Severe CTS and pregnancy - any advise appreciated!
I have severe CTS and writing this is difficult so I will endeavour to keep it brief. I have had symptoms of increasing severity for about 8 years. I have avoided steroids and surgery for as long as possible, but a few months ago decided it was time to take some action due to the intensity of pain and P&N, also the frequency of waking at night. Shortly after making this decision I fell pregnant, which has made symptoms worse. I now suffer from muscle atrophy in the thumb area, intense aching reaching up to my shoulder (bilateral) and inability to grasp and hold objects or maintain a normal standard of living. I can no longer sleep lying down and have to grab minutes sleep when I can no longer stay awake.
And my next question is - if I do nothing at this stage do I risk permanent nerve damage? Does anyone have any information on this aspect of CTS as it seems hard to find.
I apologise for the disjointed post - I'm using a phone and couldn't seem to fit it all in one go! Thanks in advance for any replies.
If you have definite weakness and atrophy of the muscles at the thumb base you are already potentially in the territory of irreversible nerve damaage. CTS should be treated before this develops. Steroid injection for CTS is safe in pregnacy after the first trimester so the answer depends on how far through your pregnancy you are. The best guide as to how to proceed at this point is going to be to get some nerve conduction studies done and find out just how severe your CTS is in physiological terms. Where are you? JB
Thank you for your reply JB. I'm in Gloucestershire, I used to live in Canterbury and did a biomedical science degree at Kent...
Anyway, in reply I'm just over 12 weeks so I assume I'm safe to have the injections now. After being referred to the consultant they decided to perform the release surgery without any preliminary tests or alternative treatments - no nerve conduction tests or mention of. I guess it's pretty obvious from my symptoms that it's severe CTS. But now as there are no surgical appointments until the new year I'm pushing for the steroids. Should I also push for nerve conduction tests? I think the NHS are rather stretched these days and is probably why it wasn't offered.
As you will probably have gathered from this site I think every patient should be tested before surgery, partly because clinical diagnosis is not perfect and partly for the benefit of the patients who do not get a good result from surgery, in whom pre-operative test results for comparison are invaluable. However many surgeons disagree with me and are entitled to their opinion. Should be easy enough to get tested in Gloucestershire JB
Thanks for your reply. After a telephone conversation with the GP he has agreed to do the injections at the surgery tomorrow. I will update on progress after that.
Ask them to tell you the dose and steroid used and whether they add a local anaesthetic to the injection or not - some people do and some don't. JB
I will indeed ask what steroid and dose. I don't want anaesthetic too so won't be having that. But I will ask if they normally would. I also have a strange update. I don't know if you have heard of Alexander technique but I had a session of that last night. I am the biggest critic of alternative therapies but I do like to try anything with an open mind. I managed a fairly good nights sleep last night as it seemed to help immensely with my left wrist which, although as bad as my right hasn't been a problem for quite as many years. I had no pain and a very reduced amount of tingling, allowing me to sleep on that side.
So today after making such a fuss about needing medical help asap with the GP I think I will decline the steroids in my left wrist, and continue with AT to see if it helps further. My right wrist is a different story and I feel if not already permanent then the damage may soon become that if I don't act now. It will be an exciting opportunity to study the effects of the two different treatments in each wrist and I will keep you updated if you are interested.
I am always interested in the outcomes for any CTS patient. It's always worth remembering that it is a condition which can spontaneously remit without any treatment, even from quite severe states, so that it is generally hard to be sure what has made the difference in any particular case but it is not impossible that postural and exercise manipulations might make a difference - after all, at a very basic level we know that simply moving your wrist and fingers makes dramatic differences to the pressure inside the carpal tunnel. Injecting one side and comparing with what happens to the other is always an interesting exercise but lots of anecdotal evidence suggests that treatent directed to one side has effects on the other one so the two hands are not truly independent. Lastly, some of the preparations used for injection are a pre-mixed combination of steroid and local anaesthetic and if that is what your doctor stocks and uses you may not have the alternative of steroid only. We use a steroid only preparation because I cannot see any logical justification for mixing the steroid with lidocaine. JB
I am obviously concerned for my pregnancy but seem to have little help from health professionals. I am trying to push for steroid injections as there is nowhere locally that can perform the release operation any time soon. So my question is, does anyone else have experience of this or any data in terms of pregnancy and steroid injections? On one hand I am told it is safe and then the next person or site I visit say I risk birth defects. I feel I cannot carry on much longer like this and am at my wits end. I never thought CTS could be so debilitating.
I wear wrist splints continuously