CPT Advice & Cortisone Shots
Hi. Firstly I wanted to say what a great resource this site is! And the forum is really useful too!
I am after a bit of advice. My doctor has given me a diagnosis or suspected CPT (& I am pretty sure it is after reading up on it).
I am female, 42yrs old, non-smoker. My symptoms have been getting worse over a period of months, starting initially with the tingling/pins & needles & numbness in my hands (not little finger) & it spreads up my arms, especially at night (& it is now waking me throughout the night). I am now getting a lot of pain (stabbing & shooting pains) in my hands, especially when I am using them for things like writing/drawing, cleaning my teeth etc. My right hand is the worst & recently if feels like it has become weaker, especially around the base of my thumb (I also keep dropping things).
I have been wearing a splint at night for a few months now & I think it helps a little, but I still get woken up throughout the night with the pain/numbness (I sometimes wear it during the day when the pain gets bad). I have had an x-ray (of my spine & my hand & wrist) which shows no abnormalities. I have been referred to see a specialist on the 13th September.
One thing I am concerned about is I had Morton Neuromas (4 of them) diagnosed in 2014, I had cortisone shots in both feet & I reacted quite badly to them (nearly passed out, felt sick & cold), & afterwards the neuroma pain was worse. In the end I had both feet operated on (& 1 Neuroma removed from each foot), but I am concerned about the idea of having to have more cortisone shots for the CPT, in case I have a similar reaction & it makes the CPT worse. If the specialist suggests cortisone injections am I likely to react in a similar way do you think? Also the last week I’ve been getting stabbing pains in my toes as well as my hands, could this be a coincidence do you think or could the CPT have aggravated the 2 neuromas I still have? (I realise feet isn’t your area of expertise so don’t worry if you can’t answer that!).
Also from reading the info on here it sounds like I should check they are going to do a Nerve Conduction Study at the very least, is that right? I am in Hertfordshire & I am seeing a consultant at Pinehill Hospital.
Many thanks
Alice
Thank you very much for your very quick response!
It must just be a coincidence about my feet, last night it particular it was like there was someone repeatedly sticking pins into my toes! That coupled with the tingling, numbness & pain from my wrist & fingers meant I didn't get a lot of sleep!
It is reassuring what you said about the cortisone injection. I will update you after my consultants appointment next week & will certainly be requesting a NCS!
Alice
Do let me know how you get on. I'm always interestd to hear how CTS is being treated elsewhere around the UK, and indeed the rest of the world for that matter. JB
Hello Dr Bland
Just thought I'd update you after my appointment yesterday. The consultant examined me asked about my history & symptoms, looked for signs of muscle wastage and did the Provocative tests.
He said I had all the classic symptoms of CTS. I asked about NCS & other investigations & he said he does them if there is a question mark over the diagnosis but in my case he was quite sure it was CTS. We discussed cortisone injections & I told him about my previous experience of them. He said he could give me an injection but in my case it would be likely to at best just give me some temporarily relief but would still result in surgery. We decided therefor to go straight for the surgery (just on the right hand initially). I am booked in for the 27th September.
Alice
That's a typical British surgeon. Did he tell you what he thought the chance of a successful result was? You really should have NCS done before surgery in my view but there are many UK surgeons who just feel that that just cramps their style and stops them just "getting on and doing what clearly needs doing". It's not primarily about making or confirming the diagnosis. The NCS give you an objective measure of the degree of nerve damage which cannot at present be gained in any other way. Good luck with the operation. Let me know how it turns out. JB
I thought you might say something like that!
His argument for not doing the NCS was that he was sure it was CTS & the NCS would be uncomfortable & unnecessary for me.
I agree with you but I am glad to have a date for surgery as I am so fed up with the pain & not sleeping.
He was confident that surgery would sort it & possibly stop the CTS in the left hand by having surgery on the right hand, is that the case sometimes?
He hasn't grasped the reason for doing NCS - far too many surgeons think of this as a 'diagnostic' test and if that's all you think it is then it's easy to see why they view it as superfluous when the diagnosis is obvious anyway. Unfortunately they also have a bit of a blind spot regarding the patients who are not improved, or are worse, after surgery - I wonder what 'confident' means - few surgeons seem willing to put a figure on their confidence and when they do so in print they are often over-optimistic - you can see the figures from my area of the UK in the surgical outcome pages and I have no reason to believe that other areas are any different.
He is however quite right that operating on the first side sometimes leads to improvement in the other hand - a peculiar observation that many people have made. JB
Just thought I would update! I had my surgery on my right (dominant) hand on 27th September (so 4 days ago). Obviously it's still early days & still quite sore but I am not getting the CT symptoms in my right hand anymore which is great. However the CTS in my left hand feels worse, I suspect because I am having to use this hand more. I know you said that sometimes operating on one hand can lead to improvement to the other hand, but would I have noticed that straight away?
Also if I do end up having to have surgery in my left hand how long do you think I should leave it between the 2 surgeries?
Many thanks for all your help & advice.
I reckon the other hand improves in about 10% of cases so it's not guaranteed by any means. If it does happen it is usually within a couple of weeks of surgery on the first hand. I think the second side can be done as soon as the first one is fully usable again. JB
As you will have gathered from the rest of the site I do indeed think that people should have nerve condution tests done before any invasive treatment for CTS (including injection). The British Orthopaedic Association thinks differently and has some guidelines out for consultation at present which suggest that NCS should not be done routinely, even before surgery. Your symptoms do indeed sound like CTS and that is by far the most likely diagnosis but I would still want to evaluate how bad it is with NCS before doing any more than splinting it. I would not worry unduly about the prior injection history in the foot - it's a completely different condition and injections for CTS are not usually painful if they are done by someone competent, even when the same patient has had painful injections elsewhere. It would be different if you had an allergic (anaphylactic) reaction to a previous injection but it sounds as though you simply had the normal response to pain to me. Nevertheless if someone does suggest injecting the CTS you should discuss this with them beofre they go ahead.
If you end up in a surgical clinic there is a fair probability that they will simply offer to operate on it - though that can be much influenced by local CCG policies.
I'm not sure what to make of the recent symptoms in the feet. Anatomically there is no plausible link between a problem in the wirst and symptoms in the feet.
Hope that helps, JB