Relapse
I'm starting a new thread in case others find this information to be useful.
Once you get your CTS to go away, regardless of the method, what is your take in regards to CTS reoccurrence? Do you think your day to day actions will be the cause of your relapse, if you were to have one? I'm passionate about fitness and love CrossFit, but it is obviously very hard on your hands and that tunnel. Should one worry about doing things like that or computer work after they get their CTS fixed or best to avoid it if possible to give yourself the best chance of living the rest of your life without anymore issues?
The medical professionals I have asked this question basically have said, no one knows. If you have to resort to surgery, should that be a major worry, doing those things and causing yourself to have surgery again? I am not aware of had bad it is or the consequences of having to do the surgery again. Or is it not a big deal to have to do the surgery more than once in your lifetime, minus the risk associated with the surgery itself? Once you destroy that structure, is it a big deal having to cut it again more than once? Or would you be at a point where surgery can't help you as there wouldn't be anything to cut again to give your tunnel more room to alleviate your symptoms. Does that make sense? I, myself, am only 36 so I hopefully have a long life ahead of me.
Curtis
Awesome reply!
If after an injection, do you think wearing a splint at night and maybe some during the day will help keep it fixed longer?
Based on what you said, sounds like most people will ultimately need surgery. Or in my case, would be the answer of lets just be done with this already. It's been too chronic for too darn long. Minus the complications of the surgery itself, what are the major consequences of surgery? I know you are destroying a structure, but what harm will come with that? So many people have it done every yr, makes you think it isn't the devil...
With my particular case, I want to just say lets do the surgery and be done for pete sake, but I have the ulnar issue too as you are aware. So I'm cautious and I like the one step at a time approach. I'm afraid the elbow brace at night will not be my permanent answer for my elbow and I will ultimately have to do that surgery, which is scary as heck as another doctor basically said he would avoid it at all costs. Too many have complications, etc. When a surgeon tells you he would avoid surgery if possible, it makes me perk up.
Curtis
My best guess at present is that about half of people with CTS bad enough to make it to medical attention might eventually need surgery before they die of something entirely unrelated. That's not 'most' in my book, but it is only a guess and this issue really needs a high quality long-term outcome study doing.
I personally woulnd't really want to wear a splint any more than clearly necessary, especially in the daytime, but I have a few patients who seem to really like their splints and are quite happy to do nothing else for their CTS. I'm fine with whatever suits the individual patient normally.
I wouldn't worry about the ulnar nerve too much - you have a very mild nerve conduction abnormality and little in the way of symptoms at present. We know even less about ulnar neuropathy than we do about CTS but it is fairly obvious that not all patients need surgery.
To understand the problems with carpal tunnel surgery you have to think about the normal function of the transverse carpal ligament. It acts a pulley for the tendons, stops them bowstringing when you bend the wrist, and supports the small bones of the wrist in an arch shape, Loss of each of those functions can have consequences for the biomechanics and structural integrity of the wrist.
Sorry thet's in a bit of a random order but hopefully I haven't missed anything. JB
I have a new nick name, splint man! I had elbow splints made yesterday, both splints on both arms. Good times. I only feel the numbness & tingling on all of my fingers except pinking and back side of ring finger, so it sounds like the ulnar nerve may be calmed down and I'm only feeling the median nerve. But I can hold up my cell phone to my ear for example and it doesn't take long at all for more discomfort to come from the median nerve. Within seconds, maybe 10-30. I'm hoping the shot helps my CTS for at while at least and then see how everything feels and not worry about the ulnar nerve at this point.
Curtis
That story of tingling and numbness on holding a phone up to the ear is common with both median and ulnar nerve problems - get a bluetooth headset/earphone :-) JB
Lots of interesting questions and basically the other medics are right - no-one really knows. I think the situations of recurrence after a good response to injection and recurrence after surgery are very different.
After injection you more or less expect it to come back sooner or later, You just hope that 'later' means 20 years rather than 20 weeks. It probably does take some trigger factor such as strenuous use of the hand to set it off again (not usually keyboard work), and when it does recur you just deal with it as exactly the same problem again with either (re)injection or surgery.
After surgery, provided the operation is done correctly and is successsfu the first time, the only way that you can truly get CTS again is if the ligament somehow manages to repair itself. This does seem to happen occasionally and usually takes 10-20 years. Re-operating in such circumstances will often be successful but these cases are very rare so we don't know much about them. The majority of people with problems after surgery do not have this type of recurrence - they either have an incorrectly performed operation or a side effect of cutting the ligament, or a complication such as complex regional pain syndrome.
So - cross-fit after surgery should be fine once fully recovered, cross-fit after injection might well trigger another attack - JB