Return of Symptoms in left hand

Sorry right hand not left...

April to October is not bad but it would have been good to get a longer remission I agree. Can you think of anything you might have done to trigger it again? We could either re-inject or go for surgery and it's probably easiest to discuss the options armed with a new set of test results so I'll send out an appointment to come and see me again and we will try to reach a decision. JB

Thank you will hopefully see you soon.

Regards

Ann

Appointment booked for the week after this one. Letter will go inthe post tomorrow. JB

Since I came to see you my right hand is getting worst. The pain has increased at night and I am now finding that I am having more problems during the day. I have started to wear my brace during the day as well as night to see if that would help. It does to a degree. You said that I could have an interim injection whilst waiting surgery. Please can you arrange this for me. Would this be at Wye on a Monday as before? and would I be able to have this done soon as work commitments due to Christmas hours.
Regards
Ann

The quickest way to get it injected would be to drop in and see us tomorrow (Monday) morning in the clinic between 9 and 12 noon. I think Wye is quite heavily booked for injections at present. JB

Sorry but I've just been able to read your reply. Thank you for getting back to me. I didn't realise that I could have the injection at the clinic. When would be next time I can come up to the clinic for the injection? Next Monday would be easiest for me if that is ok with you as someone would be able to bring me up.
Regards
Ann

Next Monday (18th November) should be fine, anytime between 9:00 and 12:00 noon. I've put a note in the diary that we are expecting you. JB

Thank you I will see you next Monday 18th it will be about 11am.
Regards
Ann

I'm having the Opp on my right wrist this Saturday at Beltinge. I need a certificate for my employers will the doctor who Is operating issue this and how long will it be for. Also how long after the Opp will I see you in the clinic?
Regards Ann

John Rine may be able to sort out some form of certificate for you - if he can't then your own GP can. We would generally expect to keep you off work for two weeks until the stitches come out at least. I generally only see people after surgery if they have a problem or they want the other hand done and we usually start that process off by writing to the patient 3 months after surgery. JB

Not sure if this is normal and it is only 5 days after surgery but I'm having a few problems I took the bulky dressing off on Tuesday and left the small pad on. I've carried on with the exercises I started on the day of surgery and started the gliding and median nerve exercises. My fingers and thumb are still slightly numb and tingly and the joints are a little stiff. When I make a fist my middle finger locks, trigger joint, this is effecting my ring and little finger locking them too. I'm getting discomfort and slight pain in my ring finger especially at the base in the joint in my palm when I stretch my fingers out straight and it aches most of the time. I do get a slight discomfort when I bend my wrist backwards and especially forwards but I also get discomfort in the my palm to the base of my fingers when I'm bending my wrist backwards and my fingers and thumb are extended. The centre of my palm is tender to touch it feels as if it is bruised, which I know that it could be due to the surgery. The dressing pad, that I can change at the weekend, does pull on my skin when I'm doing the exercises it does feel tight.Would this course the problems I'm having. Also I did have two sharp pain moments in surgery, which only lasted a second I was told about this before the surgery that I might feel something when the nerves were being protected, would this course the problems.

Regards Ann

The various aches and pains around the palm are probably not anything to worry about unduly at this stage and I would discuss these sensations with Dr Rine's team at the stitch removal visit at 2 weeks. Trigger digits are strongly associated with carpal tunnel syndrome and the change in the mechanics of the tendons following section of the transverse carpal ligament might cause them to be more troublesome just after surgery. They can be treated as well if they become a problem. JB

Thank you.

Hello Dr Bland,

I spoke to Dr Rhines as you suggested when I had the stitches out on the 18th Jan. He said he thought it was because the tendons in my hand hadn't settled. I went back for a check up on the 1st Feb because of the problems. Which I am still having. Dr Rhines did sign me off for 4 weeks originally due to the nature of my work. After seeing him on the1st he allowed me to return to work on the 3rd although I was still having problems with stiffness in my fingers and pain in my wrist. He gave me a don'ts list. But I found it took difficult. I only did 4 part days.My job is very hands on and I was finding in the evenings I was having a burning sensation in my hand and up to my elbow.
I went to my GP on Monday 10th and he has signed me off this week and next I'm on holiday. I explained to my GP what was happening and he suggest that I might try and use my braces at night to see if this would help with the tendons.
The base of my palm is still very tender and slightly swollen. I'm still getting pain in my wrist but not all the time, mostly when I do certain things. I am still doing the exercises and I'm taking ibuprofen. All though I have got to let Dr Rhines know if I'm still having problems 3 months post opp please can you give me any advise. do you think that wearing the braces will help. I know that my hand can take a few months to repair properly.
Thank you,
Ann

There's no harm in trying the wrist splints as an experiment. Some people do get these pains after carpal tunnel surgery and they seem to be an unavoidable consequence of the operation in a small percentage of patients - one of the reasons that I am relatively conservative about sending people for surgery. Fortunately, in most patients they will settle down eventually but sometimes it cn be a very prolonged process and a few unfortunate patients are left with a permanent problem so I am not going to guarantee the outcome here. In patients with less than satisfactory outcome I generally test again at some point to check on whether nerve function has changed at all but that doesn't necesarily mean that I will be able to do anything active to help. In your case I think we will aim to check your nerve conduction studies round about the end of Feb/Early March - as long as you are available. I'll send out an appointment and we can cancel it if you make a sudden recovery. JB

Thank you I will let you know if there is any change.

Ann

Evening Dr Bland

I have received a letter from you today as it is now 3 months since my operation. You have asked me to fill in a form and to see my GP, but I've just started hand therapy at Ashford. I was assessed on the 26th March, which they gave me the same exercises as I have been doing since January plus some for my thumb and recommended contrasting bathing as I'm still having problems with my fingers as the base of my palm is still swollen. The movement in my wrist is still not good its still does have restrictions but it has started to improve slowly but I'm still getting a lot of pain around the base of my thumb and that side of my wrist. This they this is still due to the inflammation I can't do anything that means twisting my wrist the pain is too much they have diagnosed a condition called De Quervains Tenosynovtis, they did a test called Finkelstien's. I'm going back this week to have a custom made splint made to restrict the movement of my thumbs tendons. I have also been told to stop the thumb exercises as these could be making things worse instead of improving the problem. I have also been having hot wax baths which does help in the short term.

The carpal-tunnel its self seams have gone, I don't have any pain at night. so hopefully once the inflammation has all gone from my hand and wrist ect things will be ok. So at the moment I'm not sure whether I should go to my GP or fill out the patient form as requested. Please can you advise me what you would like me to do.

Thank you.
Ann

We have seen you recently enough anyway that it's not really necessary to complete that form (they get sent out automatically) - I already know the story quite well. What you could do is complete another symptom severity questionnaire here on the website for me (from the MyCTS pages) so that we can track how the symptoms evolve. The last score I have is from 27th Feb so a new one now would be of interest. JB

Evening

ok I will do that.

Thank you.

Ann

Hello Dr Bland
Since I last contacted you I have finished phyiso at Ashford. I don't have any symptoms of carpal tunnel any more no pain at night or pins and needles. I still don't have full strength in my right hand but I do compensate for this. I do still get some pain and aches in my hand and wrist. The thing that has happened is that recently trigger joint had returned to the middle finger on my right hand and I've started to get it my left thumb. My thumb is worst it happens nearly every time I bend it. Please can you advise me, do I contact my GP about this or do I come back to you?
Regards
Ann

That's all a familiar story in association with CTS. The trigger digits also respond to either steroid injection or surgery but I'm afraid we don't do that and if your own GP practice does not do trigger digit injections then you will need the hand surgeons if they are troublesome. I would therefore ask your GP about the tirgger digits. The weakness of grip and wrist pains are probably related to the carpal tunnel surgery and may settle in the long term if you are lucky. JB

Thank you will contact my GP and see what they can do.
Regards
Ann