Steroid injection

You might be a non-responder, but it's worth waiting for a few weeks as some do seem to show a late improvement - that's why we aim to follow-up at 6 weeks. One of the unknowns about treating CTS with steroids is whether or not it is worth giving a second dose if it does not respond to the first. JB

Now 10 days since the injection but no improvement. It is complicated by stiffness from the 5th metacarpal fracture on 9th June and also the orthopaedic surgeon at the Canterbury fracture clinic who thought I have the beginnings of Dupuytren's contracture in the same hand. Another doctor friend confirms this view. With these 3 issues in the same hand it us difficult to discern the improvement if any. I will wait 6 weeks for a review if you think this is best.

it is often difficult to sort out the contribution made by several different problems. Dupuytren's, trigger digits and CTS often occur together so we come across this quite a bit. We'll review at 6 weeks. JB

Little improvement in my right hand and nearly 4 weeks since the injection. Should I make an appointment at 6 weeks for a review?

It sounds as though the other problems might be contributing more than the CTS. I think we should set the process of getting you to see one of the hand surgeons in motion. I'll get onto it in the morning. JB

Thankyou, I'll wait to hear from you

CTS injection follow up. As requested by Emma.

After 6 weeks there has been an improvement in my CTS symptoms but I still have mild pain ,numbness and pins and needles in my thumb and index finger. I also have an ache in my wrist at times and if I move my wrist awkwardly I can feel something like a small electric shock in the wrist area. Because the orthopaedic surgeon suggested I might also have the beginnings of a contraction in the same hand Dr Bland has referred me to a hand surgeon and I am waiting for notice of an appointment with him/her.

At least that suggests that part of the problem is CTS. It will be interesting to see what the hand surgeons make of it otherwise, so we won't interfere further at present. JB

I have heard nothing from the hand surgeon. I will ring the CPS clinic tomorrow to see what chance there is of getting an appointment soon.

I think (from memory) I was quite late sending the referral but it has gone in now. We'll check that it's in progress tomorrow. JB

Numbness and pins and needles still felt in my right index finger and thumb. Hayley the hand therapist suggested physiotherapy in case the entrapment was elsewhere ( ie not only in the wrist). I have had several physio appointments but without any change to the index finger and thumb. I will see Hayley again on 15th January and will discuss surgery.

It might also be worth considering a second dose of steroids to see if we can get any greater effect. That would be a bit 'experimental' but there is some precedent in the literature. JB

On the 6th November last year I attended at K & C with Hayley the Hand Therapist. She was able to inject my hand to treat the "trigger finger" and this has helped. She also referred me to Physiotherapy for 6 weeks in case there might be another ( contributing) cause. I returned to Julie on 15th January after completion of 5 weeks of physio. The CTS had not improved as a result of the physio. By this time my symptoms were mild and Julie gave me a 2nd steroid injection for the CTS. and we agreed to cease treatment unless my symptoms became worse in the short time. Of late my symptoms have become slightly worse but not enough to worry me. Speaking to a dental surgeon friend who has experienced CTS in both hands, he has finally had a CTS operation 5 years after steroids. The second hand will be done next week. Could this be the pattern?

It's highly unpredictable in the individual patient. If there's any doubt abut which way it's going (and I think it can be difficult in your hand because of the other problems) we can always test it again. Just drop me a line on here whenever you are curious about how the nerve is doing and we will arrange it. JB

Thanks I'll do that.

Brgds

John