Electrical tests for CTS

If done properly the electrical studies will accurately locate a problem in peripheral nerve, so if they clearly show the recognised abnormalities characteristic of CTS then you definitely have a problem with the nerve at the wrist. Problems in the neck can cause some neurophysiological abnormalities but not the changes which are typical of CTS. The difficulty with both the MRI and the NCS is that the fact that there can be shown to be an abnormality at a particular anatomical site does not necessarily mean that that abnormality is causing any symptoms. I don't think it is widely appreciated amongst the general public that modern medical testing is capable of showing many 'abnormalities' which are not, and may well not ever, cause the patient any clinical problem - so in the end we come back to the time-honoured methods of 'clinical diagnosis' with the fancy modern tests really only playing a supporting role. The questionnaire on the website here is a moderately good tool. If you have a very high score (>70%) then it is much more likely that the nerve problem at the wrist is causing most of the symptoms, whereas a score <20% would suggest that the neck is more likely to be dominating the picture but it's all a matter of probabilities, not certainty. There is often a place for a trial of treatment and it is far easier to try out a non-surgical treatment on the wrist than the neck so in cases of uncertainty it's usually better to see how the problem responds to treatment for CTS. You might also find the discussion of 'double crush syndrome' interesting - it's a controversial area. JB

Thank you for your reply. the extreme pain thwt wakes me up at night is in my forearm rather than my hand, and the questions in your test are directed mainly at the hand. I wasn't sure whether I could answer positively if the main pain is in my forearm.

I have looked into double crush syndrome and it makes a lot of sense. My situation is this:

Many years ago - 2003. - I fell off a ladder and had ongoing problems after that. Endless exercises, Physio and I was more less rehabilitated. I'm normally a fit active person with no extra weight. However early fatigue in my right arm/hand never resolved, but got gradually worse. MRI revealed impingement and osteophytes at c5/6 and v6/7. Worse at the 5/6 level. I had an indirect posterior decompression at both those levels in 2013. Electrical tests didn't show carpal tunnel at that stage. This operation did nothing for me. I had many opinions and it was decided I should have an anterior discectomy and fusion at both levels. Then I had a final opinion from a consultant who said my symptoms were consistent with 5/6 only so a single fusion at that level should suffice. Electrical tests were not redone as the physical tests of bending and flexing the hand didn't produce anything. I decided To have the single level fusion in October 2014. In February 2015 my symptoms really increased with pain in the forearm and into the thumb, forefinger and middle fingers, burning, numbness etc. Now two months on all fingers are affected and for the first time ai have pain and tingling and fatigue on the little finger side of my arm. I know this isn't carpal tunnel, but possibly the thumb and forefinger side is. I had further electrical tests in February 2015 which show moderate to severe carpal tunnel. That was why I posed the first question in this thread. If I have severe carpal tunnel something should probably be done, but I don't want my wrist opened up if the positive electrical tests could be the result of an impingement further up. My take on it all is that the operation at the 5/6 level somehow reduced the clearance at 6/7 causing the new symptoms. As for the symptoms in my thumb forefinger and middle finger, these may be carpal tunnel - a sudden onset, but I need to be able to verify this before I proceed with anything. What began with one problem seems to have turned into many, and I don't want to get onto some operation treadmill.

By far the simplest thing to do with that would to give a steroid injection at the wrist - which should be 40mg of either triamcinolone or methyprednisolone - and see what effect that has on the symptoms. It's always possible to do the questionnaire - if all the answers are essentially negative because you don't have the symptoms it asks about then it will just give you a low score but it sounds as though you do have some symptoms consistent with the CTS. Did the October 14 single level fusion achieve any more than the first operation in terms of symptom relief? JB

Many thanks again. It achieved nothing, and now as I thought I have symptoms consistent with a constriction at 6/7 which must be as a result of the operation as I didn't have them before.

As I'm writing I have burning and tingling into my middle finger and wrist. The odd thing is it's suddenly got very bad in the last two days. I was functioning passably last week. I have started taking pregabalin, and this worked last week for the pain, but nothing works now. Unfortunately I am going to Uganda for a week, leaving on Saturday. After that my daughter and I are going to Latvia and Lithunia for two weeks. She speaks Russian and has a fascination for the area, and it was my treat. When Inmade all these arrangements a few weeks ago the pain was all under control. Is this sudden onset consistent with carpal tunnel?

I can bend and move and flex all fingers and touch thumb to all of them. Buttons are ok, but I do drop things. Typing and texting causes me a lot of pain and fatigue on the hand and arm. The big problem is this dreadful pain, which used to go away when I stopped the activity, but is now present all the time.. Tomorrow I'm going to get a splint if I can.

The injection is something I'll try, and hopefully it can wait until I get back to the UK.

Once again many thanks. It's really useful to be able to articulate this, and to have the specialist insights.
Margie

It ought to be possible to get it injected before you go away, at least if the NHS had got its act together to offer this treatment efficiently. Many GP surgeries have someone who is trained and competent to do it but that's no help if your surgery is not one of them and it's very much a postcode lottery I'm afraid. The other thing that would be interesting to know is exactly how bad your NCS results were - the terms "mild, moderate, severe" don't really mean much unfortunately as different individuals use them in wildly different ways. If I were seeing you I would probably make different suggestions based on the actual results. JB

Thank you. Very difficult to see my GP, takes 3 weeks, and They are not set up. I'm panicking slightly as I now also
have these non carpal symptoms into my little finger and up the side of my arm. I'm sure overall stress and anxiety are massively contributing along with the growing realisation that the fusion I had is likely to have made things worse. Seems crazy now to be going away, but four weeks ago I was ok.

I could email you the results of the electrical tests, although I realize that might be extremely presumptuous of me, and of course all of your advice is voluntary.

Margie

I'm always happy to look at results if you don't mind sharing them. I'm sitting here at present writing a lecture about the way we misuse the terms mild/moderate/severe in our reports and it actually helps me to see a wide range of reports from different people. JB 

I'll do that. I'm looking for it now.

What email address do I use? Info [at] carpal-tunnel [dot] net fails

See the contacts page. We're having a bit of trouble with ny NHS mail account at present but hopefully it will be sorted shortly. JB