2 months of very numb feeling and doctor is recommending surgery:
Do I need to get surgery to fix the problem?
Here is what happened. Late July 2019 I was working out with weights and did too many forearm exercises. For days my forearms were swollen and sore and as they healed i developed symptoms of CTS overnight. It was really bad for the first 3 weeks in the 3 fingers and very numb to the point I needed help buttoning buttons.
I got the nerve study at the end of July and was told it was severe. He said it typically is around a 4 and mine was about a 6.5/7.
I met with the doctor today 9/17 and she said that the results indicated I needed surgery in order for it to not get worse, even indicating that I could lose total sensation if I did not get the surgery.
For the past week the tingling has lessened and i thought it was getting better. I am not sure if I am getting used to it but I can now type and press numbers on a phone when in the beginning I could not.
I am going to seek a second opinion but was hoping to hear some information here in hopes that I should wait and seek PT etc, before getting surgery. I am a 38 year old man. Not sure if that has to do with any considerations or not.
I got the results and they read:The clinical exam is significant for 4/5 weakness involving the left median hand muscle. Left median sensory loss is present.
The left median motor distal latency was prolonged. The left median motor potential was diminished in amplitude. The left median sensory potential was not recordable. On needle exam, acute changes were seen in the APB.
Today's study reveals evidence of severe acute left median neuropathy at the wrist.
Sensory Nerve Study info:
Side L - Ulnar - Digit 5, amp 28, latency 2.4
Radial Digit 1, amp 26, latency 2.8
Median - not recorded
Motor nerve study info:
Median, stim site WR, recording site APB, amp 1.2, latency 6.0
CV 60, latency 10.0
Ulnar, stim site WR, recording site ADM, amp 5.4, latency 2.3
stim site BE, amp 5.2, CV 56, latency 6.3
stim site AE, amp 4.9, CV 59, latency 8.0
The left median motor potential is diminished in amplitude. The left median motor distal latency is prolonged. The left median potential sensory is not recordable. On needle exam, acute changes are seen in the left APB.
Interpretation: Severe acute left median neuropathy at the wrist.
That is actually grade 4 CTS on my scale (out of 6). It does sound like a fairly acute compression of the nerve related to unaccustomed activity. In such circumstances, with a short history, there is some possibility that it might resolve without surgery so your impression that it is improving symptomatically may be right. However there is a catch. Sometimes the tingling and pain can improve as the nerve damage gets worse, being replaced by numbness, so you are in a difficult position. At grade 4 surgery offers a good chance of success while the prognosis would be worse at grade 5 and much worse at grade 6 so you don't really want it to get any worse than it is. If it were my hand I would be monitoring it very closely with nerve conduction studies (probably daily) to check which way it is going but that is not an option for the ordinary member of the public unfortunately. If you know how to test the muscle power of the abductor pollicis brevis muscle that is a fairly good way of checking whether it is getting worse or better. The other non-surgical option that might be worth trying with a short history like this is a local corticosteroid injection - 40mg of triamcinolone might just solve the problem here, at least until the next time you exert yourself in the same way to set it off again. If we injected it however I would probably want to check progress fairly soon with repeat nerve conduction studies - the interval depending on how the symptoms responded to injection in the first 48h. JB
Thank you! I am going to contact a doctor for a second opinion and try the injection. I really appreciate the feedback!
To clarify the nerve study doctor said it was typically 4 milliseconds and mine took about 6.5 milliseconds.