Return of Carpel tunnel symptoms after injection

I agree. I need to see you again and we can decide how to proceed and we will repeat the nerve conduction studies. There is a space in this Thursday's clinic at 12:30 if you can make that. I've booked it provisionally for now. If you cannot make Thursday it will take us several weeks to find a space I think. JB

Excellent thank you! See you then!

I have an appointment booked for the injection in Sandgate on the 10th of Dec. Unfortunately due to work commitments I am unable to attend a Thursday appointment so soon. I have asked if I could be put on a list for any cancellations. Fingers crossed! Hoping to get done very soon as I really am struggling mainly night times but daytimes too! Is it ok to continuosly take painkillers everynight until I get the injection? I took last them last night to try and get sleep, but was woken by 4am by the pain/tingling returning.

I don't think it's a major problem taking simple analgesics nightly for a short period unless you are one of the people who get gastrointestinal problems with drugs like ibuprofen. However, as you have found, simple analgesics do not actually work very well for pain from carpal tunnel syndrome (remember however that we are not entirely sure your problem is only CTS). Has there been any sign of an orthopaedic appointment? JB

Ok, I did try the pain killers again last night and this time they did not work! :-( I'm finding work harder (bank cashier) and small jobs at home harder to do too! Using a hairdryer, typing, writing, hoovering etc. some things that bring on symptons quickly. The tingling and numbness is pretty much constant. I have not heard anything re: orthopaedic appointment.

OK we will try to check with administration whether the request for an orthopaedic consultation is making it's way through the system or not. JB

Ok thank you. Much appreciated!

Hi - I'm the Co-ordinator for Neurophysiology. I've just checked on the system and found no orthopaedic waiting list entry for you so I have taken another copy around to the referral centre. I am unaware of the length of the waiting list but you should be on the waiting list.

Many thanks

Melynda

Hi Melynda,
Thank you! Very frustrating as I am really struggling day to day now. It seems to be getting worse each day!

Dr J Bland, I asked my local chemist what I could take to help relieve symptoms. They suggested Neproxen. Over the counter 9 tablets were £3.99. I rang my GP asking if I could have this on prescription, hoping I would then have enough to last until the injection, but they replied by saying just buy the over counter ones. The chemist told my they were 250mg, but the prescription onces whould be a stronger dose! I did buy some of the 250mg and took 2 at lunch time. It helped take the pain away. If I need to take 2 at a time, this is going to cost me a fortune! Is there anyway you could write a prescription for me? Thanks Michelle

I'm a non-prescribing doctor I'm afraid - I don't even have a prescription pad! Naproxen is not likely to be especially effective for CTS pain anyway - it does not respond very well to simple anti-inflammatory analgesics generally - although you may be lucky. Some people have success with amitriptyline or gabapentin but again these are not reliable. Repeat steroid injection is much the most likely thing to produce a quick short-term fix for the symptoms but as you cannot get to us on a Thursday (I'm sure Nick would inject it for you tomorrow if you could make it to the Canterbury clinic in the morning) this will have to wait until 10th December when I think it is currently booked? JB

I have thankfully managed to get my GP to prescribe for me! It doesn't relieve symptoms fully, but helps! Thats all that matters at the moment. Grateful for anything. I wish I could get time off work to attend the clinic, but as it stands I'm hoping theres a cancellation sooner than my appointment. Yes its the 10th Dec. Thank you! MH

Hi, I had the injection yesterday. Now just waiting to feel full effects! Just to let you know that I still have not received a lette re the orthopeadic appointment! Should I have heard something by now? Thanks Michelle

I would expect to have heard something from orthopaedics by Xmas. We'll check again whether there is any trace in the system of it making progress. JB

Ok, lovely thank you!

Hello,

I have just checked the hospital system and I can confirm that you are on Mr Wetherell's waiting list as of 22.11.12.

Many thanks

Melynda

Hi Mr Bland.

I thought I would give you an update re appointment with Mr Wetherell. As I have little symptoms at the moment he wants me to return in 3 months, much to my annoyance. I thought this would be the case, but I could not have gone over Christmas without having the injection. He has also identified that I have cmc at the base of both thumbs. This would explain my weakness I get. Again he wants me to have symptoms before doing anything further. If before the 3 months are up the symptoms have returned, he has asked that I contact him. I did say that I struggled to deal with everything before the injection. But hey ho!!! Hopefully this will get sorted soon!
Thanks Michelle

I did think there was some trouble with the thumb joints so at least he agrees with me. It's always difficult to decide whether to treat someone at time when they have mild symptoms - I don't have any easy answers for that. JB

The only thing that I found strange was that another doctor has decided to operate patients (noted on this forum) whilst the injections has taken away symptoms. Why do they work differently?

Essentially because no-one really knows what the right thing to do in those circumstances is - it's essentially a gamble on whether or not the symptoms will return and when after injection - occasionally they do not come back after an injection for so long that it is effectively a cure (I have encountered patients with 23 and 48 year remissions after one injection). JB

Hi Dr Bland, following my injection done on the 10th December I am having the symptons return already (first noticed the return on 16th Feb) . I am waking in the morning with numbness and tingling. I have also have 'tightness' in my hand. Dr Beach asked me to get in tough with you following my post injection checkup to see what you suggest. I do have an appointment to see Dr Wetherall on the 10th of April, would you suggest I ask for this to be brought forward?
Thanks Michelle

It wouldn't hurt to try, though Rory Wetherell's clinics are even busier than mine I think. If you can get a message to him he might just put you on the list for surgery. JB

I have been in contact with Mr Wetherells secretary and asked for an earlier appointment. Don't think its likely as I have been told he has holiday and so does his registrar. Do you think I should just ask to go on to the surgery list then?

He hasn't yet come around to the idea of putting patients straight onto the surgery list without seeing them first, though our other hand surgeon is happy to do this if I feel that patients require surgery. I therefore suspect that you will be stuck waiting for 10th April and I am afraid I have no idea how long the surgery queue is with him at present.

We do periodically review the CTS care pathway and it is about time we all got to gether and discussed it again but we are really waiting for the governments latest round of meddling changes to the NHS to take effect. The primary care trust which used to pay for the services everyone uses ceases to exist at the end of March and the replacement, four clinical commissioning groups, still seems to be rather disorganised so that there is no-one to negotiate with over the provision of services that used to cover the entire East Kent area. Everyone is therefore waiting to see what happens on 1st April - we have patients booked for surgery in primary care after that date and yet no idea who is going to pay for those operations. JB

So does this mean possibly longer waiting lists or no operation at all? Its really starting to take a toll on me again! Waiting another month to see Mr Wetherell is feeling like eternity. I feel I need another injection but also need to attend his appointment with my symptons! :-( So at the moment I feel like I'm losing a battle. If only it hadn't returned so soon.
Thanks Michelle

We seem to have growing waiting lists for everything at present I'm afraid but we are still managing to get carpal tunnel surgery done within about 6-12 weeks once we decide it's appropriate. The real challenge is in picking the right patients to operate on. If you get desperate we will just have to inject again - are you still unable to make Thursday mornings? JB

The problem is Mr Wetherell requested I attend the appointment with the symptons. So if I have the injection, will he just put me off for another 3 months. I really can't go on like this! I feel I have already waisted precious time and I could have been on the mend by now. Yes Thursdays are difficult to get to Canterbury I'm afraid.
Thanks Michelle

I think he will probably list you for surgery anyway with a story of recurrent symptoms after injection, even if we re-inject it - but it's not my place to tell him what to do. JB

Shame! If only it was lol. I think I am just going to put up with it until I have attended the appointment on the 10th. I know this sounds daft, but I already feel I've been delayed. I'm also being referred to see a surgeon for my foot and know that obviously my hand needs to get much better before I can consider this. I am against time! :-( Once I have seen Mr Wetherell I will ask to have another injection. Thank you for your understanding. Can I ask is it common to have basal arthritis along with cts? Also do most surgeons operate on both at same time?

Quite a lot of other things commonly co-exist with CTS but I don't know the answer to the surgery question - you'll have to ask the hand surgeon that one. JB

Great news. Seen Hayley Smith today and have been put on the list for surgery. She suggested I had the steroid injection. I had this done there and then. I was told it included a anesthetic. I hurt more than usual and now (5 hours later) I have sausage fingers. They are swollen and numb. Is this normal? Thanks

If they included a local anaesthetic in the injection they will have anaesthetised the nerve for some time - a bit like the dentist so yes they will be numb. Swelling can just result from not moving it for a while. We don't use a local anaesthetic in ours as there seems to be no purpose to it. JB

Thanks for the quick reply. The symptom almost seemed immediately following the injection. Im supposed to be working tomorrow so fingers crossed it will be ok by then! Thanks

The numbness form the local anaesthetic would come on within a minute or two from injection. JB

Thank you. All back to normal thank goodness! Had me worried as this didn't happen last time. But then I didn't have the anaesthetic did I! Now just to wait for an appointment for the op!

Hi Dr Bland, you tried to contact me re my carpal tunnel. I am available now. Thanks MH

I was just going through a pile of communications from patients this afternoon and trying to catch up with people an in amongst them was a post injection follow-up for you from Giles Beach from back in February - hence the call. ANy sign of a date for surgery from Ashford yet? JB 

Sorry for missing you earlier today. No not had a let yet offering a date. Thought I was pushing my luck expecting a date yet. They did advise that I should expect to wait 2 months. So should be looking around mid June for op date. Are you able to see if this has been booked? Or is this now out of your hands?

I don't have access to the orthopaedic surgical waiting list system myself to check but my colleague Michael Nicholas can get at that system and we can check on Thursday if we remember in the midst of the usual mayhem of the CTS clinic. We don't have any control over it though. JB

O ok, I will keep looking for a possible update then. Thanks!

Hi Dr Bland, I know you are very busy, but just wondered if you were able to see a date for my operation. Many thanks Michelle

No sign yet - we'll check again Thursday. JB

edit - Nick has checked the system for me and you seem to be in the queue for surgery with orthopaedics but with a deadline date of 14th August so could be any time up to then - no fixed date as yet. It may be possible to get an earlier date with flexibility on where it is done and by who. JB

Oh ok. Im on holiday from the 19th July, so was hoping it could be done early to mid June. I don't mind who does it. Can it be changed to a different surgeon to get a June date then? Also what other locations would I be looking at? I am flexible with this and really would like it done sooner rather than later as the previous steroid injection only lasted 2 months.
Many thanks Michelle

We'll see what we can do but as this one is being done in the hospital system rather than in primary care I don't control the waiting list system directly. JB

Ok, thank you for your help!

Any luck with a date? Thanks

Best I can do in primary care is 6th July in Herne Bay. Nick is investigating the hospital lists as he seems to have some quite early gaps in his lists in Canterbury/Margate. JB

Thank you. I'm going camping do you think 6th of July will be too close to my holiday? If you could let me know if Nick has any luck I would be truly grateful! MH

We had a patient cancel this morning - therefore did another operation a week early - so we now have a space next weekend if you would like to take it JB

Hi Dr Bland, as discussed on telephone, I will have to miss this one. Too short notice to arrange with work. If anything comes available in June - it would be much appreciated. Many thanks Michelle

We may try to play dominoes with some patients then - see if we can get one or two of the currently booked ones to move forward to the next couple of weeks, vacating a space for you. JB