What else can it be?
I am currently suffering from a bout of weird sensations in both my hands and forearms. I get tingling in my fingers (not much on the thumbs though) and a sensation of "shooting" pain towards the tips of my fingers on both hands; in particular the index, middle and ring fingers. Not much on thumb and little finger.
I scored quite low on the survey so not sure it is CTS. The pain never wakes me at night. However, these sensations started like 3 years ago after finishing my masters degree and always typing assignments in awkward positions. I used to use my forearms as a "pivot" while typing...
Pain usually gets worse if I clap. The first persistent bout of pain was cured after a 6 weeks yoga course but not entirely. I still used to get intermittent pain after typing for long hours or clapping during a concert say.
Recently however, started playing the guitar and kick-boxing. Weather was also aweful and temperatures were very cold (about couple of weeks ago) and pain returned very persistently...and cannot seem to shake it off....trying yoga at home again...it is very persistent and annoying sensation even now when am tyoing this...grip can also feel very weak!
I also get shooting sensations of pain towards my feet sometimes.
What else could this be? Is there maybe a differential diagnosis even resembling my description above or is it mostly an interrmittent form of CTS...maybe still in mild stage?
Thanks for any feedback.
Xavier.
Thanks Dr. Bland for your reply. I plan to see a GP on Tuesday, I am not too hopeful since I do find that they take ages to refer me to a specialist even though I have an private insurance.
I also stopped kick boxing.
The last time I had similar pain I was living in Belgium and had a scan of the wrist. The technician seemed to measure the median nerve and said that all was fine. I am concerned that could be some "pinching" in the forearm since I used to use a bad posture by resting my forearms on the table edge and use it as pivot while typing, however I used also not to keep my wrists in neutral position so not sure - thats where problems started. Can a whole scan of hand and arm reveal condition of median nerve?
The main thing that makes me think might not be typical CTS is that I dont wake up at night. But this could also be because the condition is still mild I guess. I have very narrow wrists for a man as well so could be CTS or a mild version but never been diagnosed by a GP.
Is the fact that conditon worsens with typing and clapping more likely to make it CTS?
Thanks again.
I will report more after seeing GP if of interest.
Xavier.
'Scan of the wrist'? - Ultrasound or MRI?- they might have measured the median nerve cross sectional area on ultrasound which is a fairly good indicator of CTS - probably not quite as sensitive as NCS but almost if done by someone familiar with the technique.
There are said to be median nerve entrapments in the forearm - not sure I believe in them - very hard to diagnose reliably
Waking at night is pretty characteristic of CTS but not everyone gets it so the absence of that feature does not exclude the possibility.
Typing is, if anything, probably good for CTS. Clapping doesn't help me very much - it's not a comment I have heard before
Good luck with getting a diagnosis - sounds as though it might be a bit of a thorny one. JB
Dear Dr. Bland, yes it was an Ultrasound and that is in fact what they did at the time; measure the CSA of the median nerve at the wrist.
Yesterday I went to the GP. She did test like the bending of the wrist for 60 seconds and tapping on the wrist and touch of hands with my eyes shut. Sensation is normal. I did have some symptomps towards the thumbs (especially left hand) after she finished the tests, however, the typical symptomps are more towards index, middle and sometiems ring and small fingers.
She advised wearing splints at night, however, I recall when all this started 3 years ago in Belgium I tried the splints and it seemed that the pressure on the wrist made things worse - hence also why when I clap and use extensively the wrist the condition seems to worsen. So not sure if I should try the splints again.
She advised me to take ibubrofen and wait 2 weeks. She might refer me after 2 weeks.
Do you know of any good neurologist (thats what they are called I presume?) in west london?
What should I expect when I eventually visit one? What type of tests etc...
Xavier.
The wrist bending thing is called Phalen's test and is moderately reliable. Tapping the wrist (Tinel's sign) is pretty useless. Splints at night are a good idea but they need adjusting correctly - there are illustrations on the site here of what is needed and an explanation of why - just look under treatments. Ibuprofen has not been shown to be helpful for CTS but might help other things.
I'm afraid I don't know anyone in West London - let alone a good neurologist. I have mixed feelings about which speciality is best to consult about hand problems that might be CTS. It's probably more important to find someone who is interested in the condition rather than worrying about which speciality, but the other consideration of course is the differential diagnosis - if it is not CTS then another neurological problem is more likely to be recognised by a neurologist whereas another musculoskeletal problem is more likely to be recognised by a rheumatologist or orthopaedic surgeon. Without any other evidence to help guide then I would probably opt for a specialist hand surgeon but your GP should have a fairly good feeling for who provides decent opinions locally. It is this element of a GPs local knowledge and expertise that we have, to some extent, discarded in implementing things like 'Choose and Book' in the NHS. So far as I can judge from your questionnaire answers on the web you do not have a really typical history of CTS so consideration of the alternative diagnoses is probably an important factor. I would be interested to hear the eventual diagnosis and outcome of treatment. JB
I guess CTS might be a possibility there but you are right, that is not a classical textbook history of CTS symptoms, so it would be a somewhat atypical case. The differential diagnosis of 'funny sensations in the arms' is quite wide - a few of the possibilities appear on this page. The story you have given there provides no real 'red flag' markers to point you at any specific diagnosis so I think the only practical advice one can give is see a doctor. JB