BI LATERAL CTS

That's quite a challenging one as it is entirely possible that there was some neck injury at the time of the accident which may be complicating the issue and either that, or the CTS, or the complication of CRPS, or any combination of them might be responsible for the symptoms. As usual on here I have to ask - do we have any nerve conduction studies to give us an objective measure of the nerve impairment at the carpal tunnel? Depending on what these show I might consider a trial of steroid injection at the wrist as a way of exploring what symptoms are coming from there. Unless you are on a very peculiar vegan diet or have otherwise been clearly shown to be deficient I would lay off the intensive vitamin supplements - vitamin B6 in high doses is actually neurotoxic. One more question - have you been splinting the wrist at night? JB

Yes I am splinting the left hand at night. I have never had a splint for the right one. Strangely before my accident I had various problems, Carpal tunnel in my right hand and Spondylosis in my neck, after my accident I did not have any problems with either.

I am due to see the surgeon who performed my surgery on 15th June, but hoped I could speed things up to get my life back. I know he said that the original nerve tests had showed quite a lot of restriction in my Right hand and just a slight amount in my Left.

I am having difficulty in getting anyone to listen to my hyposesis regarding the possibility that my problems may lie other than in classic CTS. The accident I had was pretty monumental and I was lucky to have survived it.

Meantime the CRPS is of equal concern to me. My body feels like it did at the time of the accident, I have pain in my arms and shoulders and general stiffness all over. I find it all so strange as I had made a msrvellous recovery and did not even require any physio.

At the time of my surgery I also felt I was going into shock as I was aware of what was happening.

I have quite a medical history. I have had Cancer and had a Radical Hysterectomy, followed by chemo, a DVT and my major accident. I took all these things in my stride, but this has floored me. I don't understand.

I will stop the B6. Is it ok to carry on with the others. I do think the Cherry juice may be helping

I am not a vegan, but I don't eat red meat. Lots of fruit, veg, fish and chicken.

The other vitamins are probably OK but vitamin supplements are not usually needed in otherwise healthy individuals eating a mixed diet. It's different if you have a malabsorbtion syndrome or pernicious anaemia. About the only one that is generally worth thinking about is Vit D if you live somewhere like I do and spend much of your life indoors too.

I would be slightly worried about the diagnosis of CRPS if you have all over stiffness and bilateral pain - the "R" stands for regional - it is usually a disorder confined to one limb. It may be worth seeking a neurological opinion on what is going on perhaps? JB

Thank you.
I am seeing my GP on Wed for a chat. I intend to ask him to refer me to a neurologist, privately, as Otherwise it would be months. I have to say I am re-assured by your comments. What I have read about CRPS was very worrying. However do you think that the swelling, whatever the cause, will go away from both hands. The finger stiffness in both hands, is mainly in the middle and ring finger, which I Did not nec associate with CPS.
This morning I have a lot of pain in both shoulders. I am not sure whether my bed may be contributing, but the mattress is new (extra firm with a soft topper)
when I had the accident I remember the tremendous pressure on my right shoulder as the car rolled, but in spite of the pain I felt, I was told that there was no break or damage there, only the collar bone and shoulder blade had fractured.
The pain I am experiencing now is very similar to the post operative pain, which after 3 months had more or less gone.
I did not tell you that I spent the winter in Spain where I was pretty active decorating a little house and one week after my return to Scotland the pain started.
Could there be a connection between climate?
Coukd there be some latent nerve damage/healing, that is causing the pain?
My GP did suggest a Cortisone injection to my left hand.

I really appreciate your giving me your time and attention. Thank you

It's very difficult to analyse such a complicated situation remotely I'm afraid. People who have a predisposition to get CTS do seem to have a propensity to get stiff hands, trigger digits and dupuytrens too so the finger stiffness may be related but I have very little idea what might have happened during your road accident. Lots of disorders seem to vary with climate - very hard to know how much of that is real change and how much just subjective. I would like to hear what the neurologist makes of it all. JB

Thank you. I appreciate the difficulties of making a diagnosis in these circumstances, but thank you for your thoughts anyway. It does give me some direction.
I will let you know of any further developments. At lleast I now have some validation for thinking that there may be another explanation for my problems.

Thank you

Saw my GP today and is he referring me urgently to an 'upper limb clinic' + I have to have bloods done next week. Don't know what urgent will be, but can hope.

I will keep you informed.

Thank you.

Could well be an intermediate assessment service - something between general practice and hospital, often run by physiotherapists - but arrangements vary widely around the country. I would be interested to hear what it turns out to be (and whether the professionals involved introduce themselves and their qualifications adequately - one of the things I know we are very lax about in my own clinic, patients often don't know if they are talking to a doctor, a nurse, a clinical scientist or an occupational therapist). JB

I am still waiting for the appointment. The positive thing is that it is the hospital I was taken to when I had my car crash, so perhaps I may be seen by someone who was involved with me at that time. At the very least they should have all my records which should make it a bit easier for me and not have to explain every detail to them.

I am now on a higher dose of Amitriptyline 25mg, and have not experienced the pain for some time now. My middle finger on my left hand is still the one that bothers me most and is still numb. I have been trying to do as much hand exercise as I can and I think there may be a small improvement. Can you tell me if Amitriptyline actually helps the nerve to settle or does it just mask the pain? Also the exercises, if I keep at it, can the stretching exercises actually rectify CARPAL TUNNEL in my left hand. My right hand (operated on) is still swollen and stiff, but again the exercises are helping and the numbness not quite so bad and I think it is slowly improving. I have gotten to the stage where I am am afraid to say too much as it is one step firward and two back.

I will keep you informed of new developments as they occur. I will find out who the person is when I finally get the app.

Thank you once again.

There are no randomized controlled studies of amitriptyline for CTS so we don't know whether it works at all - never mind whether it has any effect on the disease or just suppresses the symptoms.

Likewise there is no good evidence that exercises make any difference one way or the other. It has always struck me as odd that one faction in the CTS world believes that the 'exercise' of work causes CTS while another one believes that therapeutic 'exercise' can cure it.

All of these things are confounded by the fact that a significant group of CTS patients get better anyway even if you do nothing so in a given individual it is very hard to know if whatever you have done has really made a difference to that person. JB

Thank you. All I can say regarding Amitriptyline is that since I started taking it, I have only experienced the agonising pain twice. Prior to that I dreaded going to bed as I knew that the pain would come at some point.

Likewise when I do the finger stretches and soak in warm water it def eases the stiffness for a given period.

I find the whole experience wierd. I want to make some sense of it, but as a 'lay' person I know nothing about the nervous system and how it works.

I want someone to tell me that it is going to be alright and my hands will return to normal. At the moment it is like being in a nightmare as it is not just my hands that are affected, I feel depressed and disinterested and the pain and loss of sensation is taking over my life. I just can't believe that a little minor operstion like this could have such far reaching consequences.

The right carpal tunnel syndrome and it's surgery certainly should not have 'such far reaching consequences' so there is clearly more to be worked out here. I hope they manage to get to the bottom of it for you. JB