Post Op Typing

jamesbari
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Hi all

I had surgery on RH 3 weeks ago, it feels good and healing well.

My CTS first started from using mouse/keyboard at work. I have been working using my LH to type emails, but now my hand is feeling better i occasionally start to use my RH without thinking and although ok to begin with, after 5 mins or so my wrist starts to hurt.

My questions are;

Should i avoid typing with RH at all, and if so, when should i start trying to use it?

Am i potentially damaging something by doing this & i should take more care to avoid using RH seeing as it was this movement (typing) that had an impact or starting this whole damn nightmare :-(

Thanks all, hope people have had similar scenario to this.

& BTW this forum is the best around for all CTS worries/questions etc, I am very grateful it is here.

jeremydpbland
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It's hard to make any definite recommendation. Typing is not usually a primary cause of CTS so the history is a bit odd and I would not be sure what we are dealing with. If it wasn't CTS that was causing the symptoms but it was something to do with typing then you may just be setting it off again. Usually people who do have CTS are able to type quite soon after surgery - a week or so. JB

jamesbari
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Thanks Jeremy, the more detailed history is that my desk was moved at work and the setup not ideal ergonomically - I was sat at a strange angle, using a wrist supoort for both mouse and keyboard. Excessive workload and lots switching between screens led to my hands/fingers starting to go numb ad get tingles initally - those were my initial symptoms/recollections.

Anyway, I also play golf and swim which when i carried out these activites also triggered some pain/numbness etc. I went to docs and they did ultrasound which showed my median nerve to be (forgive me I don't know the metric measurement) 14 in RH &13 in LH (also symptomatic) and was told that was above the norm showing signs of inflammation, i.e. possible CTS matching my sypmtoms.

I did the usual splints at night - didn't help, and then was offered cortisone injections which the first round of these relieved syptoms in both hands for a few weeks but the symptoms came returned. The next round of injections didn't have the same effect and the pain/numbness became more frequent in the following weeks.

After discussion with my surgeon the only options that were given to me were deal with the pain or try surgery? If I have been mislead and more could have been done I would like to know so I can approach my surgeon and ask.

I did message him around the time i did the above post and he just said to rest the hand further for 2 weeks and avoid any activites that cause pain. I live in Gibraltar and there is only one surgeon to deal with matters like this so didn't have much in the way of options to get further opinion.

From my reading of CTS around my time of initial symptoms there appreared to be lots of info on office workers who had CTS that they thought was from typing, mouse, desk work etc. So, I'm now a bit confused and worried I have been misdiagnosed and gone through all this for no gain :-(

jamesbari
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Just an update - I thought the pain from typing was in my wrist it it’s actually in the ball of my hand ...

jeremydpbland
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It has become a widespread belief in the community that CTS is something to do with typing but the epidemiology actually shows it to be less common in people who work with keyboards all day than in manual workers with more strenuous occupations. CTS is however very common regardless of what work you do so that doesn't mean you can't get it even if you spend all day on a keyboard. It sounds as though you did have reasonable evidence of CTS - the ultrasound imaging was abnormal and the initial response to injection is a good indicator so the question then becomes - have you got something else as well. Trigger digits and thumb base arthritis frequently co-exist with CTS so we do see patients with multiple problems. These can also get better with steroids so that can be a bit confusing too. You didn't mention nerve conduction studies so I guess they relied on just the imaging before surgery. Was the tingling waking you at night beforehand? JB

jamesbari
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Thanks Jeremy, appreciate your reply. I asked for nerve conduction studies but the surgeon said that as I'd only been symptomatic since the start of 2017 they woudn't show much (?) I did ask though as I wanted to make sure. I was basically offered a choice of deal with it or surgery and I coulndn't bear the aching hands any more.

I used to wake up with numb hands, and sporadically through the night the pressure in my wrists would wake me also. The night time was worse to being with, and i got used to it and/or the lack of sleep. I always woke up with numb hands that needed shaking though.

The only time my hands ever felt normal was if I took Ibruprofen but that is not a long term solution I am comfortable with.

I spoke to my parents over the weekend and there is a history of arthitis in my family so I'm wondering if there is more to this. Last night, after doing half an hour on the putting green, the top of my right hand, and knuckles were aching just like they did previously after golf.

I have a physio appointment booked for Wednesday as I am waking up with back pain in the morning (this started since I gave up smoking around 2 weeks pre surgery in prep for healing) and will ask him about the above in case it is all linked.

The only benefit so far of all this is that I have given up smoking :-) Silver linings ....

Thanks

jeremydpbland
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The surgeon is, in my view, mistaken about the NCS and they ought to be done before any operation to provide a baseline in case of problems afterwards but it is taking a long time for hand surgeons to come to terms with this idea I'm afraid. I spent part of last week lecturing the British Society for Surgery of the Hand about how to use NCS in CTS cases and at least they didn't start throwing rotting fruit and veg so perhaps I can convince them eventually:-) I woud be rather suspicious of multiple disorders contributing to your symptoms but that is about as far as one can get on a website forum. It will be interesting to see what the eventual outcome is. JB

jamesbari
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Thanks for your valuable input, I will endeavor to respond to the thread in due course in the hope that it may help others in time.

jamesbari
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I wanted to update the thread on how things have progressed... I have had some physio on the CT scar on my right hand and done some exercises which feels really good and the scar is healing well, but as soon as I have been typing for 3 hours or more at work or playing a small amount golf my hands are hurting as they were before (whilst typing or a few hours after golf).

Pain and tingling on top of my hands & around the knuckles but if anything, my right hand is slightly better than it was pre-surgery so my thoughts are that it has alleviated some pressure from my wrist but in no way could the surgery be considered 'worth it' for the result.

Although there may have been some CTS (after initial US's) it is now quite clear there is something else at large causing me trouble. and whatever it is affects both hands to a similar degree. Tomorrow I am going back to the surgeon to describe what I am feeling and what plan he proposes to try and sort this out.

From internet searching it seems like the fact I have back ache from 5am until I get up each day 'could' be linked to the tingling in my hands due to a possible slipped disc which symptoms were described as lower back pain and tingling in arms/hands etc. whether this is far fetched or not those are both symptoms I am feeling so I will advise the surgeon of this and see what he thinks about an exploratory MRI.

Obviously, there could be other nerve issues in my arms/hands and I will ask for further ultrasound scans or a nerve study - one way or another I need to find out what is wrong as the longer this goes on the worse I am starting to feel in terms of mental strength.

If my surgeon is reluctant like he was when I asked previously for nerve studies I am going to request a second opinion, or may even consider coming back to the UK to see someone. Dr Bland - would you consider this if I came back to see you either privately via my insurance or through the NHS (I am a resident in the UK but work/live in Gibraltar most of the time)?

jeremydpbland
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It does rather sound as though we are drifting towards my original thought of - CTS plus "something". Low back pain fits in well with symptoms in the legs as a coherent presentation but to get neurological symptoms in the arms from degenerative disease in the spine the problem really has to lie in the neck. The only way that can tie in with low back pain is if the latter is a marker for disease along the whole length of the spine.

As the surgical approach has been tried and has not had enough of an impact on the problem to get you functioning normally I would be inclined to seek either a rheumatology or neurology opinion. Coming to the UK to see me is probably not a great idea as my focus and expertise is extremely narrow. I know a good deal about CTS and I've forgotten most of the rest of the medicine I ever knew so I'm not a lot of practical use for anything else. Though I do recognise a few other common hand disorders which commonly turn up in people referred with possible CTS there are still a lot of people coming through my clinic with normal NCS and ultrasound and symptoms which I am at a loss to explain or do anything about. I would also be handicapped in assessing your case by not having any pre-operative NCS results to compare with so overall I think I would be poor value for money I'm afraid.

One last consideration is that I try to keep this website rigorously non-commercial - and that includes me not making money from it by attracting paying/insured patients. I am very wary of the involvement of money in medicine generally, having seen far too many examples of it distorting clinical behaviour - and I know I'm not immune to that myself so I try to keep it at arms length where possible. JB

jamesbari
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No problem at all JB, grateful for your thoughts. Let's see what the surgeon says later today...

jamesbari
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Wow it’s been a while ... just over a year on and for a period my hands were very good, I would say a 75% improvement. My job also changed slightly with more meetings and calls and less typing - this is when the hands really started to feel good again, and no tingling at all after golf or most of the other of the pre-surgery symptoms.

However, I have now been at a new job for 5 months. At first I tried to use a normal mouse and keyboard but within minutes my hands were tingling so I ordered the ergonomic stuff and used the mouse from my previous job. This helped a lot but my new job is again at a computer most of the day and now less meetings/calls and a lot of screen work with mouse/keyboard. The tingling and numbness is starting to come back - at present it’s nowhere near as bad as it was pre-surgery and CBD vape helps to relieve pain BUT it’s there and it’s getting worse hence why I’m back here again to find help...

I only had RH surgery ... is it worth doing the left too? The tingling is definitely worse on the LH side now, and although not 100% gone in the RH it is better. I wondered if anyone else has gone through this cycle post-op and if having the other hand operated on helped the overall situation.

Thanks

jeremydpbland
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It still sounds to me as though we are dealing with a relatively mild CTS combined with something else to produce the overall symptom pattern - perhaps problems in the neck which may be aggravated by posture when working at a desk long term. I would get an up to date set of nerve conduction studies before doing anything else so that we get an objective measure of how bad the CTS component is. JB

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