Do you think symptoms will resolve soon
Hi Dr,
I have supposed CTS for 3 mths now. started with waking me up and night with whole hand tingling and managed to shake it off. Then one day, it just decided to stay, after awakening. Strangely, the night symptoms which woke me up disappeared but the day symptoms persisted till now. At first there was tingling sometimes as though I can emit electrical power.but most of time, there was just as though winter numbness in the last 2 segment of first 3.5 digit. It.s my left non dominant hand. A bit of tightness, but no pain at all, just dull numbness. No tingling now. Ncs done 2 was ago says moderate. Not superbly disturbed but is an annoyance.
Severity score is 1.34.
In your experience, if the only symptom is numbness, can it resolve by itself, and which cts stretch or exercise is most helpful?
Thank you!
Thank you for the swift reply! Does my condition sound like the reverse of what it should be? To me, the day time symptoms though constant , is more tolerable as it doesn’t wake me up from my sleep which is quite alarming each time it happened.
Forgot to say I have been on night splint for 6 wks. For other nerve problems meaning it may not be solely due to median nerve compression? What may be the other additional likelihood?
For steroids injection, I thought it is more for pain? Does it work for only numbness? Sadly, the drs that I know all are adverse to steroids, even oral steroids. What do you think of the latter? Googled a bit, seems to be beneficial too.
Lastly, how long should I wait out the general numbness of the digits for it to resolve spontaneously? Luckily it is my non dominant hand but typing does enhance the numbness.
God bless!
It may well be the splint which is controlling the night time symptoms. The median nerve runs from the brachial plexus between your neck and shoulder all the way to the hand so a problem anywhere along that course can cause similar symptoms, not just entrapment at the carpal tunnel. CTS can also be confused with a variety of other disorders of course.
Steroids seem to temporarily 'cure' CTS when they work (they fail for 20%) with all symptoms improving provided the CTS is not too bad to start off with. Pain is one of the less predicatable symptoms overall and not all CTS patients even get any pain at all to start off with.
Oral steroids are also known to benefit CTS in clinical trials but have side effects which most of us think are not acceptable for treating a condition which is known to respond rather better to local steroid injection - which is pretty much free of all the systemic problems (weight gain, diabetes, osteoporosis, moon face etc) that go with regular oral steroid treatment. I've now been looking for evidence of all the problems which people say occur with steroid injection for CTS for years and almost all of the problems turn out to be mythical provided they are used by people who know what they are doing.
The last question - impossible to know. We need to see some nerve conduction results - the only way to objectively measure how much physiological impairment there is. JB
Hi Dr Bland,
Thanks very much for your advice. Pardon me for my confusion.. You mention even severe CTS might resolve spontaneously but you also mentioned it depends on the amount of physiological impairment as read through NCS? What specific result do you typically look for in the NCS tests results to determine severity of compression like you mentioned? My nos. for latency (motor and sensory), amplititude (motor and sensory) and velocity (motor and sensory), respectively are ---latency (5.6, 3.3), amplitude (0.4, 29.6) and velocity (43, 39). In your website, there is some description, but I not sure if I interpret correctly. What is the grading/severity for this? Btw, the technician mentioned I could have Martin gruber anastomosis. Does it affect the progression of the CTS?
(From your questionnaire alone, my scoring is 1.34.)
Many many thanks!
If those are the numbers for one hand and I've worked out which is which correctly then that is probebly grade 3 CTS. They can certainly improve spontaneously sometimes. Grade 6 cases are unlikely to improve without intervention, indeed they often don't improve even with surgery. The Martyin Gruber anastomosis is just an anatomical curiosity and has no real relevance to the CTS except that it can make the NCS results confusing. JB
Hi Dr Bland,
Yes, the 1st no. Is for motor , and the second no. for sensory in those areas listed. This is for my left hand, non dominant hand, so I also puzzled why I got CTs. Could be sleeping on this side for more than 10 years.
Grade 3 is moderate ?. I am hoping my slight stretching exercise now and then would help. Some people said massages may make it worse but I really hate doing nothing but watch and see as I am afraid it would get worse if I do nothing about it.
Thank you so much,
Reiss
I've rather come around to the idea that we should ditch terms like mild, moderate etc and just say that it's grade 3 out of 6 - which is wholly unambiguous. it is a little unusual to get it first in the non-dominant hand but it does happen. Try it with a night splint - you can find a detailed description of what you need and how to adjust it here on the website and about 1/3 of people with CTS find that a splint is enough to solve the problem. JB
Regardless of what the symptoms are it can improve spontaneously. Your symptoms are somewhat atypical, perhaps sounding more like CTS a month or two back than they do now but the distribution is right for the median nerve - one should probably give consideration to other median nerve problems too. A progression from intermittent night-time symptoms to persistent daytime ones is generally thought to indicate deterioration of the condition though that belief has, curiously, never been systematically verified to my knowledge. It's something we could perhaps look at in the Canterbury database. The only simple measure which is definitely known to be helpful is a night splint. There are lots of recommended exercises but it's very hard to do double blind trials on exercises and we don't know whether they really help or not. 'Moderate' doesn't mean a lot in nerve conduction studies because there is no agreed definition of what that means. If you have a copy of the results then we can see what grade it is. For milder symptoms which are, as you say, an annoyance then the best tactic is usually local corticosteroid injection which can get rid of the symptoms quickly and is safe and convenient if done by someone who knows what they are doing. The condition does recur eventually after injection but that can take anything from weeks to decades to relapse. JB