Stenar lesion then Carpal Tunnel

Chaddy
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Following a fall, I ruptured my ulnar collateral ligament, right/dominant hand. Had a year of conservative treatment, physio, steroid injections, Consultant telling me I had sprained not ruptured ligament! Eventually asked for a second opinion from a hand surgeon. USound and MR (not done before, just an Xray) confirmed Stenar diagnosis. Open surgery end of Jan, went really well. Six weeks post op developed pain, tingling and numbness in same hand. Assumed post op complication but diagnosed as Carpal Tunnel. Driving me crazy, losing sleep at night and only been back at work for 5 weeks from original op. Had steroid injection in wrist yesterday. Hopeful of a cure! Do you have any suggestions about using a computer and mouse? Really struggling at work. If I get my wrist comfortable my thumb and hand hurt, if I get them sorted my wrist hurts! Work for NHS, job under review- again. Unhelpful boss, terrified of taking more time off work. Anything considered! I am a nurse manager so life is about meetings, driving to meetings, and computer reports etc.

jeremydpbland
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First question has to be where exactly the pain, tingling and numbness are - ie which fingers are worst affected. Running through the symptom questionaire on here would be useful too, and the response to injection in about 48 hours will also be informative. JB

Chaddy
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Thank you. The pain, numbness and tingling is in my thumb, index and middle finger, plus one side of my ring finger as bizarre as it sounds. I will do your symptom questionnaire as suggested.

jeremydpbland
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That distribution is not bizarre, it is exactly anatomically right for the median nerve and typical of CTS - though many patients are not observant enough to spot the 'splitting' of the ring finger - so that is certainly one feature supportive of the diagnosis. I am not sure exactly what is involved in the ulnar collateral ligament repair but I would not usually have expected most minor surgical procedures in the hand to preciptate CTS six weeks later -- though it is not impossible. Regarding your original question about mouse/computer I would aim to rest the hand to some extent - ie don't do anything with it that hurts but keep the fingers moving - until the steroid injection has a chance to take effect - usually about 48 hours. As soon as it feels comfortable I would go back to using the hand normally.  Pain after injection is quite variable and is discussed elsewhere on the site so it is impossible to give hard and fast rules for what to do after injection. If it does not respond to injection then you really need some nerve conduction studies done - I see that you had a 62% score on the symptom questionnaire so there is a very good chance that the diagnosis of CTS is right. JB

Chaddy
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Thanks for the reassurance and helpful comments which are much appreciated. Now roughly 60 hours post injection. Less pain in wrist but finger tips still tingling/ numb. Hopeful that will resolve soon.

Chaddy
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Hello again. One week post injection, my finger tips (thumb, index, middle) are still quite numb, particularly in the morning/ til lunchtime. Using keyboard now, is like an electric shock through my fingers when I touch each letter. Do you think there is any chance of improvement?

jeremydpbland
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There is still some chance of improvement but it is getting rapidly smaller - we have seen people improve up to 4 weeks or so after injection. What you really need however is a set of nerve conduction studies doing. Does your hospital have a neurophysiology department?

Chaddy
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I would assume so. I am seeing my Consultant again on Monday next week. I will see what he says, and let you know. Thank you again for advice and suggestions.

Chaddy
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Still suffering. Now listed for urgent decompression. Hope it works and I can get on with my life again.

jeremydpbland
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I would still want some NCS performing before surgery if it were me. If a request came to me with a planned surgery date on I would make sure they got done before the operation - but not all areas of the NHS are the same. Surgery for CTS does have failures (fortunately quite few but you can see our local figures here on the website) and when it does not work a set of pre-operative NCS are invaluable for working out what has gone wrong. Good luck! JB

Chaddy
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Thanks Jeremy. I dont think that I have the confidence to ask for NCS. I will take my chances I suppose. Your site has been so reassuring. I will keep in touch.

Chaddy
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Hi Jeremy. Went to see surgeon last Monday. No discernible result from injection. Numbness in finger tips ( thumb, index, middle) was constant. Listed for urgent decompression which was done yesterday. Open surgery under local. As soon as anaesthetic wore off I could feel my fingertips. Hopeful that this has sorted it out now. Fingers crossed.

jeremydpbland
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Sounds promising. The usual story with carpal tunnel decompression, provided the diagnosis is right and the condition not too advanced, is of patients reporting that the night after the operation is the first decent night's sleep they have had for ages. Thankyou for letting me know how it's going. JB

Chaddy
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Good morning Jeremy. One week post op and feeling good! Still have sutures in hand but all symptoms mainly disappeared. Tip of middle finger still feels a bit 'odd' and numb but otherwise really pleased! Just thought I would send some positive news rather than the 'woe is me' kind! Again, thanks for your support.

jeremydpbland
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Glad to hear it is turning out well. Best wishes JB

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