Feeling frustrated with possible early symptoms/signs.
Hi there -
Apologies, this is pretty long winded.
I'm finding myself frustrated with some symptoms that seem to lean towards CTS, but at the same time it feels like things don't entirely line up - or there's enough inconsistency that has me second guessing - that said I've been to a clinic where they had me do some blood work to rule some things out and it seems nothing turned up. I was given a referral to a neurologist but I apparently there's a wait time of about 3 months and I need to wait for them to contact me to schedule the appointment, so I'm stuck waiting to do further testing to actually confirm anything.
For the last few months I've been feeling a variety of discomforts in my hands - some of it seems like it might be symptoms of carpal, and some sound more like cubital, and some I'm not really sure about but searches keep bringing me back to CTS since that's the biggest cause of hand pains.
For background, I'm 29, male weighed about 180lbs at 5'2 back when I first started to have symptoms. I work at a computer and spend most of my leisure time at a computer and am otherwise pretty sedentary - I think I eat alright, but otherwise I do think my lifestyle certainly puts me at risk of things like CTS, but nevertheless it surprises me a bit since a lot of conventional wisdom I've seen suggests it's not particularly common at my age, and not particularly common to happen from computer use alone?
I recall it starting in January as initially just some odd discomfort in my left hand - I don't recall exactly how it was but it was sort of like an odd sensation in the palm or fingers - it stuck around for a day or two so it kind of reached that "this doesn't seem quite right" point that lead me to figure maybe now is the time to start to get some exercise again. So started going for 30 minutes on an elliptical, three times a week. (And for what it's worth I've later tried both taking a break for a week and tried treadmill for a few weeks on the off chance that activity provoked some symptoms.)
It's a little hard to say the exact track my symptoms took - I think it was mostly some pain in my left pinky finger, and an odd sensation in the tips of various fingers - I don't recall it in the thumb often, mostly index middle, maybe ring? Numbness/tingling doesn't feel like the right word - it was really slight, just a strange bother that was mostly noticeable if I rubbed the fingers together? Things were kinda sporadic.
Things stuck around enough that I made a variety of attempts to alleviate the problem - hand/wrist stretches, taking more breaks, playing more games with controllers rather then keyboard and mouse, trying to be more aware of my wrist position, some slight adjustments to try to improve the ergonomics of my setup (raising chair up a bit, using a footrest) - somewhere along the way I started to find it harder to get a good arm position at my desk - it felt like the edge of the desk was digging into me more no matter how I adjusted my position.
I saw a doc after a few weeks of symptoms - he did some basic examination, did tinel's test which kinda only hurt where he hit - he insisted it wasn't CTS, and to just give it some more time to go away, but i could come back if it didn't go away.
Again, I'm finding it tricky to recall the symptoms exactly - they didn't seem particularly severe - just kinda persistent and I didn't want to totally ignore them (I certainly tried a few times hoping that I maybe was just stressing too much.) - sometime after the first doc visit I got an adjustable desk to try to further improve my ergonomics (which I can't say I've had much luck with), but I also had a few cases where I woke up to numb/sleeping hands (and possibly arms?) - a lot of people seem to describe CTS symptoms as being worse at night or keeping them awake, this didn't feel the case beyond waking up to sleeping hands - it also wouldn't stick around for long and I could usually rest lightly but comfortably until I had to actually get up.
That happened a few, maybe a handful of times in feburary it didn't really feel like there was a pattern, it wasn't every night. I think i'd occasionally go a few nights before having it happen again. I started taking notes of my symptoms at the start of this month - I haven't noted waking to numb/sleeping hands this month, even before I started splinting two weeks ago. That said, I do find myself second guessing myself - when I do wake I find myself checking my hands and wondering about the feeling - sometimes I think there might be a slightly numbness, but nothing as clearly obvious as the previous events.
Mid-late February after I had woken to the numb hands a few times I saw a doc for the second time (got a different person though), and as mentioned at top they advised blood work and gave me a referral to a neurologist (but did not do any physical examination.)
The symptoms I've been feeling as of late has been mostly the odd sensation in my finger tips (index, middle, sometimes ring?) - again it's hard to establish an exact pattern, while it's there most days the severity and when it shows up feels slightly random? Like computer use feels like it can provoke it, but it does seem like a consistent thing - it can bother me after a short bit of use, or I can use things for awhile without it bothering me much.
Similarly, I've run into discomfort in the pinky-side of my palm on many occasions, often while using my computer. Again, what makes it show up feels almost random.
I feel like there's been a few occasions of soreness or a "tightness" in the wrist.
One that has me a bit more concerned is for maybe a month now I've been having some pain my right index finger - I remember when it first showed up - I had been drawing for a bit and occasionally holding the pen between my index and middle while using the mouse - I thought I maybe strained something but it hasn't really gone away. it's somewhat on and off, bothering me more some days then others, it's tricky to describe because it doesn't hurt when I flex it down, hold a pen, use a mouse - and it's not locking in place like described with trigger finger - it just sometimes hurts when I do certain things - sometimes bending it back, twisting a tap, pulling off socks - I can kinda express the pain by placing my middle finger on top of the index and sliding it back - it feels like it might be more in the base or between the index and middle?
A lot of the time it feels like these symptoms happen in isolation?
As mentioned before I've been splinting for two weeks now to be on the safe side - I didn't really have problems with nighttime symptoms before and it's difficult to say if I've seen improvement in my daytime symptoms.
While I understand early symptoms can come and go, these symptoms feel frequent but very mild. Again, I'm finding myself feeling frustrated and the perceived lack of a pattern - I feel like I've hand symptoms even on occasions where i've attempted to take things easy, spend time away from a computer, on my (bus) commute to/from work - and the mixture of symptoms that suggest CTS (odd sensation in tips of index and middle, wrist discomforts) and the pinky side problems like the pains in the pinky and that side of the palm.
Thanks for the response.
Do you have any thoughts on the specific index finger problems I mentioned? (A pain sometimes when I move it in certain ways, feels more like it might be in the base towards the middle finger) - It feels pretty out of line with my other symptoms - the splints I have don't restrict finger movement and I'm wondering if something like that would help.
The waiting game is probably beneficial as you say, but it's certainly difficult when I'm not sure what will cause me discomfort, and the discomfort can be hard to make go away when it's particularly bothersome. On some level I wonder if I'm under reporting my symptoms but for the most part I don't think its made anything more difficult to do (aside from above mentioned issues with the index) - and the mild or lacking nighttime symptoms seem to suggest I don't have anything too severe.
Also, I had a rather bizarre experience overnight - I woke up at one point (not in noticeable pain or discomfort) and I thought my left hand fingers might be numb - I tapped my thumb to my index and middle and felt a very sudden and very pronounced numbness and tingling throughout that side of the hand and fingers. I got up and took of the splint - and the sensation died off after a minute or two. (I attempted to tap the median nerve to see if I could reproduce but didn't have much luck - I sort of realize this probably isn't a strong test because I could have just done it poorly) I left the splint off, didn't really pay attention to my wrist position and didn't really find much discomfort in the next few hours of rest. (Granted I don't think I fell back into a deep sleep but that's sort of typical for my sleep pattern.)
Can something like this be cause by the splint? I'm wondering if I had it maybe too tight, or positioned poorly because when I took it off there was noticeable marks on my skin where the thumb hole was and on the forearm where the splint ended.
Unless you also have a local tendon problem such as a trigger digit developing I don't have any very useful insights into the index finger I'm afraid. Splints for CTS should be worn quite loose - you only need to keep the wrist straight, not cut off the circulation to the fingers! As long as it is tight enough to not fall off it should be OK. The tapping test (Tinel's sign) is next to useless in CTS - don't worry about it. JB
At the risk of sounding like a hypochondriac - Is there better ways to self-diagnose my finger? I mostly thought it not to be trigger finger since that largely mentions locking in place which isn't the case - that said it does seem like there's a pop/click sound if I fully flex/clench that finger into the palm that doesn't happen with other fingers / other hand.
Trigger digits don't necessarily lock in place until they become more severe - the process that leads to that can be uncomfortable long before you get the obvious trigger click. I don't know of any simple self diagnosis tricks - they are usually recognised on examination by a hand surgeon. JB
You are right that CTS is uncommon in your demographic, but that doesn't mean it is unknown. It is also quite striking in my data that the symptoms of physiologically very mild CTS tend to be a bit vague and nonspecific and that the presentation becomes more immediately recognisable as CTS as it gets worse. The best course of action at this point is to get some nerve conduction studies done, which will give an objective measure of the state of your median nerves, and given the little finger symptoms it would be a good idea to check the ulnar nerves too. If you are within range of someone who understands peripheral nerve ultrasound imaging then that is also worthwhile as a double check on the carpal tunnel. Other possible explanations mostly lie in the territory of orthopaedics and rheumatology but there are also a variety of other neurological disorders that can masquerade as CTS so the neurologist is not a bad first port of call and if there is no neurological explanation then you can move on to other specialities. I think this is one of the occasions where a three month wait may not actually be that much of a bad thing - it provides time for the problem to develop a little and perhaps become easier to diagnose or, in some cases, to go away, and with mild and intermittent symptoms like yours it is relatively unlikely that there is a serious disease which needs urgent treatment now. JB