Agony from CT help needed


I was diagnosed with rheumatoid arthritis last spring and this has caused me lots of pain and misery. It is in my fingers but for the last 3 weeks i have been suffering very badly with CTS. I know what it is as I have had bouts of it before but never like this. My right and dominant hand is in constant pain and I have pins and needles most of the time.
I am a teacher in a new job and at the moment I can’t even hold a pen as my fingers won’t work properly and are very stiff. It is impossible for me to grip things including a pen.
When I look at exercises they all say make a fist but I cant! It’s far too painful.
I am on a range of medication for my RA including naproxen, zapain, Pregabalin and liquid morphine. None of these
Are touching the pain, particularly bad between 1 and 3 am when I wake up crying and can’t get back to sleep due to the pain, and I mean proper agony.
I wear a splint in bed but usually take it off in the middle of the night because it causes more pain.
I am due to have a steroid injection in early feb but I am worried in case it doesn’t work as I have them for my RA with mixed success.
An anyone PLEASE help with advice to a few questions?
Is it bad that i can’t make a fist or hold things. Should I force it? If so, how?
Are there any other methods of pain relief? (I have the frozen peas on now and am typing on my phone very awkwardly with my left ha d).
Will I get better so that i can do my job?
Lastly, thanks for reading this.


The limitation of movement/grasp is probably not primarily due to the CTS element of this. It's more likely that a flare-up of the arthritis is doing that and that the resulting inflammation and swelling is increasing the pressure in the carpal tunnel and aggravating the CTS part of the problem. Steroid injection is a good quick fix in those circumstances and is likely to be more effective for CTS than for RA joints so no harm in trying but you may well end up needing the aid of a hand surgeon. Apart from splints, steroids and surgery there are no other proven treatments for CTS though some people find that icing/warming alternately seem to help. It's probably not a good idea to force movement ona joint that is very painful but at the same time one has to bear in mind that joints that are immobilised become stiff and painful as a result so there's a happy medium inbetween. Have you had a set of nerve conduction studies done to establish how bad the CTS is? JB


Thank you so much, Dr Bland, for your extremely helpful response.
I have my next appointment with my rheumatologist next Tuesday (21/01/20) so will ask her about the nerve test.
Again, many thanks for your swift response,
Best wishes

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