Help and hopefully advice
Firstly i'd like to say what a brilliant site this is, some very helpful and useful information on here.
About 4.5 years ago I had bilateral decompression performed just before Christmas, symptoms were quite bad (my definition) in both hands and were making working very hard - was then a self employed satellite engineer. Right hand was always worse than left hand, and this was backed up by the NCS results.
I tried splints for both hands to no avail and also had a steroid injection in right hand, which made no difference at all, apart from been extremely painful and causing a bad reaction to the point i went to A&E a few hours after having injection. I was ok immediately after the injection, but over the next couple of hours I would go from been absolutely fine, to be very disorientated, cold sweats, slurring and very confused, only to return to normal a few minutes later. This persisted for 2-3 hours, at which point other half dragged me to A&E, by the time I was seen it had stopped. Never did get to the bottom of it, but put me off having it again. The injection was done to try and help whilst waiting for the op.
Hands were quite painful after the op, i struggled doing anything for the first few days following the op, pressing buttons on a remote control was about as much as I could manage.
I suffered with a lot of pain, numbness, swelling and tingling before the op, GP had put me on Tramadol which helped with the pain.
Things did improve after the op, but never went away completely, still suffered with some pain, numbness, swelling and tingling but not as bad as before, although would wake up near enough every morning with completely dead hands and have to throw them over the edge of the bed to get some feeling back.
About six months after the op, i had an accident whilst working, a ladder was dropped on me from three floors up, with the hook on the back of the ladder landing in the area at the bottom of the thumb between the hand on my right hand. I had surgery a couple of days later to check for damage, which was performed under a local block. Apart from the impact of the ladders the surgeon reported no further damage was done. I had about 6 weeks off work to allow it to recover. The thumb will now not extend fully down due to the scar tissue and some tightness of the skin.
Over the years since the surgery the conditions have returned and i am now pretty much back to where I started before the original surgery. I have changed my profession so I am no longer working "on the tools" and am now office based.
Whenever i do anything with my hands, it doesn't take long before my hands start really hurting general pain through the area at the base of my thumb and through my wrists. They will swell quite substantially, most of the time I am unable to get my thumb to touch the tip of my little finger. For example if using a hammer, I get maybe 2-3 hits with the hammer before my hands start to hurt to where I have to stop.
Sitting in the chair and holding a plate to each from (with my left hand) becomes painful after a few minutes and I have to repeatedly put it down to rest my hand. Driving can cause problems with my right hand and I start getting some pain and discomfort in it and a period of holding the steering wheel and after a long period of driving it is very uncomfortable.
If I do a lot of typing over a few days, which happens quite frequently my hands also become very uncomfortable. Recently they have on a few occasions, not following any particular use, swelled and gone very hard, hot and quite blotchy and itchy. This has happened both during the day and evening.
i don't take any pain killers unless they are particularly bad, when I struggling to hold a glass or cup of coffee, i have quite a high pain threshold - when the ladders landed on me, i didn't have any pain relief at the hospital whilst they were prodding and cleaning the wound out, not until i got home and took what had been prescribed.
I have gone back to the original surgeon at QEHB Birmingham, in whom I have every confidence and get on with, I have been referred for a further set of NCS studies which are scheduled in for a couple of weeks time. These have been done several times previously, on my elbows as well in case there was anything with the Ulna nerve?
As I say I have every confidence in the consultant I am seeing, suppose I am after your opinion as well, as I am getting close to wits end with it now. I used to do climbing and teach outdoor activities, which i no longer do as I don't have the ability to keep hold of the rope for long enough if something went wrong, I have also had to stop shooting (shotguns) which I used to do quite regularly (once a week at least)
Thanks
Hi
It's taken just over 12 months to move any further along with the above, and nothing has really changed.
I was sent back fro further NCS tests, which returned normal results and indicated no reoccurrence of the CTS, so the surgeon (Mr Powers) referred me for an MRI of the neck.
I finally had this a few weeks ago, and a letter from the hospital this morning. There is nothing to demonstrate any nerve root pinching in the neck. The last NCS demonstrated that the nerves are conducting normally across the wrists, not further surgery is required, the test did confirm that at some stage in the past i have had some irritation of the nerve roots int he next and this is usually a manifestation of early neck wear and tear with intermittent compression.
As there is no current compression of those nerves, there is nothing to be offered by way of referral or surgically, advice is to keep neck mobile.
I am not at a loss as to what to do, the symptoms have not got any better at all, if anything they are worse and there is no more pain across the joints in the fingers on both hands, although more prominent on the right hand, i have started occasionally getting a deep pain to the scarring and general impact area on the right hand from the ladders.
Any advice you might have on where to turn or what to do now would be appreciated, as I am at somewhat of dead end at the moment, and need to get something resolved about the pain and swelling, after 6+ years now it lost any appeal it may have had.
Thanks
That's a really tough problem and you may find the only resource left to you is referral to a pain management team. If they are available I will happily take a look at the nerve conduction results and there may be a little more that could be done by way of investigations but it is quite likely that tests at this point will not reveal an obvious avenue of treatment. Has your surgeon offered a diagnosis for the current problem? JB
I don't have the results, but i will see if I am able to get them.
I am going to go back to the GP and see if they can do anything more in terms of referral.
With regards further diagnosis, nothing has been offered. it was said in the letter i received there was nothing more to be done in terms of referral or surgically and I would not need to attend the clinic.
... which does rather leave you in limbo with not very functional hands doesn't it! Let's see if there are any clues in whatever results we can lay our hands on. JB
Hi again.
Apologies for a long delay, unfortunately work tends to take over sometimes.
I've not been able to get results of anything, between work and life it slipped through the net.
The last couple of weeks hands have been playing up worse than normal and getting worse, and the last couple of nights i have woken up during the night with a very cold and numb left hand and my right wrist in some quite significant pain.
I have been doing a few bits around the house the last couple of days, but nothing too much more than a bit of light cleaning, it was hoovering around today chasing cob webs for example and had to give up after a few minutes as was struggling to group the vacuum pole.
Writing has become quite challenging recently, i am only able to manage 2-3 lines of writing before having to keep stopping to break as it becomes very painful and the pad at the bottom of the right thumb get quite hard and red.
Both hands are now swollen a lot of the time, I try to monitor this by trying to touch my little finger to my thumb, which I am not able to achieve easily and is quite painful to do.
I am going back to the GP this week, but is there anything you can suggest as this is getting quite frustrating now and really starting to impact upon life quit a bit now.
Thanks
It really is a thorny problem and I don't think I have any other useful suggestions without being able to see you. As I said to someone a week or two back, one of the frustrating things about running this site is getting stories from patients which make me itch to get my hands on them and take a look a look at the problem for myself - there is only so much you can achieve through a written exchange like this and I really need to see the hands and the NCS results and ultrasound imaging to have the best chance of saying anything useful (and even then there are cases that stump me completely of course). Do you know which neurophysiologist tested you last in Birmingham? JB
I don't know who tested last i'm afraid, although I will be getting in touch with Mr Power's secretary today to ask for copies of the results.
I saw the GP last week, who has prescribed naproxen and co-codoamol for a month to see if that helps, but so far not made any difference, and this week the hands are getting substantially worse.
Thanks
Well at least that attempt at treatment adds a little more in the way of diagnostic clues. Analgesics of that type work for some kinds of pain, predominantly those associated with inflammation, but are generally poor for nerve related pain. Good luck with finding some of the records. It's interesting how many of the American visitors to the site have ready access to all their results whereas relatively few people in the UK manage this. Personally I've always felt that patient held records were a pretty good idea but I seem to be in a minority. JB
That's a pretty complex story of course and I think to make any real progress with it I would want to see the hands, look through the entire series of NCS results, and almost certainly take a look at the ultrasound imaging too as well as working in conjunction with a decent hand surgeon - it sounds as though you may have one of those. My first guess would be that in fact you do not have a single unifying diagnosis and that there is perhaps a bit of CTS, some residual side effects form the first surgery, some additional soft tissue injury from the ladders, possibly some arthritic change in some of the undrlying small joints and maybe even a bit of complex regional pain syndrome. The response to the very first injection is interesting and unusual but I don't suppose you know exactly what steroid preparation and dose was used as it was so long ago?
I wonder who your neurophysiologist is - there are lots around Birmingham now. I did part of my training at the old QE and there were only about 5 consultants in the area then. You can always ask them to copy the latest results to me if you like but you will probably get as good an opinion from any of them as long as they have a chance to think about it. In some set-ups now the NCS will be carried out by a technician and only seen by a consultant later, if at all. That is fine for ordinary screening tests for CTS but less suitable for a case as complicated as this. JB