CTS Injection on 2 August 2011 ... Update
Last night I tried sleeping for the first time without a splint. A good result, no numbness or discomfort. So far, the injection appears to be successful. Since the 2nd August, I have been able to carry out all of the activities that would previously have brought on symptoms of CTS without any problems.
Once again, many thanks for your help and advice and I'll keep you updated.
I have a question for Dr Bland.
Thanks to the injection, the symptoms of CTS have virtually disappeared for the time being. During the period that the CTS does not give me any trouble, is it the case that the problem is temporarily "cured"? In other words, if I now had a third NCS test, would that be lower that the level 3 that I have previously registered?
Many thanks.
I would very much like to know the definitive answer to that! Unfortunately we do not have the resources to carry out a systematic study of the response to injection which would include repeating every patient's nerve conduction studies and ultrasound a few weeks after injection so all we have to work with are test results recorded when people do come back to see us - which is usually because they have relapsed of course. I do however have a few cases where we have been able to record again during the remission phase - either because they happen to have been referred with something else, or because the two hands have been behaving differently - we may have injected both sides and only one may have relapsed. Those few follow-up studies done during remission generally show improvement in both nerve conduction and ultrasound images of the median nerve and this is in keeping with the few published formal studies of injection which have used NCS as an outcome measure. My own data suggests that the amount of improvement seen is greater with surgery than with injection, which is interesting but perhaps unsurprising.
My best guess is that injection really does effect a temporary 'cure' as such - but that the underlying predisposition to develop CTS remains, waiting to be triggered again at some future date - whereas the surgical solution alters the structure of the wirst in such a way that a buildup in pressure in the carpal tunnel becomes more or less impossible. I hope that makes sense. JB
Now it's just a matter of how long it will last - which seems to be pretty random - 3-6 months would be about average but it is a skewed distribution with a very long 'tail' so you can get lucky. JB