HRT
I have my testing to be done in a couple of weeks. I've done the questionnaire but thought that maybe it could have asked about hormones. I had a total hysterectomy in 2002 and CT symptoms started a couple of months later. As my mother had breast cancer many years ago I chose not to have HRT. I tried all the natural routes but my joints became worse as well as the carpal tunnel. I was tested at grade 1 and when tested again, it was negative. My osteopath first thought it was CTS and linked it to the enforced menopause. I attended a menopause clinic in 2005 and was advised to go on a low dose of HRT to protect my joints (especially as I have had a spinal fusion) and within no time, the symptoms decreased to a point when I could get on with life with only the occasional blip. Last year though, I found a lump in my breast which was fortunately diagnosed as a fatty nodule and was advised to come off HRT. I took my last tablet in October and within two weeks, I was aware that the problems were there again. As I write this, I'm currently having to sit upright to sleep, with pillows on my lap to rest my arms, I can't wear rings as the fingers swell up, I wear my splints at work (checkout chick!) to give the hands some support, I can forget taking lids off jars or opening cans......thank goodness for my husband and father! How I wish I could go back to the hormones......how many sufferers feel weepy, old and decrepit!!!!!!!!! (I apologise...feeling very sorry for myself as I type this as there's still no relief from it all day and I know that it's going to get worse as night draws on)
Thank you for your reply and please don't apologise for the waiting time, I was rather surprised at how soon the appointment is. I've tried the splints at night, but still have to sit up. I went to my usual Pilates class tonight (trying everything to help the pains in all my joints) and ended up in floods of tears with the pain of lying down. I had to give it up as a bad job and try exercises with my hands on a chair and kneeling up. I'm certainly a challenge for my instructor! I don't expect miracles but I'm counting down the days until testing. AKC
Looking back at your old records you seem to be one of an unfortunate, small group of patients with very severe subjective symptoms despite very mild neurophysiological abnormalities - at least when last tested. One cannot help wondering whether there is actually another disease process present too - especially if there are pains in other joints away from the hands?. We'll have a talk about it when I see you. JB
Thank you for seeing me this week. I rang up about getting steroid injections and requested a Monday so that I could go back to work on Tuesday. The lady who I was talking to read to me from the instructions that they send with the appointment date and I was told that I would have to rest completely for the first 24 hours and not to do any repetitive movements for 48 hours. As I work on a till in a supermarket (highly repetitive and quite heavy work!) I'm wondering if 48 hours is enough for my sort of job, or would I be wise to err on the side of caution and take longer to recover. I obviously want to give my hands the very best chance of recovery, so would welcome your advice. If you advise me to take more time, how much longer? I have also made an appointment to see my GP for a referral to an orthopaedic specialist, I hope to get some answers regarding my poorly joints as well.
Thank you very much for your help
AKC.
We obviously need to revisit the advice being handed out by the SIPC office - sorry! There is no medical/scientific evidence to suggest that any particular behaviour after a carpal tunnel steroid injection is either beneficial or mandatory. For all we know it might even make the injection work better if you go back to using the hand immediately - no-one has done a trial to find out. The majority of injections seem to be carried out successfully with the patient able to continue normal activites within hours and a fair number of people are so unfazed by the procedure as to be able to drive home immediately. I think the reason for this advice is that in a minority of patients the injection itself is very painful and one may need to rest the hands until this settles. There is also the curious phenomenon known as 'steroid flare' which you can read about in the steroid section here - the injection itself is not a problem but localised symptoms develop afterwards and persist for a day or two. This does not appear to be very common with carpal tunnel injections. The advice is therefore covering for a worst case scenario. it is also possible that they are quoting from a 'generic' advice sheet for local steroid injections, not specifically one for carpal tunnel injections. The official advice for patients having carpal tunnel injections in the East Kent Care Pathway is given on this website HERE. My approach to this would be to get it injected on a Monday anyway. If it feels OK on Tuesday go to work. If you are unlucky enough to have pain on Tuesday then call in sick. JB
There are questions in there about your reproductive state including use of hormonal contraception and hormone replacement. They are not perfect as the range of possible situations for women nowadays is surprisingly complex and sometimes it can be quite difficult to know quite what a given individual's internal hormonal state is. The questions which we use here however do allow us to broadly group women into a small number of categories which are useful for assessing the risk of CTS. There clearly is a link between female hormones and CTS, especially during pregnancy and about the time of the menopause so a recurrence of symptoms after stopping HRT is no surprise. Are you wearing the splints at night - most people find that sleeping in them helps somewhat even if it does not cure the problem. I'm sorry about the almost 5 week wait for testing - we seem to have too many people with CTS in East Kent at present. JB