Symptoms returning

That does sound rather like early recurrence of the CTS and it would certainly be worth trying the splint again, sooner rather than later I think. We don't really know whether it is a good idea to re-inject early or whether it is better to wait until it has got back to the same severity as it was before a first injection. Nor do we really know whether a second injection is a better option than surgery. If you would like to try the experiment of an early second injection then I will be happy to arrange that and follow up the outcome as long as you appreciate that this would not be a decision based on any very good evidence. JB

Thank you for your prompt reply. I will try the wrist splint at night, see how it goes for a couple of weeks and report back to you.

Fair enough. I have met a few patients who have had 'minor relapses' of CTS which have then resolved again without major efforts at treatment so it is possible that it may settle again. JB

In the 2 weeks since my last post my symptoms have got much worse, particularly during the night. I have tried the wrist splint at night and also tried exercises during the day but finally gave both up during the second week, as they seemed to exacerbate my symptoms. The pain, tingling and numbness from fingers to elbow get so intense during the night that I am often unable to sleep - to the extent that I realise something will have to be done. I am happy to be guided by you as to whether I should try a second steroid injection or opt for surgery.

If symptoms are that severe then I would go for a second injection as a quick fix and we we will then plan to re-test it and review the situation when I can manage to fit you in. Give the SIPC office a call to book a further injection and let me know what date they come up with and we will try to work round that. JB

Thank you for your advice Dr. Bland. I telephoned the SIPC office this morning and they have given me an appointment on Wednesday 12th June at Estuary View for the second steroid injection.

That's fairly quick - good!. I've scheduled a follow up with me for 6 or 7 weeks later and I'll check your nerve conductions then and see how it is responding but feel free to keep in touch on here too. JB

Dear Dr. Bland,

I updated my Severity Assessment on 9th June, prior to having a second steroid injection on 12th June. Following the second injection there was an immediate improvement in symptoms and I had my first decent night's sleep for 4 weeks, which was wonderful! Very few symptoms since then - certainly nothing to bother me. I have an appointment for a Nerve Conduction test on 22nd July. I had a phone call from Estuary View yesterday re a follow-up appointment. After telling them about my appointment on 22nd July they wondered if a 6-week follow up with them would be necessary. I said I would contact you and get back to them.

That appointment with me will serve as review after injection so we can spare Estuary view the trouble I think. I'm glad to hear it has improved again. JB

Dear Dr. Bland,

From 2nd steroid injection on 12th June until the Nerve Conduction Test on 22nd July my CTS was no problem at all. Strangely, immediately following the test my symptoms slowly began again. First of all I thought the test may have irritated my fingers and thought it would settle down. Unfortunately, after another month, it doesn't seem to have settled - the numb fingers are back. Has anyone else reported this happening after a Nerve Conduction Test? It does seem odd, especially when the result showed my CTS had dropped from Grade 4 to 2. If the length of time between a steroid injection and symptoms recurring is likely to get shorter each time do you think surgery would be the better option?

There are no reports of NCS aggravating CTS nor does there seem to be a general trend for duration of remission to get shorter with serial injections - instead the intervals between injections appear to be random and equally unpredictable every time. I think it might be interesting to test them again and see if it really is returning towards grade 4 and if it is measurable worse I perhaps would be inclined to head for surgery. I'll send out an appointment. JB

Dear Dr. Bland,

I hope I haven't complicated matters but thought I'd better let you know that I fell off my bike on 2nd Sept. and broke my right wrist. It was X-rayed at K&C who then sent me to Wm. Harvey where my wrist was manipulated, plaster cast applied & another X-ray taken.
The plaster cast was replaced with a fibreglass cast on 11th Sept. at K&C. I am due to have this removed on 9th Oct. and start physiotherapy on 10th. I am booked in for C.T. surgery on 9th November at Herne Bay. Will this appointment go ahead do you think? If not, will I be able to have another steroid injection in the meantime?

I'll discuss that one with the surgeon - 4 weeks from cast removal to surgery. I'll let you know. JB

Dear Dr. Bland,

I attended Mr. N. Singh's outpatient clinic today at K&C, had my cast removed and an X-ray taken. I have been given a wrist splint to wear during the day and start physiotherapy tomorrow. I discussed the issue of my planned C.T.S. surgery on 9th Nov. with Mr. Singh. He is of the opinion that the surgery should be delayed - he suggested at least two months from now. Would it be possible to have the surgery at K&C instead of Herne Bay?

I still need to discuss this with some of the surgeons - it's an unusual situation - leave it with me for a day or two. JB

What has happened to the CTS symptoms during all this? JB

I have spoken with Mr Smith and he is of the opinion that there is no predetermined ideal time to carry out carpal tunnel decompression following distal radius fracture. However it would seem sensible for full function to be restored prior to surgery as operating on a patient who has existing stiffness, residual swelling and/or pain would almost certainly exacerbate those symptoms. The suggestion that 2 months would be adequate are perfectly sensible but this may be exsessive or inadequate depending on the individuals clinical condition.I'm sure it's not beyond the realms of possibility to assess your condition prior to booking a definite surgery date. Hope that helps

You asked what happened to the CTS symptoms following my broken wrist. To begin with, to my surprise, my symptoms seemed to diminish - numbness and pins & needles weren't so much in evidence. I was beginning to hope that some sort of reversal had ocurred due to the accident. However, it wasn't long before they resumed & began to cause quite a bit of discomfort. At the moment I am coping with it - I don't think I've got any choice!

I attended my first physio appointment yesterday. The physiotherapist's advice was to leave the wrist splint off during the day and use the wrist as much as possible (the splint was very restrictive from the exercise point of view) but use the splint at night if the CT pain disturbed my sleep. I asked if a steroid injection would be possible while my wrist is quite stiff and swollen, if the symptoms became more severe. The physiotherapist didn't think injecting would be a problem. I have been given a sheet of exercises & my next appointment is on 17th Oct. I'll let you know how I get on. What is your opinion re a steroid injection?

I doubt if injection would do any harm. We're still collecting opinions about surgery. JB

I've now had replies from several of the surgeons and it looks like we will defer surgery for a while. I'll move your surgery appointment to the next available slot. We can however inject in the meantime if symptoms are troublesome. JB

I received my surgery appointments today. Is it possible to make the 21st. Dec. & 4th Jan. times a bit later in the morning? We live in Faversham & my husband (who is 76) is concerned about driving in the dark & possible bad road conditions in the winter months.

I think I will opt for a steroid injection in the meantime, if you think there is time before surgery. I used to have periods during the day when the numbness disappeared but now it is constant day & night, the middle & ring fingers being the worst affected. Could this have been exacerbated by the wrist exercises I have been given to do by Physio? Sometimes I wonder whether any pain/discomfort I have is due to the wrist healing process or the CTS.

My previous 2 injections have been at Sittingbourne & Whitstable. Do you now do them at K&C?

The 4th Jan appointment can be negotiated with Dr Rine at the pre-op visit and can almost certainly be later but it's harder to do anything about the 21st December as that list is fully booked and moving you later would mean negotiating with someone else to move them earlier.

We can inject for you in Canterbury on a Monday morning between 9 and 12am, just let me know which Monday you want to come and I will make sure that we are not too overloaded with hordes of people needing injections. If it feels as though it is getting markedly worse we might also re-test it for you to see if the grade is changing if there is time. I don't know the answer about exercises I'm afraid. JB

Thank you for your prompt reply Dr. Bland. Could you book me in for a steroid injection on Monday, 4th November please?

OK noted in the diary, 4th November - any time between 9 and 12. JB

Would it be useful if I did another Symptom Severity Test on line before I attend the clinic on 4th Nov - even though the CTS symptoms may have been affected by the wrist fracture healing process?

By all means do one online and store it. However, we will probably ask you to do a paper one on the 4th anyway - for technical reasons it is hard for me to import a new one from the website at present and much easier to just read a paper one. JB

Before my last steroid injection on 4th November the inside of my ring finger and middle finger had already become permanently numb, down to the fingertips. Unfortunately this did not improve following the injection. The surgery, which had been delayed because of my wrist fracture, took place on 14th December at Herne Bay. Again these two fingers remained numb. Since then I sometimes think I can detect an improvement in the insides of both fingers from the top downwards, but not reaching the fingertips. At other times I wonder if this may be wishful thinking on my part. Would a nerve conduction test determine whether or not there has been permanent nerve damage? Other than numbness I have some stiffness in these two fingers and in my hand but movement is OK. I am not sure if the hand stiffness is due to CTS or the wrist fracture.

Michael Nicholas, who administered the steroid injection on 4th November, kindly took time to look at the copies of the before and after wrist X-Rays (as I didn't really understand them) and asked me to let him know the outcome of the steroid injection and the surgery. Could you please update him for me?

Its a bit early after surgery to come to any conclusion about the persistent numbness as this can take a long time to improve. It is not obviously getting better at our routine 3-month follow-up we will test it again at that point to see how much change there has been in the NCS. Have the other CTS symptoms improved? I'll let Michael know how you are getting on as well. JB

Thank you for your prompt reply - I did wonder if I was being a little premature! I have no obvious CTS symptoms, other than the numb fingers and stiffness. Any actual pain on movement is definitely from the site of the fracture.

Fair enough - we'll see how it is at the three month point. JB

Dear Dr. Bland,

It is now over 3 months since my surgery on 14th December and I still have numbness in my middle and ring fingers. I haven't received the routine 3-month follow-up appointment yet but could you arrange a nerve conduction test for me please? I hope this will determine whether or not there has been permanent nerve damage.

You are probably in the current bundle of 3 months follow-up letters but given those persistent symptoms I'll schedule a follow-up test anyway. I'll add a bit to this message when I've done that so remind me if nothing happens for a day or two. JB

You asked me to remind you Dr. Bland - still haven't had a follow-up letter. Have you scheduled a follow-up test yet?

Re-test scheduled for 8th April. Both the appointment letter for that and the 3 month post surgical follow-up letter should be in the post somewhere. JB

So sorry to be a nuisance Dr. Bland but I will be away from 7th to 11th April. Can the re-test be changed to the following week (or next week if you have a cancellation)?

I might be able to find a slot in the week beginning 14th April - I'll have a look in the morning - I'm in Oxford next week. JB

I received the 3-month follow-up letter this morning. As you are arranging a nerve conduction test for me in a couple of weeks, am I correct in assuming it will not be necessary to make a GP appointment to examine my hand, as instructed in the letter?

I think we could deal with all of that in one visit here, and I've found a clinic space on Monday 14th April. Letter going in the post. JB

Thank you Dr. Bland - I'll see you on 14th April.

Dear Dr Bland,

When I saw you and Emma on 14th April for a nerve conduction test you confirmed that I had developed trigger finger in the middle finger of my left hand. Emma referred me to Hand Therapy for problems with my right hand and said they may be able to help with the trigger finger as well. I have since been using a finger splint at night, but this doesn't seem to be helping. I have an appointment with Hand Therapy on 22nd May - will they be able to treat the trigger finger? If so, I am happy to wait, rather than make a G.P. appointment.

Yes they should have some ideas as to what to do with the trigger digit. It's not my field but I understand that, as with CTS, the options really constitute physio, splinting, steroids and surgery. JB

Dear Dr.Bland,

When I saw you on 14th April for a nerve conduction test you said you wanted to do another NCT in three months time so you could compare the two. I haven't had an appointment through yet so thought I'd better let you know.

Regards J

I've just sent out an appointment for next week. JB