve. I avoid the split, which to me means it is an irritant overall.
I will post updates if you are interested, I'll be seeing a hand surgeon and doing a nerve test in a week or so ....
Thank you again
I'm always interested to hear how these things turn out. Ask for a copy of your nerve conduction studies when they get done - most departments will be happy to let you have them. It's possible that a tendon injury could be producing enough swelling to trigger a secondary CTS and in very early CTS the symptoms are often rather non-typical so it's worth keeping the possibility in mind. JB
Although those sensory symptoms lie within the territory of the median nerve they are not really typical of CTS. I think the first things one would want to know in anlysing that are exacty what sort of injuries we are talking about and the precise distribution of the numbness. There is a single nerve branch in the palm which provides some of the sensation for both the thumb and index finger - but crucially it doesn't supply the whole of those two digits so one would want to know if the sensory disturbance matches a known anatomical territory.
To deal with your more specific questions - yes almost any acute injury can resolve, but they don't necessariy do so, generally diagnosis comes before surgery. The loss of hand function may result from a variety of nerve, tendon, joint, soft tissue problems or a mixture - again diagnosis is the key here. CTS is quite often seen after wrist fractures and other fairly major injuries but there are no figures on minor injuries, perhaps because of the difficulty of defining minor injury. Even after fractures I suspect that most people who develop CTS were prediposed to it anyway. The best ways of locating the precise site of the problem are nerve conduction studies and ultrasound imaging - ideally both. The comments about the wrist brace are interesting - what did the physio think was a 'good' position if keeping the wrist straight helps?
I would suggest consulting a specialist hand surgeon, and insisting on some investigations before surgery. JB