Swelling of the hand after steriod injection

theillustratedmum
User offline. Last seen 2 years 16 weeks ago. Offline

I have had 4 weeks with splints but they didn't make any difference, so I today saw my GP who gave me an injection in my right wrist on the spot. The injection itself was not bad at all but since then the pain is unbearable from my fingers, right up my arm, this I expect is quite normal but my whole hand has swollen very much, my thumb & fingers are especially bad. Is this normal? Also if this does not help in the long run what will happen next?
Many thanks for taking the time to read this
Kind regards

jeremydpbland
User offline. Last seen 1 hour 40 min ago. Offline

No that is very definitely not normal - neither the pain nor the swelling. Go back and see your GP as soon as possible. In the original referral for nerve conduction studies your GP did not ask me to intervene in the management of the case so I should not interfere but if I heard this from a patient who I was treating I would want to see you tomorrow. Has there been any colour change in the fingers? Did you feel any tingling on needle insertion? JB

theillustratedmum
User offline. Last seen 2 years 16 weeks ago. Offline

thank you for getting back to me, my fingers are very blotchy apart from that they aren't very different in colour. The injection itself didn't hurt too much but my hand was already quite numb by the time he did the injection just from the position it was.
Thank you

jeremydpbland
User offline. Last seen 1 hour 40 min ago. Offline

Well this could be some odd kind of hypersensitivity reaction to the injection - most probably to a component other than the steroid - but there are also completely different disorders which would present with a swollen, painful hand/arm and this definitely needs looking at - unless of course the problem has resolved today. JB

theillustratedmum
User offline. Last seen 2 years 16 weeks ago. Offline

Thank you for the advice, I have an appointment to see my GP as my hand & fingers are still a bit puffy and painful.
thanks again
Kind regards

jeremydpbland
User offline. Last seen 1 hour 40 min ago. Offline

I hope it has turned out OK - I would be interested to know what diagnosis, if any, is offered for this acute episode and how it turns out - even though I am not officially looking after you. We see very few significant complications from carpal tunnel injection and I think they should be better documented in general. JB

theillustratedmum
User offline. Last seen 2 years 16 weeks ago. Offline

Sorry for the delay in updating you. My doctor diagnosed a severe reaction to the injection and referred me to ICATS pain clinic, who are now referring me on to orthopaedics at the William Harvey for operations on both hands. It seems that I was allergic to the aesthetic, I have had facet joint injections in my lower spine a while ago which also caused me a lot of pain rather than helping, which at the time we were unsure as to why they seemed to make it worse. My doctor now thinks that I should avoid steroid injections and general as well as local aesthetic where I can.
Many thanks

jeremydpbland
User offline. Last seen 1 hour 40 min ago. Offline

Thankyou for the follow up information. Personally I suspect that genuine hypersensitivity reactions to steroids are probably very unusual indeed and that most people who have a bad reaction are reacting to some other component of the injection. If he used a local anaestheic mixed with the steroid, as many people do, then that obviously further increases the number of things in the injected 'cocktail' to which you could react and the story of pain on facet joint injections is therefore also interesting - I wonder what they used to inject those? Unfortunately the exact details of what is being injected are rarely made known to the patients on the receiving end. I presume that the swelling did settle in the end? If so then what happened to the original CTS symptoms? As some time has passed it might also be worth repeating your nerve conduction studies before taking a knife to the wrists - I generally consider that results are starting to get rather out of date after about 6 months and yours were 8th September so it's already 4 months now, it could well be 6 by the time you get through the orthopaedic process. It's also, of course, pretty hard to operate on the carpal tunnel without anaesthesia of some kind - usually local - so you will present an interesting management challenge. JB

theillustratedmum
User offline. Last seen 2 years 16 weeks ago. Offline

The swelling and pain went within a couple of days. The CTS symptoms may have settled a little after the swelling went but I still had some numbness at night & it still ached. After a couple of weeks it was certainly back to how it was before. The CTS symptoms now are very severe, in both hands. Just to complicate things, I have a blown disc in my neck (C6-7) which is complicating the problem on the left side. I had foraminotomy surgery to help with symptoms about 4 years ago. They were going to take the disc but felt that if they took it, then within 10 years would have to take the ones either side as they aren't too good either. I have still experienced problems with it since so it complicates the CTS problem as the symptoms are so similar. Since Christmas my left hand has worsened which I'm unsure whether it is caused by my neck or my wrists. The top half of my thumb, index finger and middle finger are permanently numb and I have upper arm pain too. My right hand which I was told the CTS is worse in, is also a lot more painful now, I can't even do simple things like peel potatoes as the pain in my hands and wrists, is so strong. I am on slow release morphine daily, amongst other thing for my back problems and this doesn't seem to help the pain in my hands.
Sal

jeremydpbland
User offline. Last seen 1 hour 40 min ago. Offline

I think given the added complication of the known disc lesion in the neck and the rather poor symptomatic response to injection (disregarding the 'reaction') one would be very wary of predicting the outcome of surgery for CTS here - but on the other hand you do not have a lot of other alternatives. I hope you get seen by one of the specialist hand surgeons and if it is operated I would be interested to hear how it turns out. JB

theillustratedmum
User offline. Last seen 2 years 16 weeks ago. Offline

I will certainly let you know what action if any is taken and what the outcome is. Personally I wish I was under your care but I'm sure it will be fine wherever I end up being seen. Thank you!
Sal

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