request for a referral of US CT specialists and a question about CT
I'm a 44 y.o. female who first got CT symptoms almost three years ago during pregnancy with twins. I had both numbness and pain in my hand and wrist. Almost two years ago, I had a steroid injection, which helped me with the pain. The numbness disappeared by itself several weeks after the birth of the twins. During the following two years, I tried to do strength exercise wearing wrist protectors to avoid injuring the wrists more, but had to give up on yoga exercises. The pain was gone and I didn't think about CT anymore. However, as the kids grew bigger, lifting them put more pressure on my wrists and a week ago, the pain return. Currently, I'm experiencing pain in my wrist and pinkie finger. The pain is not awful, but it's disturbing and appears to be getting worse. Should I start thinking about a surgery or it's better to try a surgery alternative? If the latter, what would you recommend? If the former, could you recommend a reliable CT specialist in the US (preferably in Los Angeles)? I would really like to find a reliable specialist.
Dear Dr. Bland, Thank you very much for taking time to respond! I really appreciate it. Last night the pain spread to my forearm, so I iced it and wore a splint. It's a little better today.
Last time I went to a hand and wrist specialist who advised me to get a surgery without conducting any tests. Although the injection helped, I am hesitant to go back. Having a test prior to a surgery would be ideal. That's why I contacted you in the hope you might know some local colleagues who share your approach to CTS. Again, thank you very much for your attention to my inquiry. Best regards, O.
You could run through the questionnaire here to get an estimate of the probability that the diagnosis is right. To make sure it gets tested you could consult a neurologist with qualifications in electrodiagnostic medicine. The AANEM maintain a publicly available list of their members on their website which can be searched by location so that's a good way to find someone who is qualified in the field in the USA. JB
Find some night splints (see the treatment section) and try those for a few weeks before doing anything more invasive. There is only a modest chance of them solving the problem but if it resolves with only that then you have avoided any risk at all. If that does not solve the problem then you could either inject again or go for surgery. In my view neither should be done without checking the nerve conduction studies first but many doctors disagree with me. The distribution of your current symptoms is not altogether typical for CTS so it would be a good idea to get some support for the diagnosis in this case I think.
I'm afraid I don't know anyone in LA with a particular interest in CTS - sorry. Any specialist hand surgeon will generally make a good job of the surgery if you decide to go that way. It's not a difficult operation and the only thing you want to avoid if possible is a surgeon from a different field offering to do the odd one 'because it's a simple operation'. Like most things I believe that carpal tunnel surgery gets better with practice so you want someone who has done a few thousand ideally. For injection the same thing probably applies - find someone who is well practiced and check what steroid and dose they use. We recommend 40mg of either triamcinolone or methylprednisolone without local anaesthetic. JB