Nightly numbness of hand & fingers

alisonh
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Dear Dr Bland
I came and saw you on the 29th Sept 2011 , the nerve studies which were done showed I had Mild carpal tunnel syndrome grade 1 ( My U/S measurement was 11), you kindly arranged for me to have a Steroid injection that same day for which I was very grateful. The injection considerably improved my night time symptoms of the pain and tingling in my right hand and fingers; however over the last 6 weeks these symptoms have reappeared and now seem to be much worse than they were previously: I generally wake up after 4 - 5 hours sleep with a totally numb hand and wrist. Last night it took a good 15 minutes to regain any sensation in that hand and it was the most painful it had ever been and even now, a few hours later it feels uncomfortable.
I did have an MRI scan on Aug 1 2011 under Dr N Munro which showed some mild Spondylotic changes in my Cervical spine. The disc did indent the cord but there was no signal change in the cord. Dr Munro did advise me that the spinal cord changes may have related to the symptoms in my right hand?
Can you please advise me whether I need to be re-assessed, and by whom?
I work as a Nursing Sister at Kent & Canterbury Hospital.
Thankyou very much.

jeremydpbland
Online

It's more likely to be the CTS coming back than the neck. We should test you again. I'll send out an appointment on Tuesday when we all get back to work. JB

alisonh
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Thankyou so much for your quick reply; I look foreward to seeing you in the near future. Thanks again, Alison.

jeremydpbland
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We have a space this Thursday morning (12th) if you want to drop in at 12:30 - JB

alisonh
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Thankyou so much for slotting me in, it is much appreciated; I will be there at 12.30.

alisonh
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Hi Dr. Bland
Just quick update as requested: I had my steroid injection last Thursday ( 19/04/12 ) Thanks very much.
The actual injection was much more painful than my first one . My hand felt very uncomfortable for the first couple of days and i needed to take painkillers. It's now four days after and it feels much improved,however i do have some tingling sensations in my hand during the day and night-but i have had no more overnight numbness. I hope this is a good sign that the injection has worked. Fingers crossed.
Thanks again for your help.
Alison

jeremydpbland
Online

It sounds fairly promising so far and tends to support my suspicion that it was the CTS coming back rather than the neck I think. Unfortunately there is a fair chance that we will see more of it yet but it will be interesting to see how long this remission lasts. JB

alisonh
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Will keep you posted!
Alison

alisonh
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Dear Dr Bland

I am afraid that I now have the symptoms back again. During the last couple of weeks I have been woken at night with a numbness in my right hand and to a lesser degree in my left hand as well. The symptoms are not as bad as they were when I saw you in April; however over the last couple of days I have had a painful right hand and wrist during the day which I do not remember having before.
Do you think I need to be reassessed or should I wait a bit longer to see if the symptoms get worse?

Thankyou,

Alison

jeremydpbland
Online

Occasionally I come across people who seem to be having a relapse and then it spontaneously improves again but not very often so the odds are on it becoming a serious problem again. We should probably see you again and have a talk about surgery I think. When would be the best day to try and fit you into a clinic? JB

alisonh
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Thankyou for your very quick reply. I work Monday and Thursday at KCH so ideally either of these days are the most suitable.
I am unsure about Surgery at the moment as I have a three year old son, so it would make post-op recovery very difficult.

Many thanks

Alison

jeremydpbland
Online

Lets see you as an early patient next Thursday then, at the start of the CTS clinic (8:30 1st November). Nick will be here at about 9:00 so we would be able to inject again if necessary. Treating CTS by serial injection is not evidence based medicine but over the course of 8 years of running this clinic I have come to the conclusion that, for some patients, it is not unreasonable to continue with occasional injections provided that the nerve conduction studies are not deteriorating and the intervals between injections are not too short (ie less than about a 6 month average interval). I doubt if many orthopaedic surgeons would agree with me however. JB

alisonh
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November 1st at 08:30 would be great. Thank you for seeing me so quickly. If we decide to try another injection i think i would prefer to have it done on a day where i didn't have to go back to work straight away - unfortunately i would have to on the 1st as we are short staffed. Perhaps the injection may last longer if i rested my hand afterwards.-maybe worth a try?
Many thanks
Alison

jeremydpbland
Online

There is (you will be getting use to this theme on this website) no concrete scientific evidence that either resting it or using it after injection makes any difference to the outcome one way or the other. We tend to take an entirely pragmatic view that, if it feels OK after injection then you can use it - even 5 minutes later. We can make a final decision on the day of course as to whether to inject it on the spot or choose another convenient opportunity. JB

alisonh
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OK that's sounds great- thanks very much. See you on the 1st Nov.
Alison

alisonh
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Just a quick update;

Thanks very much for seeing me last Thursday. Thanks also to Nick for doing my steroid injection. The night following the injection i did wake with pins and needles and slight numbness in 3 fingers-but upon waking it seemed to disappear quickly. I have had no problems since. In fact my hand seemed to recover much quicker this time following the injection-with not really any discomfort after the first day. Just a slight ache and not needing to take painkillers.The actual injection wasn't as painful as my second one. It's wonderful not having been woken up the last few nights with pain.
Thank you!

Just a quick question; Does anyone with Grade 1 Carpel tunnel have surgery?
Many Thanks
Alison

jeremydpbland
Online

Glad to hear it's feeling OK at present. We even operate on people of grade 0 sometimes! - ie normal nerve conduction studies. If everything else points to it being CTS then I think that amounts to sufficient grounds for surgery but I would always want to try non-surgical treatments first in such cases. JB

alisonh
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Thank you.
I'm really hoping that this injection lasts for a little longer than my other two. I think if my symptoms reappear after 5- 6 months again i will have to think more seriously about having surgery.
I'll keep you posted.
Thanks again for all your help.
Alison

jeremydpbland
Online

We are beginning to get some useful data on the outcomes of serial injections - we are just about to publish some observations of the success of second compared to first injections but really we want to follow up lots of people through third, fourth....and also look at the surgical outcome in those who give up and resort to surgery after a variable number of injections. There is hardly anything in the existing scientific literature to guide us as to what is the best course of action once you get to the stage of relapse after one injection. JB

alisonh
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Thankyou for your reply; I will see how things go over the next few months, and if and when I have further problems with my wrist I will contact you again and see what you recommend.

Thanks again, Alison

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