Questionaire Results.

Having looked through your questionaire answers I would agree with the website's automated assessment that they are not really typical CTS and that was presumably the impression gained by your GP too. You sound a little uncertain about the response to steroids but maybe that's just me over-interpreting what you've written.

The questionnaire was originally developed using patients who did not have an existing diagnosis of CTS and who had not been treated for it so it is 'tuned' to detect such cases - it is therefore likely that it would perform less well diagnostically in other groups of patients and even in it's target group it is of course by no means infallible. You have already had yours injected so you are not a treatment naieve patient.

Another thing to consider is the possible coexistence of two problems. When patients with low web scores do turn out to have nerve conduction evidence of CTS they do tend to show relatively mild abnormalities and I often wonder whether they have a median nerve problem at the carpal tunnel which is something of a red herring because it is causing few of the symptoms - do you have the results of your NCS? JB

Thanks for the reply, unfortunately I don't have the results currently. Athough next time I visit my Doctors I will ask for a copy.
As for the steroid injections. It seemed better at first, but either has stopped working or has not worked as well as I thought.
I polish metal using rotating machinery, sometimes hand held machines, I struggle to do this for more than an hour.

Unless your nerve conduction abnormalities were very definite I would have some doubts about whether CTS is the main problem then. It is easy to overinterpret mild abnormalities on nerve conduction studies and now that all and sundry are being encouraged to do their own those of us whose speciality it is are a bit wary of some of the reports that are being quoted. JB

Morning, I have uploaded my result from the Nerve Conduction Studies.
Hopefully the image links will work!
The results from both the first appointment and the second (first results from right hand were inconclusive) are all in the same image.

Thanks again,
Chris

http://img62.imageshack.us/img62/2112/m20v.jpg

http://img838.imageshack.us/img838/2117/l2gq.jpg

http://img825.imageshack.us/img825/2605/dgz6.jpg

OK those studies are interesting. The exact interpretation depends on the normal values for the laboratory in which they were performed. These appear to have been done by a semi-retired neurophysiologist now based in a GP surgery and the printed results do not show his normal ranges. Had these results been obtained in my own lab - where we use the same machine interestingly, your left hand would have been grade 1 CTS in the initial studies, the right hand normal. The right hand results on the second study are, if anything slightly better, though the difference is probably not significant. It is a pity that the opportunity was not taken to repeat the left hand as well in November. If his normal ranges are much stricter than mine then the left hand might be as high as grade 3. You would usually want to test the right hand further using one of the sensitive comparative tests for CTS which show up small differences in conduction speed between the median and ulnar, or median and radial nerves, but these seem not to have been done.

I think it is perhaps worth thinking at this point - which hand feels worse to you? If symptoms are worse in the right hand and assuming you are right handed, then I would have considerable reservations about whether such a minimal CTS is really the explanation for the symptoms. I would also be a little wary of surgery on the left side as even there the nerve conduction abnormality is not very marked. I would put quite a lot of weight on the response to injection as this has been shown to be a fairly strong predictor of the response to surgery. You might even consider a second injection with fairly careful monitoring of how the symptoms respond. If symptoms persist and no alternative diagnosis becomes apparent then eventually you may have no alternative but to operate on it and keep your fingers crossed.

If you do have surgery I would be very interested to know the outcome. One of my future projects for this website is trying to build personalised predictive models for CTS treatment. We may be able to give people more objective predictions of the likely success rate of various treatments if we manage to collect enough outcome data. JB

Thanks again for the reply, I've left things a while to think about what you said and also to monitor my symptoms.
I now have numbness in both hands in the morning when I wake up, but not during the night (at least it doesn't wake me).
I tried Acupuncture on 15-7-13 with the mindset that probablyowuldnt work. It was acupuncture then some herbs to soak in boiling water and then put hands in it for 10 minutes when it has cooled. It seems to have changed the pain in my hands, I don't have numb hands as often in the morning and using vibratatory tool doesn't affect me as much. I will complete the treatment they gave me and then complete the questionaire again as it would be good to compare to what it was like before.

I am left handed, and generally my left hand is the most painfull.

My doctor seems to have concluded that it is CTS and that surgery is the only step to take.

Ive noticed the numbness in my hands occurs mostly when holding something with a small diameter, such as a broom handle, or paintbrush etc. or when using vibrating machines.

Power grip round small objects (brooms, bicycle handlebars etc) certainly seems to agravate CTS and vibration is known to be a problem too so that element of the story makes sense, as does the symptoms being worse in the dominant hand. I'm not very impressed with acupuncture so far but it's impossible to judge from single cases, especially in a condition like CTS which naturally waxes and wanes anyway. Are you splinting them at night at present? JB

I did started using the wrist splints again, but that's when the numb hands in the mornings started (the same night I started using the splint) so I stopped using them thinking it was connected. It carried on after I stopped using the splints.

Quite a nice illiustration of how hard it can be to analyse whether something is making a difference to symptoms sometimes. Overall I think you present us with quite a diagnostically difficult case in terms of symptoms and history, with marginal neurophysiology and somewhat uncertain responses to treatment so far. If you decide to go ahead with surgery in the end I would be fascinated to know the outcome. JB

I've had to re-register as I don't know the password and can't remember which email address I used to register.

Anyway, I still get symptoms on and off. I had numb hands for two week when I woke up but then nothing for ages. Using my iPad a lot still makes my fingers numb.

In the last two weeks my thumb I can't really move without a lot of pain when I wake up, it gradually gets better during the day. There is a clicking sensation that feels like a joint is coming out of place. There is also pain in a bone that sticks out behind the thumb in the wrist.
I've not fallen or injured it as far as I know.
I'm off to see a doctor when I can't get an appointment but do you think this is likely Carpel Tunnel related?

The thumb pain, joint clicking and bony prominence are unlikely to be related to CTS - arthritic change in the thumb joints is quite common. I'll sort out your registrations later and email you the login and a new password. JB

Thanks, it's possible I no longer use the email address I registered with.

Hi, I am back. I have had on and off pain since my last post, but never as bad as my first posts in 2013. I have not woken up with numb / painful hands for a very long time. Vibrating tools can still be bad, such as drilling.
I am an Engineering Manager and use my hands all day with no real problems. Small fiddly work does get painful after a few minutes, ands I get a muscle spasm sometimes when holding something very thin such as a wire, it is a similar reaction to getting an electric shock with the rapid hand retraction. Other people who have seen it also think it looks like I got an electric shock.

The main time my pain is bad is when using a computer mouse / keyboard. I am starting a new job in a few weeks which will be mainly computer work. I'm wondering if there have been any new knowledge gained about Carpel Tunnel which might make it easier for me? Or I may see if I can get a private steroid injection to try it again. Or even try Acupuncture again!
Or you you have any thing else you can recommend? I've tried using an upright mouse, it's better, but still painfull.

Looking back through the thread I think it remains rather uncertain whether the problem is actually CTS. There have been no very striking developments in treating it in the last 7 years and the only approaches with a really good evidence base behind them remain splints, steroids and surgery but in your case I think the initial challenge is diagnosis rather than treatment. It would certainly be worth repeating your nerve conduction studies after such a long gap to see if anything has changed, and ultrasound imaging of your median nerves would also be interesting if you can find anyone local who is good at nerve ultrasound (there aren't many I'm afraid).

I think you have a couple of accounts here on the website again so we might do a bit of tidying up later but there's a busy clinic today.

This topic is attracting spam so I'm locking it. We can pick up in a new one.

JB