Continued CT
I've had 2 releases to the left and right hands between 2008 & 2010. Additionally, I had a decompression to the inner forearms for continued numbness, tingling, and stiffness to all fingers. Had an EMG yesterday that reflects very little slowing in the median nerves but no ct. My fingers just continue to show these symptoms after all these surgeries and the stiffness and pain has definitely increased. I've had plenty of therapy, several injections prior to the surgeries, take plenty of medications, use braces at night and a soft one for my dominant hand in the daytime. What in the world gives? The more I use my hands for anything, the more sustained the symptoms are!
Hi Jeremy, thanks for the reply and Happy New Year! Yes that would be 2 each hand. Before each surgery EMGs were done and each did in fact show CT and or slowing in the median nerves(I will in fact look back on all the EMGs from the past). After the fourth surgery, (2011), I did have an X-ray of the hands done which showed arthritis in the hands, maybe that might have been expected. Would any neck issues contribute in numbness in the thumb, index, and middle fingers especially? Appreciate your input and I am going to pull out all my hand information today.
Yes you can certainly get similar hand symptoms from irritation/compression of the C6 and C7 nerve roots in the neck and CTS is not the only cause of slowing of median nerve conduction so it's worth going back to the old results to see if they did show a pattern which could only be interpreted as CTS. We have one participant on the site here who had 4 operations on the same hand based on NCS evidence of 'CTS' before the right diagnosis became apparent. JB
Hi Jeremy, thanks for your replies. I am really nervous at this point because now I realize I've had all these surgeries and maybe it was all for nothing! It's not like I can take them back. Just curious, what was the right diagnosis for the one patient your talking about? Was it pertaining to the neck? Is that person reporting they are doing better? Now after all this time I have continued stiffness and general hand pain along with the other symptoms now that I've gotten almost 8 years older since the original surgeries.
These are the comments from my study last week:
Comments:
1. The hands were cool; the left hand was warmed prior to sensory conduction
studies being performed but the right hand was not.
2. Bilateral median motor and digital sensory conduction studies are normal.
3. Bilateral ulnar motor and digital sensory conduction studies are normal.
4. Bilateral radial sensory conduction studies recording from the anatomic
snuffbox are normal. On the right radial digital sensory peak latency is
mildly prolonged, but falls within normal range with temperature correction.
Skin surface temperature was > 32 C in the upper extremities and > 30 C in
the lower extremities, unless otherwise stated.
See Test Data Below
Abnormal study. There is chronic reinnervation limited to the left median
nerve-innervated abductor pollicis brevis and pronator teres muscles; it
seems probable that these findings are residual from prior left carpal tunnel
syndrome treated with carpal tunnel release surgery in 2008, and prior
compressive injury of the proximal left median nerve which prompted
decompressive surgery on the proximal median nerve in 2010. There is no
current evidence of right or left carpal tunnel syndrome. There is no current
evidence of acute/ongoing injury to more proximal portions of the median
nerves on either side (including no evidence of injury to the right or left
(Name Deleted) CONFIDENTIAL Page 34 of 60
anterior osseous nerve which arise from the median nerve in the forearm).
There is no evidence of ulnar neuropathy on either side. There is no evidence
of right C6-T1 radiculopathy or left C5-T1 radiculopathy.
TEST DATA
Motor Nerve Conductions:
Nerve Lat Amp Lat Dif Dist CV Site
. ms mV ms mm m/s
Median.R to Abductor pollicis brevis.R
. 3.8 6.9 3.8 70 Wrist
. 8.0 6.4 4.2 240 57.1 Elbow
Ulnar.R to Abductor digiti minimi (manus).R
. 2.8 9.9 2.8 70 Wrist
. 6.6 9.8 3.8 235 61.8 Below elbow
. 8.6 9.8 2.0 115 57.5 Above elbow
Median.L to Abductor pollicis brevis.L
. 4.1 6.0 4.1 70 Wrist
. 8.4 5.3 4.3 240 55.8 Elbow
Ulnar.L to Abductor digiti minimi (manus).L
. 3.0 9.3 3.0 70 Wrist
. 7.2 8.3 4.2 235 55.9 Below elbow
. 9.3 8.2 2.1 120 57.1 Above elbow
Sensory Nerve Conductions:
Nerve Takeoff Peak
. Lat ms Lat ms Amp uV Site
Median & Radial.R to Wrist.R
. 2.0 2.5 17.1 Digit I (Median)
. 2.6 3.2 10.1 Digit I (Radial)
Median.R to Digit II (index finger).R
. 2.6 3.5 29.0 Wrist
Ulnar.R to Digit V (little finger).R
. 2.7 3.5 17.9 Wrist
Radial.R to Anatomical snuff box.R
. 1.7 2.5 19.9 Forearm
Median.L to Digit II (index finger).L
. 2.3 3.0 22.6 Wrist
(Name Deleted) CONFIDENTIAL Page 35 of 60
Ulnar.L to Digit V (little finger).L
. 2.2 2.9 18.2 Wrist
Radial.L to Anatomical snuff box.L
. 1.5 1.9 20.6 Forearm
Did she just rule out any cervical issues?? She ruled out any further c/t, so where does that leave me after 4 surgeries and 2 massive 7" scars on both inner elbows?
The earlier patient probably has an inflammatory polyneuropathy, one form of a group of diseases often abbreviated to CIDP. Your current nerve conduction results seem to be pretty normal (though I will look through the numbers in detail later) so you are probably quite unlikely to have something like that. The only comment made about abnormality there relates to the needle study which was thought to show evidence of earlier problems. That was interpreted as being evidence of the earlier CTS and pronator syndrome but such changes are nonspecific and could equally well have been evidence of other processes so the interpretation depends heavily on the earlier test results. Looking at the way those were done and reported I guess this is the USA? JB
Does that mean 2 operations on each hand? - ie 4 in total, and was that the first EMG? The obvious first thought, if it is failing to respond to any kind of treatment for CTS is perhaps - 'maybe the diagnosis is wrong?' To start thinking about that we really need to go right back to the original symptom pattern and investigation results, if you can remember that far back.
JB