First Injection

It's hard to be sure whether the stiffness of the fingers is something to do with the CTS or whether it is genuinely a problem with those joints. Keep us informed and we will continue to think about it. I will also move this discussion into the Canterbury patients forum once you have had a chance to see this. JB

Thanks for your reply. Finger problem is now mainly stiffness in the second finger which I can make touch my palm but with a lot of pain. The stiffness appears to be in the middle joint and there is also still some numbness in this finger. I also have aches in my biceps and leg muscles which I assume is not related to CTS.

It is safe to assume that lower limb symptoms are not related to CTS. My guess would be that the stiff finger joint is perhaps also a different problem but we will see how it evolves. JB

It is now one week after injection into my right hand and although the severe pain has subsided which I am thankful for, I feel that the underlying CTS problem remains ie. that there is still a loss of feeling in the second and third finger, the palm and finger tips are ultra sensitive and the second finger joint is still swollen and therefore restricting my ability to grip. The steroid injection also in my case appeared to adversely affect my muscles generally, causing aching and a general feeling of weakness therefore I would be reluctant to have any further injections..

I feel in hindsight that I wish I had requested to go down the surgical route rather than injections and if this an option would you please consider placing me on the waiting list. I have read your notes around surgery and understand the risks involved.

I certainly wouldn't expect general aching and weakness from a single dose of steroids and we need to keep an open mind about what other problems you may have - certainly the swollen finger joint seems very likely to be some form of arthritis rather than being directly linked to the CTS. The sensory loss in the fingers however almost certainly is related to the CTS.

In general you can expect the same sort of change in symptoms from surgery that you get from injection - the major difference is that the improvement with surgery is more likely to be permanent. At the moment I could find you a date for surgery in Herne Bay on 8th February. We might be able to get an earlier date in Margate or Canterbury - but it might also be later done that way as I have less control over the way operations are booked in the main hospitals. JB

Thankyou for your understanding. Would you kindly book me in for 8th February but also try for an earlier date elsewhere. I am willing to travel any distance to expedite the situation. Many thanks.

If I book the 8th Feb in Herne Bay then I can't also put you on another waiting list. We occasionally get cancellations in Herne Bay, though not often, so there is small chance of being brought forwards there but there is no mechanism for just being on standby for a completely different waiting list. Have a think about it as I won't be booking anything until Thursday now. JB

Thankyou for your comments. Would you kindly book me in for 8th February in Herne Bay. JC.

Booked. An appointment letter will go in the post tomorrow morning. JB

Many thanks for booking my appointment.

Just for the record I am still having problems with my right hand second finger ie. it is very stiff and the finger tips and palm are very sensitive. Also my muscles generally feel very weak and are very stiff and painful when I move.

My GP has diagnosed my finger problem to do with Dupuytrens Contracture which he feels may have been masked by the Carpul tunnel problems and he has booked me an appointment with an orthopedic hand surgeon in January. Happy days! JC.

Dupuytrens is very common in people with CTS but it still sounds as though you have more widespread symptoms than can be easliy explained just by local problems in the hand. Well worth seeing one of the hand surgeons though. JB

I saw the Orthopedic surgeon today, thanks to an unexpected call from QEQM. The stiff finger has now been diagnosed as "trigger finger" for which the normal response as you probably know is an injection. However as my CTS injection was on 3rd Dec. it was deemed too close and I have to return after three weeks when a decision will be made on whether to inject or not. Regarding my general arthritic symptoms the consultant advised me to take this up with my GP. JC.

It sounds as though we are all a bit suspicious that you might have more generalised underlying problems. JB

Since my last message my doctor has injected my RH 1st finger on 6th Jan. which has improved the movement but still has some numbness and stiffness at the knuckle joint. The LH index finger is also showing similar symptoms. I've had no Carpal Tunnel pains as before but the muscle pain around the biceps on both arms still persists and I'm continuing with pain killers for this. Ive had a blood test for Polymialgia which was negative. My doctor's current theory is that I have osteoarthritis in the neck area and I'm booked in for an MRI scan on Ist Feb. I am also booked in for carpal tunnel surgery at Herne Bay on 8th Feb.

My question is: If the osteoarthritis theory proves to be correct could this have been the original problem leading to inflamed tendons which then showed up as carpul tunnel syndrome? Also, as I currently have no current carpal tunnel symptoms, would it be prudent to cancel or postpone surgery on 8th Feb?
I hope this all makes sense.
Thankyou
JC.

Yes it is at least theoretically possible that osteoarthritis could indirectly predispose you to CTS, with or without inflammation of the tendons. However, that does not mean that the CTS element of it would necesarily respond to treating the osteoarthritis, not least because there is no easy treatment for osteoarthritis. If the CTS symptoms are markedly better we can postpone surgery. If we do that then I think it would also be worth planning to see you again so that I can fully catch up with the latest situation. JB

Thanks for your comments. Could you please make an appointment for me to see you again then as soon as one is available.JC

OK I've deferred the surgery booking for now. I can re-test you again on Thursday afternoon at 14:30 and we can have a discussion about the best way to proceed. There's no time to get an appointment letter to you so just turn up at my clinic on Thursday. JB

thankyou, I'll be there 1430 Thursday. JC.

See you then, I've booked it into the diary. JB

Hi Dr Bland,
Since I last saw you I was diagnosed via MRI scan with a torn tendon in my upper right arm. This healed naturally and I've been ok all summer. A few weeks ago I started getting stiffness and pain in my right hand following some paint stripping at home. I expected this to subside after a week or two but the stiffness and pain when gripping or for instance trying to open a jar, has persisted. I saw my doctor today and he has suggested I contact you direct via this forum with a view to having more CTS tests. If you would prefer my doctor to make another referral he will do this. I carried out another CTS survey in October and the results are on my record. If I still do have CTS I would prefer to go down the injection route at least initially.
Thank you.

No need for a new referral at present - we will send out a new appointment and see what we are dealing with. We will need to have a talk about the pros and cons of serial injections too. JB