Sudden changes to the symptoms in my right hand

Hello Jeremy. I hope you will have time to review and comment on this update to my original forum post (Should I proceed with CTS release surgery on my second hand) back in April 2015. It describes some recent and sudden changes to the symptoms in my right hand.

SUMMARY OF CASE HISTORY:
Symptoms of numbness in left hand (predominantly middle finger) started in approx. 2011/12. GP did not initially help, but eventually referred me to specialist. Had NCS in Oct 2014 and was diagnosed on LHS as having severe CTS and severe ulnar neuropathy at elbow, and on RHS as having mild indications of both conditions. In Jan 2015 I had Carpal Tunnel and Cubital Tunnel release surgery on LHS.

In April 2015 you kindly reviewed my pre-op NCS data and classified me as CTS Grade 5 LHS and Grade 0 RHS. You were not convinced by the NCS data of any ulnar nerve abnormality at my right elbow. In July 2015 I requested another NCS which was carried out Feb 2016. You also reviewed these results and concluded I was still CTS Grade 0 RHS.

Following the comments and advice you provided in 2016, I decided to continue monitoring my right hand symptoms and not have surgery. For the past 6 years (up to present) my symptoms have mainly been feelings of numbness in the tips of thumb and index/middle fingers, very similar to my previous experience with left hand (i.e. not experiencing any classic pain or waking during night time symptoms).

I have been concentrating on looking for any signs of thumb muscle wasting, and also any loss in dexterity when pinching and holding items between index/middle fingers and thumb (which I did progressively notice in my left hand).

LATEST SITUATION:
To date I have not noticed either loss of dexterity or signs of thumb muscle wasting in my right hand, and I have not suffered pain, just some numbness of thumb and finger tips.

However a week ago, when first waking, the fingers in my right hand were painful, weak, stiff and difficult to move initially. The gripping force between thumb and index/middle fingers was significantly reduced.

Over the next two days there was also some swelling/puffiness in the wrist area (arm side of wrist crease line, and on side/edge of wrist at base of thumb, and the area was sensitive to touch. Skin colour was normal. The swelling/ puffiness then cleared. The strength of grip between thumb and index/middle fingers has improved a bit, but has not fully recovered.

Over the last 3 to 4 days there have been some variations in capability when using my hand. When it is weakest, there is some moderate pain when exerting any forces on the fingers (e.g. just washing my face is uncomfortable), discomfort when flexing the wrist, and pillar pain when pushing up out of a chair. Even on a better day, the reduced strength in my hand and discomfort when I load it is making some normal activities difficult.

This morning some swelling as previously described has returned, but less than before. The numbness at finger tips may be a bit worse than before, but I’m not sure about that. Prior to onset of these symptoms a week ago, I had not undertaken any strenuous or repetitive activities with the hand to provoke a problem.

My current situation leads me to the following questions..
1) Do my new symptoms indicate CTS as the most likely cause, or could it be something else?
2) If CTS, then is it a temporary “flare up” that is likely to settle, or am I at the start of a continuing condition that may start to permanently damage the nerve?

Based on the previous severe damage from CTS to thumb muscle in my left hand, I need to make sure my right hand is not compromised in the same way.

My first thoughts are to request another NCS via my GP, so that any presence of CTS can be identified and categorised, and the new NCS data compared with previous test results in 2016. This information then provides a reliable basis to decide what is happening and what to do.

I would be very grateful for you to.review my post and for any comments and guidance you are willing to provide.