New to CTS, possible borderline diagnosis. Have some questions

v10003
Offline

Hello everyone. At the bottom of this post I have some questions mainly regarding : Are there conditions which can give a false positive/mask themselves as CTS on a nerve conduction study? But let me get into my history first a bit..
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I believe I have either developed tendonitis or CTS from doing repetitive self scalp and neck massage with my hands using massage tools called bian stones. I did the massages for 5-6 months, almost every day. They helped with scalp itchiness, stress release, and muscle soreness. I got in a habit of doing them and they really helped me.

Unfortunately, I started to develop some sharp shooting pains in both my wrists, I believe due to the sharp angle at which I held the massage stones. I kind of ignored the pain, thinking it was just my hands getting used to the exercises. Well the pain continued. I didn't have numbness or tingling, just the sharp shooting pains in my wrists. Really that was my main symptom. So 6 months into massage I decided to take some time off. I took about 4-5 months off and the pain decreased dramatically, but was still there here and there. I decided recently to start the exercises again, but in a somewhat different way using only my hands, at less of a sharp angle. Only one 20 minute session. I also went to the gym that day to do some hanging exercises, maybe the strain from that did it. Now it seems I have some weakness/clumsiness in my right hand. A lingering tired kind of feeling. Pain is still intermittent, but this sudden weakness in my right hand is the most concerning thing.

Also, throughout this whole ordeal, just being on my phone texting or the computer would cause intermittent pain sometimes in my wrists but not all the time. But now since I did that one day of massage coupled with hanging exercises at the gym, this weakness in my right hand just appeared all of the sudden.

I went to see my hand specialist, went for an emg/ncs, and the technician said I showed latency at just above normal levels. So a borderline/mild CTS diagnosis. I believe my latency for my right median was 3.8 for sensory and 3.7 on left for sensory. Normal is >3.6 yes?

Anyways, couple questions here:

1) Is it possible a wrist strain or wrist tendonitis can mask itself as a positive CTS diagnosis on an NCS?

2) I was extremely tired from working the graveyard shift prior on the day of taking my NCS. Could this effect latency results?

3) What other factors, besides lotions/creams, could effect and bring about a false positive diagnosis on an NCS?

Thanks so much in advance to anyone in the know!

jeremydpbland
Online

Those are not really typical symptoms of CTS. The first thing to understand about this diagnosis is that it is made primarily on the clinical symptoms, and occasionally signs, and that if the symptoms are not those of CTS then it doesn't really matter what the NCS show - ie it is not a diagnosis which is either made or excluded by the NCS.

Secondly there is not a single universal set of normal values for NCS - they vary from lab to lab - so if your lab say those values are outside their normal range we cannot argue with them, though normal ranges are statistically defined and usually 'outside the normal range' means that one in 20 normal individuals will have results like this.

Tendonitis/tenosynovitis do not affect your nerve conduction results unless they cause a secondary carpal tunnel syndrome, nor is tiredness likely to affect them. Temperature can have quite a marked effect though - cold hands are a potent cause of nerve slowing and the superficial skin temperature may not match the core tempreature if you have been out in the cold and then been quickly warmed.

The commonest reason for 'false positive' NCS suggesting CTS is the statistical one above but there are also quite a lot of technical recording errors and some other disorders such as polyneuropathy cn be mistaken for CTS by the unwary. JB

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