Do I have CTS?
Hello,
exactly three weeks ago I awoke (in a hotel) and couldn't close my right hand, kind of an electric shock in the middle
of the movement preventing to go further; also for example it was impossible to open a knob-door with my right hand.
This complete impossibility of closing the right hand occurred only once since then, but in the morning it is there
in a weaker form. After one week, tingling and partial numbness started in the thumb/index/middle finger of the right
hand, and after two weeks the left hand started showing the same symptoms. Today (three weeks later) it seems
the severity of the symptoms of the left hand is comparable to the right hand (while in the left hand there is less tingling,
but more thumb-pain). The tingling and partial numbness in the right hand is constantly there, day and night.
I have physiotherapy (had it before, due to rotator cuff syndrome), osteopathy (had it before, due to the rotator cuff
syndrome) and a GP. Actually I am consulting two osteopaths, and they both seem to converge on CTS, while the
GP is not convinced (however I only experienced GP's which investigate whatever problem in a minute), and the
physiotherapist is now on holiday, so didn't get the latest developments.
I went now through the automated CTS-diagnosis, and got
13/07/2012
Diagnostic questionnaire
Severity left/right
3
3.18
Impairment left/right
2.63
3
Scores ANN/LRP
-7%
3%
Hmm, unfortunately those percent-scores are not really explained, but it looks like as if that system doesn't think that
I have CTS --- is this the right interpretation?
Any comments most welcome!
Best regards
Oliver
Thanks for the reply!
I still do not really know how to handle the British health system (living in Swansea now for 11 years, but that's my
first more serious problem). In Germany I would go to the "GP", and get a referral to a specialist. This doesn't seem
to happen here, only after a very long time.
So well, from my GP I got an X-ray referral (for some possible neck degeneration (though I don't have neck pain); it seems
X-rays are rather cheap, while MRI via NHS seems to take a very long time).
And from my second osteopath I got a referral for MRI (which I pay myself), to see whether there is a trapped nerve
(dont' know the precise terminology).
With that MRI my osteopath then wants to recommend a specialist here in Swansea. Perhaps that specialist might do
such a nerve conduction study.
Could it be a mix of things? A (lighter) De Quervain's tendinitis feels somehow present to me (Finkelstein's test,
according to http://orthoinfo.aaos.org/topic.cfm?topic=a00007, creates some pain). But apparently that doesn't
explain the tingling and numbness. But that's of course just guessing ...
Once I know some new information, I post it (perhaps there is some interest in how it turns out).
Thanks again
Oliver
I'm certainly interested in how it turns out. It always seems odd to me that all sorts of people in the UK seem to be able to get MRI's done at the drop of a hat but relatively few seem to be able to arrange NCS.
You are right that de Quervain's does not really account for the tingling. As a conventional medic I am a little sceptical about osteopaths but there are some good ones around and obviously I do not know yours. Paying for MRI is an expensive business and should not really be necessary - if it is indicated the NHS will do it - sometimes too easily in my area I think!
If the problem has persisted for quite a few weeks then I would have thought a referral to a rheumatologist or hand surgeon would be in order. JB
Yes those scores make it pretty unlikely that your problem is CTS but the questionnaire is by no means infallible so they should not be taken as ruling it out completely - remember this is statistics we are playing with here and about 10% of people with questionnaire scores below 20 do turn out to have evidence of CTS when tested - though most of them are very mild cases neurophysiologically. You do have one quite striking finding in that the tingling and numbness lie clearly in the territory of the median nerve, so even if it is not CTS, those symptoms would make one wonder about other median nerve disorders so I would think nerve conduction studies would be appropriate anyway. The other symptoms sound more musculoskeletal/rheumatological. Someone knowledgeable probably needs to see the hand when you are having difficulty closing/opening the fingers. JB