Update following injection on Nov 1

There will be a difficult decision to be made as to whether it is worth operating on. I would feel much more optimistic about surgery if the short term response to injection is convincing improvement so we will see how it works out for a few days. Sometime next weekend would you repeat the symptom severity questionnaire please so that I can see how the answers have changed (go to the My CTS pages and find the option that says 'take a new severity test') JB

Hello Dr Bland, it has been 9 days since the injection in my right hand and it's not good news I'm afraid. I have just taken another severity score. I have still got constant tingling in my thumb and fingers and a numbness on the tips. Despite wearing the splint most of the day I am still getting the same symptoms where the tingling in my hand suddenly intensifies and runs all the way up my arm and across to the middle of my chest. This lasts about 20 seconds and then fades back to just the tingling in my hand. This seems to happen when I am using my hand, raising it up to brush my hair, swinging it while walking along, sometimes when typing or writing (but not always). It can happen several times an hour. At night I am only getting the tingling in my hand, not the other symptoms, but this is while wearing the splint every night.
I agree about being happier about surgery if I had had a better response to the injection. Before we do consider it I would like to rule out any other possible causes in case it is a trapped nerve somewhere else or something other than CTS. Should I be going back to my GP and seeking a referral to the musculoskeletal service? or should I see an osteopath? I am not sure what to do next for the best but happy to try anything!
Thank you for your support.
Regards Natalie

It's certainly worth looking for other things. It is also the case that a fair proportion of people with symptoms like this and normal test results will get better without any treatment anyway and we never do find out what it was so there is always the possibility that it may improve. See your GP again and see if he/she can arrange MRI of your neck. I will send a supplementary EMG report out on Monday covering progress so far. Osteopath's sometimes seem to have success with this sort of thing but at some cost and with small but definite risks I would generally recommend exploring conventional avenues first. I will see you again in a week or two and go over things again at that point. JB

Thank you, I will ask my GP for an appointment. How do I book a follow up appointment with you, or will you send me an appointment letter? Regards Natalie

I'll find an appointment slot we can work with when I amend your records tomorrow and send out a letter. JB

Thank you, I'm away week beginning December 3 but fine apart from that. kind regards.

Hi Dr Bland. I have an MRI scan booked for 13 December. No real change in the symptoms. It doesn't seem to be so bad at night but still getting the pain shooting up my arm and across chest during the day, especially when raising my arm. I just hope the cause can be identified so something can be done as pins and needles in right hand still pretty constant. Can't help but worry what the long-term effects might be. I'll let you know what happens. Is there anything I should do in the meantime? Regards Natalie

If MRI is the 13th December I will see you on the 20th - with a bit of luck there will be an MRI report by then. JB

Thank you, will you send me an appointment letter or should I just pop in? Regards Natalie

I'll send out an appointment letter tomorrow morning with a time. JB

Hi Dr Bland, no MRI results yet, is there any chance you could chase them up for me please? The earliest Neurology appointment on choose and book was 5 March at the William Harvey, which makes me hope the results will show up something more easily treatable by physio. There was no indication of who I would be seeing or how to ask for a cancellation but at least I'm in the system.
Thank you, Natalie

I'll have a look for the MRI report next time I'm in the office in a few days. JB

The MRI has now been reported. The radiologists were not happy with the quality of the images but so far as they could see there was no major compression of the nerve roots or spinal cord. The formal report should reach your GP about now I think. That leaves us with no clear diagnosis as yet for the shoulder problem. I would be inclined to seek an opinion from one of the orthopaedic surgeons with a special interest in shoulders next but your GP may or may not agree so lets see what he says. JB

Thanks for the update Dr Bland, it is depressing that we can't find the root of the problem, I have an appointment with my GP Dr Glynn on Friday and will pass on your suggestion. Regards Natalie

OK. Let me know the outcome and if there's anything I can do to help I will but I think the majority of the problem is probably not CTS, JB

Hi Dr Bland, I thought I would let you know that I had my first physio appointment today at K&C. The physio thinks the amount of time I have spent working on my laptop with my head bent and not changing position for many hours at a time is a major contribution to compressed discs in my neck which have irritated the nerves and that is what is triggering the pins and needles in my arm and hand. Her manipulation of points in my neck triggered the more intense pins and needles which I have suffered from when using my right hand. So it's several weeks of physio now and regular exercises. Dr Glynn agreed with your suggestion about a referral to an orthopaedic consultant and I also have the referral to neurology. Both not until March. hopefully I won't need them but at least I am in the queue and there is no certainty that the physio will get to the bottom of all of it.
Thank you for all of your advice. I'll keep you posted. It is interesting that my first set of symptoms were so close to CTS which is why I wanted to share my experience. Especially because it can be confused with other things, although I do think there may have been some level of CTS.
Regards Natalie

We never did find any evidence of NCS on the nerve conduction studies but the ultrasound imaging was certainly abnormal on the right side and I think the current assessment that there may just have been a minor contribution from CTS is probably going to turn out to be right. I think it illustrates how useful local steroid injection is as a diagnostic approach when there is uncertainty about whether a lab finding at the wrist is actually relevant to the symptoms or not. It's also a nice illustration of how not every presentation with symptoms in the median nerve distribution turns out to be CTS. Thanks for the updates, as usual. JB

I think the biggest difference post steroid injection was that I wasn't getting the night-time problems when my right hand was going numb. That was definitely, symptoms-wise the biggest signal of CTS for me and went on for about a year before any other symptoms started.
The neck problem causes more pain when I'm raising and using my arm during the day. A huge help now is a memory foam neck pillow which is curved to support your neck and keep everything straight. It also stops me from sleeping with my arms above my head hugging the pillow too.
Anyway, I'll keep posting about my progress because I think this forum is a brilliant way to share my experience with other people, thank you for providing it. NHS choices is also very good for practical advice and forums, I would recommend to others.
Regards Natalie

Hi Dr Bland, I wanted to give you an update because I had my appointment with Dr Karlsson yesterday. She was happy with the MRI scan and did not feel that compression in that area was the cause of the problem. She thinks stiffness in the neck and shoulders is a major factor to my problems (I now have worse symptoms in my left hand, the index finger is very numb and thumb and middle finger quite numb) and she felt that there was some CTS evident in my left hand/wrist. My right hand is a lot better although i have increasingly painful pins and needles in both hands and lower arms especially when I have been using them a lot. Would I be able to come back and see you to have some tests on my left hand please? I don't know whether it is due to the injection in my right wrist but the right side is much improved compared to the left side now.
Regards Natalie

It's easy enough to test it again. I'm in Birmingham at a conference for two days but I will ask the office staff in Canterbury to find an appointment for you. JB

Hi Dr Bland, thank you for offering me another appointment. I have actually cancelled it because in the meantime I have been responding well to physio and especially acupuncture focussing on my cervical spine region and upper back. I now have only very mild pins and needles in both hands and it isn't waking me at night. I didn't want to take up an appointment slot when other people are suffering worse symptoms and need to see you but if the situation gets worse I will let you know and would appreciate being able to come back if necessary. Regards Natalie

No problem - you can always contact me through this site. JB

Hi Dr Bland, I thought I would give you an update. I was eventually seen by Mr Lau, spine specialist at Kent and Canterbury who was able to read more into the MRI scan. He agreed with you that my conditions were unlikely to be CTS but instead it was the degeneration of the disc at C7 which was irritating the nerves coming down into the arms and hands. It could have laid dormant for some time but I obviously did something to trigger the irritation, which was made worse by the stiffness in my shoulders and upper back from too long spent sitting at a desk, typing etc, especially on the dreaded laptop!
At their worse my symptoms were severe pins and needles in my hands and lower arms which would shoot up my arms and across my chest several times an hour, numb fingers and numb fingers and hands at night (the latter I think did indicate some CTS as we have discussed).
I have had extensive physio treatment on my neck and upper back including acupuncture and traction at Kent and Canterbury (the physios have been fantastic) and I now only have mild tingling in my hands and none of the other symptoms. I've had to make some adjustments obviously to posture and work patterns and I need to be careful with my neck and keep doing the exercises the physio dept gave me but hopefully the previous symptoms won't return and if they do I'll have a much better idea of what's causing them.
I just thought I'd complete the picture for you!
Regards Natalie

Thanks very much for the update and I'm glad you eventually seem to have achieved a satisfactory result. It looks as though we perhaps figured it out correctly after the injection. JB