Continuing symptoms

Defintely worth a try with injection - or the other alternative would be to join the ultrasound treatment trial if you can spare the considerable amount of time needed. I will amend your records tomorrow and after that you can call the SIPC office to arrange injection if you want to go that way, or you can just reply to me on here if you are interested in the ultrasound trial. JB

Ok thanks. I would have been interested in the trial and have had a look at the details on this site, but unfortunately would find it impossible to get away from work for that amount of time. I will call the SIPC office later. Thank-you.

We generally run the ultrasound treatments in the early evening. JB

I usually work until about 6.30, what time are the treatments? Also, I fractured my left wrist a couple of years ago. it was set with K-wires but I have some (very) mild deformity. Is this a contradindication to the injections?

The previous wrist injury is not a contraindication to either injection or ultrasound. It may be possible to arrange ultrasound after work - you would need to discuss this with the man running the trial if you are interested as he does the therapy sessions himself. JB

Dear Dr Bland,
I had my wrists injected on 22nd November. They are better than they were but I still have to wear the splints at night. I have an appt for NCS on 5th Feb and have had a letter asking me to complete the diagnostic questionnaire again, but I can't get back into it. It has just re-saved my original results with today's date. How can I get back to the start of the diagnostic questionnaire?

It's ok, I saw your response to Kelly below and have completed the severity score test, but please note, the responses to the questions about numbness and pain at night are when wearing splints. Also, I had an MRI of my head and neck at the Chaucer hospital in May last year - not sure if it would be helpful for you to access the results prior to my appt. thanks.

MRI done at the Chaucer is not recorded in our radiology system as far as I know. If you have a copy of the report that would be useful. The severity questionnaire is intended to reflect the symptoms as they are at any given point - not how they might be if you did something different, such as leaving off the splint, so you have it exactly right. Lots of people have trouble finding that link to add a new severity questionnaire but I'm not sure how I can make it more obvious. We are going to stop people coming back to the site and simply creating a new acount under a different name but the same reference number though - something which causes chaos in my data caollection:-)

Hi, thank-you for your time and patience with my questions on Tuesday. I have been thinking about our discussion and would like to change my mind about treatment. I said I would give the injections another go but now think I would like to go for the surgical option. I am assuming that only one would be done at a time? if that is the case, I would like the right hand to be done first and perhaps try the injection again in the left hand meanwhile. would it be possible to have the surgery done in Herne Bay by the GP you mentioned? what do you think?

That would certainly be possible but he is booked up until 20th April. We would indeed do only one hand at a time so one might consider the possibility of booking surgery but injecting while waiting. JB

OK thanks. I will book to have injections while waiting. do I need to do anything about booking the surgery?

I will book you a slot and put an appointment letter in the post when I get in to the office tomorrow. JB

Booked this morning - letter should go out in Monday's post JB

Dear Dr Bland, I had surgery on my right hand in April this year. Whilst the numbness and tingling are a lot better, I am left with an ache, stiffness and reduced strength in that hand and wondered whether some physio might help to loosen it up a bit? Also, because of the right wrist ache, I am tending to use my left hand for the mouse which is making the numbness in the left hand worse, although it is fine as long as I don't use the computer and wearing the splint at night when it is bad does help. Would appreciate your views. Many thanks.

Some loss of grip strength and stiffness is not that uncommon after carpal tunnel surgery. There is no good quality evidence regarding whether the interventions of the hand therapists make any difference to this but it probably does no harm to try. In the first instance it might be a good idea to test them again, make sure that the right nerve is better and see if the left is now deteriorating. Can you sprare the time to come in for a test? JB

Hi yes, I can do that. Thanks.

OK I've made an appointment - letter should go out in today's post - not for a few weeks I'm afraid. JB

That's fine. Thank-you.

Dear Dr Bland, I had my right wrist operated on about a year ago and it is now doing well. My left wrist was not too bad at the time and in fact also seemed to improve for while after the surgery. However of late my left wrist has been causing me a lot of pain and stiffness and I have reduced range of movement in it. There is also some numbness and tingling in my fingers. I have tried going back to wearing the splint at night which enables me to sleep, but when I take it off in the morning my wrist is very painful and difficult to move. I have completed the severity rating score which unsurprisingly is worse. I drove through France a few weeks ago and it was after the long drive that it started bothering me again. I thought it might settle once I was back but it seems to be getting worse rather than better. Please can you advise?
thank-you.

At least a part of that may be the CTS of course but the story of wrist pain and stiffness might indicate another problem. We can always measure the CTS again and see if it measurably worse and where there is diagnostic uncertainty a trial of local steroid injection is often quite a useful tactic. Would you like me to send out an appointment? JB

thank-you. yes please do send me an appt. i did wonder if the pain may be to do with my previous fracture in the lef twrist, but I think there is nerve pain as well. The spllints ease it at night but in the morning the pain is worse than if I do not wear the splints. It gets better gradually during the day as i mobilise it and responds acceptably to simple analgesics.

OK there's an appointment going out in today's post. JB

thank you, I have received the appointment for next Monday. Since I last posted the pain in my wrist has got worse and there is slight swelling and inflammation on the inside of my wrist. I was awake for much of the night and getting washed and dressed in the morning is very painful. I am concerned that I have much reduced range of motion because of the pain and am wondering whether it is best to rest it whilst it is inflamed or whether I should attempt to keep it moving?

My inclincation would be to rest it over the weekend until we can see what it looks like on Monday. JB