Is there anything else I can try to fix this? Frustrated.
Good afternoon,
I am a 28-year-old male with diagnosed CTS in both wrists. I am a lifelong musician (percussionist, piano and guitar). I teach band for a living so holding and playing instruments is a major part of my day, along with typing at the computer. I'm also a pretty regular video gamer at home during the evenings, when I get a chance. These are the only things I can think of that could have aggravated the nerve.
The first symptom I remember was over two years ago when I felt my fingers burning after playing piano or typing too long. It wasn't a big deal, so I just ignored it. The symptoms did not become an "issue" until about five months ago. I went to the doctor fearing arthritis (my mother has it), and they referred me to a hand specialist. An x-ray and MRI confirmed that I do not have arthritis, so the doctor ordered a nerve conduction study/EMG which confirmed "mild CTS" in both wrists. I've received a steroid injection locally in my right wrist, and it numbed my right hand up for about a day, but otherwise did not improve the symptoms.
My symptoms: tingling and slight numbness of hand and forearm, burning feeling in my hands, feeling of "electricity" shooting up hand when I tap my median nerve at the wrists (I can trace this nerve up underneath my forearm and it tingles all the way up), burning upper forearm (opposite side of elbow), fatigue in hands and fingers immediately following repetitive motions (i.e. typing, gaming, playing an instrument), fatigue in inner elbow after lifting or holding something. There are however some symptoms that I am NOT experiencing that most usually do: sharp, shooting pain at the wrists, and decreased mobility. These are not an issue for me.
Throughout all of this, I have kept an open mind. I have been wrist splinting every night for four months. I've gone to physical therapy and completed their program to no avail. I've rested for months, kicking my video game habit and not playing any instruments. I'm taking a multivitamin with B6, B12 and magnesium. I have severely cut the amount of caffeine and sugar I consume in a day. I have iced, I have heated, I have stretched, and I have just tried to get my mind off of it. I've been to ten different appointments, gotten an two x-rays and an MRI, along with my NCS/EMG, and spent almost $1000 on appointments, splints, supplements, etc. I got a local steroid injection, tried oral steroid regimens, and every over the counter drug I can imagine for inflammation. I've even switched mattresses, pillows, sleeping positions and nearly everything you can imagine about the way my work desk is set up at work. I've abandoned playing instruments for my students.
At my last doctor's appointment, the hand surgeon told me I have three options at this point: 1.) wait and see if it improves over a long period of time, such as 6 months to one year 2.) try a prescription for Lyrica (not interested in this option), or 3.) get the surgery. I am beyond frustrated by these options, and I feel all hope is lost. I could just surrender and get surgery, but I am concerned reading on here that it could be ineffective and may mess me up forever. It just seems like yet another lost cause.
I'm irritated that despite this being the most common nerve entrapment issue, there is no clear cut answer to how to get over this problem. This has been nothing short of a nightmare, and for someone with anxiety it is 100x worse. I question, research and exhaust all options to death.
If there is anyone out there that has symptoms similar to mine that can suggest something that I have not already done, please feel free to share. At this point, I am willing to try just about anything. Please feel free to join in the discussion.
It's not really a typical story for CTS, at least as presented there, so I wonder if everyone is being distracted by mild nerve conduction abnormalities into assuming that it must be CTS? False positive NCS results are not uncommon - do you have a copy of the results? JB
Thank you for your prompt response! I so appreciate you taking the time to look at this.
The results are here: https://drive.google.com/open?id=1j4o1KvmgqdbRCRvT_S5_DGiUCBQ-Uido
This link should be accessible without needing to log into a Google account.
The primary issue for me right now seems to be on the inside elbows, although the test results do not indicate this. I will say my symptoms were not "flaring up" at the time I took the test, and I remember worrying that maybe the test would not reflect my actual condition. That is probably just my ignorance at work. My symptoms now are considerably worse in the elbow than they were when I took this test, and it makes me think a second test might be good, perhaps by a different doctor.
One last item of note: he did not use the needle probes any higher than my wrist. No probing of the elbow or arm which I thought was strange.
Thank you again!
A few more thoughts...trying to make sure I get everything down in case there are any "clues" that help.
As part of my physical therapy, I did stretches, nerve flossing, lacrosse ball therapy along the arm, etc. After the exercises, I could definitely feel the symptoms. I especially feel a burning sensation when I massage the area just above my wrist and my palm. I typically massage outward, and also side to side. The burning goes away with rest.
I can feel the "electricity" sensation at the wrist when I tap it, but I also feel it at other spots up my arm. I can feel it near the elbow on the underside of my forearm when I massage the area, and I can also feel it along my tricep when I massage deeply enough. At this point that is as far as I can trace it, and I'm not sure if that is even relevant.
The inside of my upper forearm (opposite my elbow) is a common source of burning and weakness, especially when typing at my laptop computer when it is on my lap. I try to avoid doing this. If I had to describe the feeling, I would say it feels like someone is stretching the tendon on the inside of my elbow (connecting bicep to forearm) like a rubber band pulled taut.
I apologize if any of this is confusing or redundant. I want to be as forthcoming as possible for clarity!
Those NCS results would qualify as grade 2 bilateral CTS on my scale, using that lab's reported normal ranges -which is fairly mild as the scale goes up to 6. Having NCS evidence of grade 2 median neuropathy does not prove that the median nerve is the source of the symptoms and as your symptoms are not really entirely typical of CTS I think some thought should be given to the possibility that the 'CTS' is a red herring. The suggestion of seeking a second opinion from a fresh viewpoint is probably a good one. JB
A few things I forgot to mention:
I text frequently with my thumbs, and I ride a motorcycle. These are two things that could have contributed to the aggravation of the nerve, but I have stopped doing those things for months now.
Also, I feel best right when I wake up. I assume this is because of the splint, but it could also prove that rest is the best thing for me. I do not have a big problem with waking up in the middle of the night like everyone complains about, though the fatigue does get worse in the evening hours, presumably due to all of the use during the day.
Hope any of this information helps in any way.