advice please

lefthanded
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Dear Dr Bland,

Having seen you numerous times with my cts I now seek advice for my daughter! She is also type 1 diabetic and has been suffering for months now with general pins and needles in her right hand. This has now become constant pins and needles in her ring and little finger - she says it comes from her arm down her wrist and into her fingers. She reports it feels like an el;electric current. It is now affecting her sleep. I'm not sure it is cts? Her GP has (unhelpfully) told her that she is too young for cts and that she needs to stop bending her elbow if this increases the pins and needles!! Does it sound like cts to you? If not - should we be seeing someone about nerve tests or simply leave it as advised by GP?

Thanks in advance as ever.

jeremydpbland
Online

Start by getting her to do the symptom questionnaire on here and we'll take it from there. JB

lefthanded
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Dear Dr Bland,

Really appreciate your response. My daughter has carried out a diagnosis questionnaire on my log-in (dated today).

jeremydpbland
Online

Unfortunately she cannot do that as using your login only repeats the final part of the questionnaire and therefore mixes some of her characteristics with some of yours. She will need to create a new account for herself and do the whole questionnaire.JB

lefthanded
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OK - thanks. She's just created an account. It won't let her log-in though - presumably it will take a while to load her new account?

jeremydpbland
Online

Without a Canterbury reference number she will need to click a link in an automatically generated email to confirm her identity before gaining access to the site. If she has not received them email then first check the spam folder. If all else email me her chosen username and I will unlock the account. JB

lefthanded
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Dear Dr Bland,

Thank you so very much (as always) for your advice and support. I emailed Emma earlier and she validated my daughter's new cts account. Jemma has now completed the diagnostic test. Please pass on my sincere thanks to Emma. Oh how I wish everything in life was as easy to deal with as your forum...you should run training for every health agency!! I'll leave my daughter in your very capable hands now...

jeremydpbland
Online

Emma must know the account name then. I'll take it from there tomorrow. JB

jeremydpbland
Online

OK I've looked at that symptom questionnaire. It sounds more like a problem with the ulnar nerve than CTS and the advice to keep the elbow straight and not lean on it is good. If it persists then this disorder too can be tested by us, though we don't treat it in the way we do CTS. We do take direct GP referrals though. JB

lefthanded
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Hi again!

This time it's me and not my daughter! Afraid the cts has returned to my right wrist - same symptoms as always and getting quite bad at night. Is there any way of getting to see you without seeing my Gp? Not sure if things have changed since I last came?! I'm on holiday in 2 weeks so that would probably be better than trying to get time off work atm.

Thanks in advance as always ;)

jeremydpbland
Online

At present we can still make follow-up appointments direct as needed. It keeps the load off general practitioners and I think the CCGs accept that we don't abuse this - only seeing patients when there is a clinical reason to do so. We'll see what we can do in terms of appointments but it is peak holiday season and between us being away and patients being away it's sometimes difficult to agree a convenient time. JB

lefthanded
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OK - if it helps then I'll take anything that comes up rather than being silly about not taking time off work! Thanks again though - really appreciate it.

jeremydpbland
Online

We've found a space with Emma on 13th July - letter in the post. JB

lefthanded
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Thank you so very very much. As ever a brilliant service ;)

lefthanded
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2 weeks since Emma injected right wrist (thank you Emma - brilliant as usual!) and wanted to update you. Symptoms ceased almost immediately and now totally symptom free. Yippee! Usual side effects - red cheeks (about 36 hours after injection and lasted about 72 hours). Ridiculously high blood sugars - worse than previous injections for some reason - had to triple both long and short acting insulin and then sugars still ranged from 8 - 20! This lasted for 10 days - now back to normal thankfully. Am concerned about atrophy getting worse - think my wrist may waste away at some point! Think this may have to be last steroid - if it all flares up again I think I'll opt for surgery - but hoping that will be at least 6 months before i need to be worrying about that. Thank you to you all again for the amazing help. Until next time...!

jeremydpbland
Online

Thankyou. One can't help wondering if a little local tissue atrophy is what is really needed in the carpal tunnel - to make more room for the nerve! JB

lefthanded
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Dear Dr Bland,

I'm afraid it's all starting again in right hand/wrist. Numbness each night and during day now too. Have also lost all sensation on skin between index finger and middle finger on top of hand up to wrist. Not sure if this is anything to do with the CTS but it's very odd. Never had that before! Any chance of being reviewed again? Am I still able to do this through you or do I need to go via Dr?

Thanks as always, in advance

jeremydpbland
Online

If by the 'top' you mean what most of us would probably call the 'back' of the hand then that is not really the territory fo the median nerve so a bit odd for CTS. Yes we can review again. I'll send out an appointment. JB

lefthanded
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Dear Dr Bland,

Many thanks as always for sorting out an appointment.

Yes - I should have said the back of my hand. It's very odd. The loss of sensation starts from between knuckles and finger joint and extends almost pretty much along the back of hand to wrist - but only along a narrow vertical path. Every now and again with a certain hand movement I get a shooting/ripping type pain as if something is tearing (I know it's not!) and then it's just an odd sensation for a bit. A bit disconcerting but glad not related to CTS - should have worked that out myself!

jeremydpbland
Online

Sounds like the territory of the superficial radial nerve. We'll test it and see. JB

lefthanded
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Dear Dr Bland,

Sorry to bother you again. My symptoms are getting worse and I'm wondering whether it is carpal tunnel again or the radial nerve as you suggested? Would symptoms be at all similar? I am getting numbness in the thumb and first 2 fingers pretty much all night and pain across the back of my hand from the knuckle region to wrist area - almost like severe cramp. I am also getting sporadic pain like cramp up the forearm from wrist to about half way up arm. Not quite the usual symptoms. If it is the radial nerve what is the treatment/if any?
Have received appointment letter - is there any chance of being seen next week - I am on holiday and it would avoid me having to beg/grovel time away from school?
Many thanks as always - and no problem if no appointments - but if you get a cancellation next week I'd take it!

jeremydpbland
Online

I'll take a look at the diary tomorrow but I think it's pretty full next week at present. I think we need to see you and test to figure out whether we are dealing with CTS or radial nerve or something else. JB

lefthanded
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Dear Dr Bland,

Many thanks for seeing me 2 weeks ago. I have received the appointment for surgery on Jan 5th, however the pain at night (and during the day) is quite severe now and I am getting very little sleep as a result. I wondered if it would now be possible to have a steroid before the surgery? I realise I opted not to have one because of the side effects it causes my diabetes; however I think the benefits will outweigh these effects!

Many thanks as always

jeremydpbland
Online

We can do that but we also have an earlier slot for surgery just now as a result of a cancellation - would you like to move into that? JB

lefthanded
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Dear Dr Bland,

Thank you. What date would that be? I have to organise teaching cover so need a bit of warning.

jeremydpbland
Online

2nd December I think - a good chance of a quick fix if you can take it. JB

lefthanded
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I will have to check at school - I somehow doubt I'll be allowed as it is right as the Christmas rush begins. I'll give it a go and respond as soon as possible. Thanks.

lefthanded
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Ok. Just spoken to Head and she's said it's ok for 2nd. If there's any way it could be after lunch that would be great as I'm supposed to be leading an open event at school in the morning. Really appreciate your help.

jeremydpbland
Online

I'm afraid the surgery slot is at 9:15 am with a pre-op assessment this coming Saturday 18th at 11:10. I'll move the current surgery booking now on the assumtion that's OK before anyone else ppinches the slot :-) JB

lefthanded
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Ok. Thank you so very much. Can I just check that the location is the same as last time - reculver?

jeremydpbland
Online

Yes Beltinge and Reculver Surgery. JB

lefthanded
Offline

Cannot thank you enough. Amazing service as always.

lefthanded
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Dear Dr Bland,

Quick question - surgery performed on Saturday - brilliant result. Exercising as told to do - experiencing numbness at intervals during day at tips of thumb and first 4 fingers. Do I need to be doing more hand exercising? Was hoping to get back to work for a few mornings next week as stitches are ok. Presumably this is ok? What would you advise?

Thanks as always

jeremydpbland
Online

I don't have any very evidence based answers for those questions I'm afraid. The quality of studies on what to do after surgery is abysmal. I would do as much as you feel comfortable with, provided you are able to move the fingers a reasonable amount. The only thing which I think is probably not a good idea is holding the hand immobile for a week - which will just allow all the inflamed tissue in the area of the surgery to stick together in a mass. JB

lefthanded
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Dear Dr Bland,

Perfect - popped into school today to discuss going back and just need my boss to be less 'risk aware' now! I've apparently got to get a 'fit to return to work' certificate from my GP before I can go back!! Honestly!

Thanks as always. I'll let you know how it goes with the pins and needles - I suspect I'm just being inpatient as it's only 6 days post op!

If I'm not in contact again before the big day - a very Happy Christmas to you and everyone in your dept! ;)

jeremydpbland
Online

It's a bit of an imposition on very busy GPs isn't it. I'm considering removing the GP follow-up part of the way we do carpal tunnel surgery. It's been a useful exercise in making sure that GPs are aware of how this system works and the sort of results achieved but I think most GPs in East Kent now know about it and we could probably spare them one extra task. JB

lefthanded
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I agree totally. Surely there is only any point going if there is a problem? Anyhow - thanks again for everything.

lefthanded
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Dear Dr Bland,

Happy new year!

Quick question please. Swelling and pain either side of the scar site is still quite pronounced (no infection). I went back to work full time a week after surgery but have just had 2 weeks off for Christmas (lucky me). Have been using hand as normal. Anything else I can do to get rid of swelling or am I simply not being patient? My GP simply suggested keeping my hand elevated as much as possible...should I be using it more/carrying on with exercises? I have full use of hand (but certain twisting movements are still quite painful).

jeremydpbland
Online

That swelling either side of the scar is quite common. It does eventually settle in most people but in a few it can be a persistent nuisance I'm afraid. Massage is often recommended but hard evidence that it helps is a bit thin on the ground - though it probably doesn't do any harm. JB

MNicholas
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I used to actively encourage my surgical patients to commence scar massage with a water based lotion as soon as the wound was sufficiently healed. As Dr Bland suggests, much of the evidence to support the practice is anecdotal but it did appear to promote improved scar cosmesis. Remodelling of tissues following surgery can take up to a year so I wouldn't be overly concerned.
Nick, Surgical Care Practitioner

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