Advice

mark-deadspace
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Hi, my GP has had a nerve conduction test done and that was ok, I have pain in both wrists and have drop things at work for the past 6 months. I can not open tops like jam jars etc. My grip feels week and I don't get much sleep due to the pain.
Can anyone give me some advice.

My Gp says I might have Carpal Tunnel due to the pain and loss off grip, have got physio this week, and I might be sent for injections

jeremydpbland
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There isn't really enough information there to make a diagnosis. There are many possible causes of wrist pain and dropping things. The questionnaire on this site will give you a moderately accurate assessment of the probability that you have CTS - anyone can use the questionnaire, not just my own patients. Steroid injection is actually quite a good 'test' for whether you have CTS - if the symptoms respond quickly and dramatically to injection then that greatly increases the probability that that is the right diagnosis. If you get sent to a good physio then they may be more familiar with the range of problems that can occur in the wrist and hand than your GP but like all professions they vary in expertise - some are good at hands, some at necks and some at chests. JB

mark-deadspace
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Ok thanks JB, I will do the test and see what that comes op with for me. Is there in the mean time I can use to help with the pain. It keeps me awake at night and I forgot to say that I have loss of sensation in the thumb and the two fingers next two it. I am going to sevenoaks hospital to see a physio at 9am. I had my nerve conduction test done a borough Green Medical centre and am due back next month.

jeremydpbland
Online

The sensory symptoms in the fingers are much more characteristic of CTS. The question of what to take for pain is a tricky one without a diagnosis - CTS generally does not respond well to ordinary painkillers. The best and safest self-help measure for night-time symptoms is to try wearing a wrist splint at night. These can be ordered online or found in larger chemists and there is a description of exactly what to look for and how to adjust them under the treatments tab here.

Nerve conduction studies done at Borough Green is an interesting report - were they done using a smallish (ie handheld) machine? JB

mark-deadspace
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Hi JB it was done by placing a electrode on one off my fingers can't remember which one and they had a small device like a small hand hold and then they sent the impulses to that nerve and checked it on a laptop. They did both hands and they said it looked ok no nerve damage. I am due back in March to see a GP at Borough Green. Will let you know how I got on when I go to physio on Tuesday. Will look into the splints. Mark

jeremydpbland
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OK I recognise that device and I do not trust the results from it. It is suitable for use only as an initial screening tool for possible CTS but I would not accept a normal reading from it as adequate evidence of normality and I would not contemplate surgery based on an abnormal reading from it without getting some real NCS done first. JB

mark-deadspace
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Ok thanks for that, what should of been used to test the nerve. Can you advise me on this and what I could do to get a proper test done. I have got physio on tuesday on my letter it say he is a extended scope physio what does that mean. Sorry about the questions but would like some help

jeremydpbland
Online

If your GP has bought into the idea of doing their own NCS using one of these handheld devices they are likely to be unwilling to refer you to a properly qualified clinical neurophysiologist to get a definitive set of results I am afraid but you can try. GPs in your area do have access to refer directly for clinical neurophysiology.

Extended scope physio just refers to a physiotherapist who has been given more freedom to diagnose and treat patients than was traditional, in the same way that we now allow some nurses to diagnose and prescribe. It is often very hard to know what additional training or learning these people have done to qualify for such a role - some of them are very good though. It has become quite difficult now in the UK for patients to understand the qualifications and training of the various people they see I'm afraid. JB

mark-deadspace
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I have been told today that I have CTS in both hands, I have been given two splints and had one injection in the left hand. I go back in 6 weeks for another injection and to see how I am finding the splints. Thanks for all your advice and time JB

jeremydpbland
Online

Sounds like a good practical approach to the problem. If the injected hand is markedly better in 2 days time that will be good evidence in favour of the diagnosis (and an example of the handheld device giving a false negative) JB

mark-deadspace
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Hi.
Have seen DR Varmma at Borough Green Medical Centre and he is going to do surgery on my left hand on the 20th March at Borough Green any advice on what to expect during surgery and what I can do to help recovery afterwards. I think its going to be open cut surgery. He said that I would be sitting only thing that I am concerned is that how will my hand be kept still.
Hope you can help.
Mark

jeremydpbland
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I would not contemplate surgery without some proper nerve conduction studies myself but there are people whose opinions on this differ and their views are legitimate. I think a key factor here is how it responded to injection - if it felt much better for even a short time after injection then that is fairly good evidence of CTS but if it did not respond at all to injection I would be very wary of surgery. Keeping the hand still is not usually a problem. JB

mark-deadspace
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Hi thanks for that, the injection did not really do anything and that is what I told dr varmma, I am really willing to try any thing as the pain is really getting bad and my wrists are getting bad with the breaking down of the boxes that I put out on fresh foods. I will have a think about what you said but I am willing to try any thing

jeremydpbland
Online

Your initial test results with the mediracer were said to normal were they not. It's not a great machine but better than nothing. Combine that with a lack of response to injection and a fairly low symptom score on here and I think there has to be some doubt about the diagnosis. On the information I can see here I would get a second opinion from a rheumatologist or hand surgeon before taking a knife to it myself, but of course I do not have the advantage of having met you, listened to the story and been able to see the hand so your GP is in a much better position than me to assess it and I cannot argue with another doctor's clinical decisions based only on a web discussion I'm afraid.  JB

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