Just beginning diagnosis process


Hello from the US, and thank you truly for this website's wealth of information.

I am in the early stages of diagnosis. Unsure yet whether CTS. Healthy, 35 years of age. This is the long/short of the symptoms:

* Long-term (2+ years) hand/forearm discomfort historically presenting as aches/fatigue, massaging palm muscles etc., after computer use.
* Nearer-term symptoms aching/fatigue outside of computer use during daily activities
* About a month ago I got weakness/pain in the right forearm extensor muscles and tendons, even just when lifting my wrist. I switched to computer mouse use with my left hand (non-dominant) and quickly got same symptoms on left. Those symptoms substantially but not completely subsided after ceasing traditional typing. Flexing wrist still often causes a bit of a "catch" in the tendons.
* In the last week and a half, classic CTS-like symptoms occurring in both hands: tingling and change in sensation in thumb+2 fingers, weakened grip, thumb muscle aching, hand fatigue, and a feeling of clumsiness with the hands.

I also have essential tremor which seems to have gotten worse with the last week and a half of CTS symptoms, possibly contributing to the clumsy feeling. The forearm weakness is what sent me to the doctor but the CTS-like symptoms most concern me now. I had an NCV/EMG done, showing reduced Right Median Motor (APB) amplitude and Left Ulnar Motor (ADM) velocity as the only issues. I could email my test results if it was helpful. I was not pleased with the technician doing my NCV; incredibly rushed and stopped halfway through to work as receptionist for 15 minutes. I see a hand orthopaedist/surgeon tomorrow morning. This will be the first physician with the knowledge to give some guidance.

Sorry if this post is unfocused. Here are some random questions:

1) I never wake up at night with symptoms. Still possible to be CTS?
2) Is it a coincidence that I have an NCV showing right median issues, but left ulnar issues, yet CTS symptoms in both hands, even the one without tested median issue? My left median nerve tested fine and yet I have some tingling and hand issues in the CTS-controlled parts of that hand.
3) If I have CTS, what severity does this sound like? The weakness, clumsiness, and sensation changes are distressing.

Thank you, truly.


The original symptoms don't immediately sound like CTS but some of the more recent ones obviously could be. I'll happily look at the NCS results if you want to email them over. Usually amplitude changes in the motor studies are not significant unless they are really gross - the conduction velocities are much more reliable measurements. You don't have to have night-time symptoms for it to be CTS - I think this depends on your habitual sleeping position. Patients with early and somewhat atypical CTS symptoms tend to have pretty mild CTS but this is not a hard and fast rule.

it would be a good idea to run through the diagnostic qustionnaire on here too to see what sort of score you come up with. JB


Dr. Bland:

I have been reading through the forum posts here and I am absolutely astonished at how freely you give your time and knowledge. A simple written thanks seems wholly inadequate.

I will email you my nerve study in the next few minutes. I'll be honest in that, if I do have CTS, I firmly believe I have some other complications affecting me. I have aches and pains through much of the hand and wrist, including on the back-side, which obviously don't seem like classic CTS. The tendonitis-like symptoms that originally sent me to the doctor seem like overuse issues. I don't know if any of that could present CTS-like symptoms.

I'm keen to be armed with some information before my visit to the hand specialist. Thank you.


I've replied by email about the NCS in detail. I think we should keep that off the public forum. JB

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