return of symptoms in both hands

We could try once more with injections given that the September nerve conduction studies were still very mild but it is beginning to sound as though we are heading for surgery in the long run. Give the office a call a bit later today to book another injection and let me know how it responds. If there is any uncertainty about the response we will probably test it again afterwards JB

I had both wrists injected on 14th December in Folkestone and am now symptom free in both hands once again. The injections took about 4 days to take effect. The injections were a little uncomfortable, no worse than a blood test, and I had a pretty impressive bruise on my right wrist afterwards.

At what point would you recommend surgery? The injections are great whilst they work, but when they wear off, my hands keep me awake an awful long time at night. The right hand is the worse affected - the symptoms had escalated before injection and I had developed a pain in my elbow at night - once dead my hands didn't really seem to come to until I was up and about in the morning.

It's impossible to say in advance how long this round of injections are likely to last, even knowing about the first round. I would not recommend operating on an asymptomatic hand in any circumstances though so there is not much more to be done just now. Get in touch with me as soon as it starts to recur - there is no point enduring sleepless nights and as soon as it becomes clear that such a pattern of symptoms is becoming re-established we will take some further action - whether re-test, re-inject or operate I would not want to pre-judge as a lot depends on how long the interval has been. JB

Hello

I'm glad to say that 6 weeks post injection my hands are still totally symptom free.

What I have noticed however is that since the injection my watch has become much looser and spins on my wrist. Also I have developed hollows in both wrists where I had the injections - they are quite noticeable when I clench my wrists. I don't seem to remember them being there before. Does this sound like a side-effect of the injection, and if so, is it likely to be permanent.

The interesting thing is that many patients with CTS have a slight diffuse swelling in the region where the injection is usually placed. This has been most often noticed in the American literature where it has been called a 'volar hot dog' - volar being another name for the flexor aspect of the wrist. If this goes away with treatment then it might well be perceived as the effect you are describing. No-one seems to know just what the 'volar hot dog' consists of. Repeated steroid injections do cause local tissue atrophy (reduction in tissue bulk) but in CTS it has always seemed to me that what you really want is less bulk in the carpal tunnel so a bit of atrophy may not be a bad thing as long as nothing is unduly weakened. I would not worry about it as long as the symptoms have cleared up but if you are scientifically inclined you might make a careful recording of the wrist circumference with a tape measure and then see if it gets larger if and when the symptoms recur. You might have to make quite a few measurements at different times, temperatures etc to get an idea of how much natural variability there is anyway. JB