Risk of delaying surgery 1 year?
Hello!
I'm wondering if there is any good way of judging the urgency of surgery for long-standing, moderate-to-severe CTS (Say, have surgery asap vs. wait a year if symptoms are manageable?) If I wait a year I"ll have benefits to pay for my lost time at work-it's a US thing. If there's a good chance of more damage I'd rather take the financial loss and do it now. Or, if I've managed till now, will a year make little difference? (30 year gradual history, worsened in last 2 years, my strength & function is pretty good, but thenar atrophy is visible. EMG/NCV shows both motor and sensory nerve changes.) Glad for any thoughts!
Summary of my abnormals, 3 weeks ago:
Right Median Motor nerve showed reduced amplitude (palm, 4.3mV), prolonged distal onset latency (wrist, 6.6ms) and reduced amplitude (wrist, 3.4mV). Right Median Anti Sensory showed reduced amplitude (palm, 9.4micro-volts?), prolonged distal peak latency (wrist, 6.4ms), reduced amplitude (wrist, 7.8), decreased conduction velocity (wrist-3rd dig, 22m/s), and abnormal peak latency difference (wrist-palm, 3.8ms).
Left is Mild-Moderate: motor distal latency: (wrist, 4.7) anti sensory DPL (wrist, 4.1), CV (wrist-3rd digit, 34m/s), PLD (wrist-palm 2.2). All other numbers are normal.
Needle eval of Right Abd Poll Brev showed increased motor unit amp 25%Rect, and 25% IP. Other muscles normal.
My Dr.(Ortho Surg) seemed fine with waiting, citing millions (maybe?) of fibers in various states—I think suggesting that they don’t all go bad at once—but I wish I had asked for a little more explanation of his thoughts. Numbness was sporadic until 2-3 years ago, then consistently at night (splints help), and in the last year right side is numb and more achy consistently with use activities (drive, write, mouse, paint, etc.), with some days having constant mild tingling and pain, and some days normal unless overused. My age fyi--49. I did let him give me a steroid injection (my first), which does seem to help-- almost no numbness now, but I do get occasional mild ache or quick twinge of pain. Sometimes I think it might be other muscles or tendons compensating. I wear a splint with any activity. Can we expect that fewer symptoms implies less change to the nerves, or is that not the way it works?
Thanks for your thoughtful attention. This is an impressive website and program.
Rebecca
Those results would be grade 5 right and grade 3 left in my terms. If it feels better after injection then it probaby is. In an ideal world one would repeat the NCS 4-6 weeks after injection to check progress but this is too expensive for most health systems to consider it as a routine process. Measurable improvement correlated with the clinical improvement would suggest that it is then safe to defer surgery until the symptoms start to subjectively deteriorate again. Very occasionally I think you can get a 'disconnect' between the subjective change in symptoms and change in nerve function. This can occur after surgery for very severe CTS when numbness due to absence of nerve function can change to tingling and pain as nerve fibres start working again and this can be interpreted subjectively as the situation getting worse. More controversially I think that a change in the opposite direction, from tingling and pain to loss of sensation, can occasionally be interpreted as improvement by the patient. The trick is to analyse each symptom separately, and in cases of doubt be ruled by the change in power in the abductor pollicis brevis muscle - though you need to know how to test this correctly. JB
There's no reliable crystal ball I'm afraid but it's probably a fair bet to assume, with a history that long, that it will stay true to form and not change very rapidly. If you have your NCS results that would be useful - there should be figures on there for the distal motor latency of the median nerve and the amplitude of the surface motor potential if you can find them? JB