Things seem to be getting worse, but no definitive answer from the doc.


Firstly, I'd like to express my gratitude to Dr. Bland for his commitment, I am pleased and amazed at his responses to people who are suffering from hand and wrist problems. Of course, I am currently one of them.

My problems began about four months ago, after I pushed through the pain to finish a video edit for a client over two weeks. I was at the computer, mouse clenched, for upwards of 8 hours per day, and did not take proper breaks. When pain crept in, I ignorantly powered through it. Eventually, though, the pain in my wrists became too much, so I stopped using the computer for a couple weeks and the discomfort went away.

That is, until I started the next video edit. In spite of having switched to a trackball mouse and rearranging my workstation in an extremely ergonomic way, I can't use the computer for more than 10 minutes without being forced by pain to stop. Because the trackball allows my wrist to be stationary, the problem has spread from my right wrist to the forearm and hand when I use the computer. I am forced to stop working by a dull ache which overtakes the arm from the forearm to the hand, including the wrist.

I've visited an orthopedic surgeon, who ordered an MRI of my right wrist, and X-rays of both wrists. The images showed no anomalies, so the doctor said he thinks it is tendinitis. A week later, I woke up with a numb index finger, and since then I have noticed pins and needles sensations in my right and left hands. I returned to the doctor, he did the phalen's and tinel sign tests, handed me some literature about CTS, and I was off. No plan of action, no medication. He said "it sounds like CTS," but he did not speak in concrete terms. Here in Japan, doctors don't proffer too much information about your ailment, and I just wasn't sure what to ask at the time.

Things have since gotten much worse, particularly in my left wrist, which I hadn't even brought to my doctor's attention. The past two nights, I have found myself awoken by odd sensations in my left forearm, down to my fingers. At this time, I feel weakness in the left forearm, along with tingling.

I am scheduled to return to the doctor's office on Tuesday, but I'm just not sure what to ask for. I want to mention to him that my score on was 4%, but since this is Japan, he won't know what I'm talking about.

Here's a summary of my symptoms:

Intermittent tingling in all fingers, including the little finger in rare occasions, in both hands.

When I am not using the computer, I have little or no discomfort.

Both wrists "click" and "crunch" often if I rotate them. It feels like there is some kind of "mechanical problem," for lack of a better way to explain the feeling.

I have been awoken by feelings of weakness and pins and needles in my left arm the past two nights.

I can only use the computer for around 10 minutes before pain in the forearm, wrist, and hands forces me to stop.

All of these problems first appeared around four months ago after very long periods of poor ergonomics at the computer.

As I mentioned before, I reside in Japan, so for me it can be quite difficult to get direct answers from the doctor. It's also fairly hard for me to switch doctors, so any information or advice is greatly appreciated.

Thank you so very much,

Aaron in Japan


It's interesting to have a contributor from Japan and thankyou for posting.

Reading that story my first thoughts would not have been of CTS. I have encountered a few patients over the years giving stories, and seen more accounts on the web, of hand and forearm pain which seem to be strongly linked to desk/computer work of some kind. These people have been given various diagnoses including CTS, tendonitis and many others and the main common feature of most of them is that treatment has been fairly unsuccessful. Of course it may well be the case that the reason these cases are so prominent is precisely because they are persisting despite treatment and there may be lots of people out there who get this syndrome, change their keyboard and it goes away so they then forget about it. There does however seem to be a 'hard core' of desk workers with hard to diagnose and hard to treat pain.

In the few that I have come across personally there has rarely been any concrete laboratory evidence of CTS as such and I do not believe that this particular syndrome (ie forearm and hand pain which is severely aggravated after 10 minutes of mouse/keyboard/trackball use) is commonly due to CTS but that is not to say that CTS is never a contributor to it. CTS is so common in general that it inevitably sometimes co-exists with other disorders anyway. It is also true to say that CTS can sometimes be a secondary development consequent upon other disease processes in the arm and if these are not recognised the best treatment opportunities may be missed because too much attention is paid to the secondary issue.

The low score on the questionnaire here I think tends to confirm my first impression that CTS is perhaps not a major issue here. You can interpret it two ways - either that there is only a 4% chance of you having CTS at all, or that you may have CTS but there is a very high chance that there is other pathology either causing the CTS or contributing independently to the symptoms.

My first thought as to a diagnosis here would probably be of a task specific dystonia but the differential diagnosis is extremely wide and we are very unlikely to be able to work it out via the web from the other side of the world (and that is not of course the purpose of this website anyway). What would be very useful to me, should you have time and remember, is a follow up report of the eventual diagnosis and response to treatment (or lack of it). The more of these cases we collect together the more chance there is of understanding what is going on.

Good luck with the Japanese doctors. Japan is one of the more active research sources for clinical neurophysiology and there have been many good CTS publications from Japan. They were very good hosts for the last international congress of clinical neurophysiology in Kobe. JB

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