Severe symptoms and long nhs waiting lists
Hi, I first went to my gp 2 1/2 year ago as I had been having trouble with grip and cramping in both hands. Blood tests revealed nothing but I was put on anti inflammatories and then Amitriptaline after I was given it for back pain but it helped with the pain in my hands more. Short version is I came of the medication earlier this year as I was having really bad side effects and the symptoms with my hands have gotten really bad very fast. The cramping and grip and mild numbness was always there but now my left hand is practically useless and over use of my right is causing even further problems into my upper arm, shoulder and neck. Have been using splints for months which Only help marginally but I have less shooting pains as can’t move the wrist independently. Can’t sleep on either side as my arms go completely dead.
I had NIS done two weeks ago and was told depending the results I ‘may’ be sent an app to see the consultant after he looks at my test in the virtual clinic. I’m now panicking this has been left for far too long and even if I eventually have surgery it’s a fair bit down the line given nhs waiting lists at this time. This is now affecting my livelihood and I’ve had to cut back on my job. I naively thought the consultant would see my test results and realise I needed to be seen quickly but obviously that isn’t the case.
No very little was said during this test and the nurse just said it would be forwarded to the consultant to have a look. My gp has been very lax this entire time, even tried to fob me off with a comment about how common joint and hand pain can be as we get older. I’m 38 and very active, this is a nightmare in the gym and has been for some time.. never mind my work. I had cts during my last pregnancy and the symptoms are the same plus lots more pain and cramping.
Thanks for your reply I appreciate it.
It seems you were seen in a clinic where the tests are performed by a member of the scientific/technical staff and then looked at by one of the medical staff later. We do something similar in Canterbury except that the people interpreting the results are just in the next room so that we can give an immediate opinion. You can still ask for a copy of the results to be sent to you and most departments are happy to do this - nerve conduction study reports are hardly very controversial. 38 is actually a little on the young side for CTS outside the context of pregnancy though it's certainly not impossible - we see much younger patients sometimes. JB
Received letters today to say my tests were normal and I have a follow up appointment with orthopaedic surgery clinic. I’m so confused, not sure what next steps would be and what could be causing such severe cramping and loss of strength in both wrists and hands.
Well at least normal results fit well with the fact that it doesn't actually sound very much like CTS. You now need a well qualified opinion from someone who can see and examine your hands and go over the full history - likely to be either a hand surgeon or a neurologist I think. Some of the possible other diagnoses are listed on the 'diagnosing CTS' page JB
Thank you for your input JB, I appreciate it. Can I ask if you have experience with Rheumatoid patients experiencing CTS and would that be likely to give a ‘normal’ nerve induction study ? it’s RA I have been treated for for two years. My right wrist up my forearm feels like it’s in a complete muscle seizure right now, nothing is easing it but I can shake off the numbness somewhat.
RA is one of several disease that can have CTS as a complication. The inflammation of the synovium that occurs in RA can produce swelling and thus increase the pressure within the carpal tunnel. I don't see it as much as I used to because RA is quite an uncommon disease to start off with and has become much more treatable in recent years but I still pick up the occasional new case. RA itself does not generally affect the nerve conduction studies, though a few patients do get a generalised polyneuropathy as a different nerve complication. If RA causes CTS however then the NCS will become abnormal - the CTS in RA behaves just like CTS of any other cause in terms of both symptoms and test results. JB
Hi JB just a little update. I had X-rays yesterday on my neck which is now very painful and waiting for an Mri. But surgeon said Cervical ridiculopthy ( sp?? ) is very likely. Strange that neck pain is my last physical symptom. I have complete numbness in my left hand and right wrist and arm is totally seized up. He said it’s common a misdiagnosis of carpal tunnel and rotator cuff injury ( which I was plagued with all last year ). So you were right it’s def not carpal.
Cervical radiculopathy is certainly an important alternate diagnosis. You don't necessarily feel the symptoms in the neck, though there are often clues in the form of stiffness, lmited range of movement or creaking. The word is derived from the latin for root - radix - and refers to the nerve roots which emerge from the spine to form the nerves running down the arm. It's a harder problem to treat than CTS unfortunately and again you are a little on the young side for your neck to be wearing out - perhaps it's further complicated by the diagnosis of RA which you mentioned as well. JB
Overall it doesn't sound very typical of CTS (having checked your answers on the questionnaire) so you probably need to see a hand specialist. DId you ask for a copy of the NCS results? JB