Stress related?

jaymartin50
Online

Is there any evidence to suggest CTS could be linked to stress?

jeremydpbland
Offline

Not really. The problem is that no-one knows how to measure 'stress', at least in its colloquial sense (there is a technical engineering meaning too) - and if you can't measure it then it's pretty hard to study whether it is related to CTS. One man's stress is very much another's ordinary day at the office so it's essentially a subjective judgement and all you can do is ask people how stressed they feel and then you get tangled up in cause and effect - people with CTS are likely to feel more stressed than those without it I think. JB

jaymartin50
Online

Thank you for your reply. The reason I ask is that I have had a very stressful year during which I have developed CTS. The doctor who did the nerve conduction study asked me to relax, as I understood him to mean, tension would affect the results of the test. I have been sleeping with tightly clenched fists and clenched jaw. Wearing splints for the last few weeks has helped the painful CTS symptoms I have been suffering. In the daytime, I function relatively normally apart from some numbness and tingling when I hold something for too long. If I were to have steroid injections but still slept with clenched fists would CTS be likely to return?

jeremydpbland
Offline

I do not believe that being tense at the time of testing would directly affect median nerve function but it certainly makes it harder to record satisfactory signals from the nerves so we do generally ask our patients to try and relax for nerve conduction studies. There is always a high risk of recurrence after steroid injection, regardless of what you do with the hands I'm afraid, but on the other hand it is a relatively safe treatment to try. JB

jaymartin50
Online

Thank you for your reply, I would be grateful if you would consider this. Four months ago I experienced constant problems of numbness/tingling/pain in both hands during the night. Nerve conduction tests show I have "severe CTS" in both hands. Wearing splints at night has helped me to sleep much better and apart from numbness when I hold a book for too long, I have few problems during the day. In fact, driving 180 miles today was fine. If I need further treatment I think I would prefer to try steroid injections but the doctor who did the nerve conduction study seemed to be implying that surgery would be necessary. As I am accessing treatment under private health insurance things seem to be moving rather too quickly. Obviously, I do not want to suffer permanent nerve damage, but because of personal circumstances, I do not feel I can entertain the idea of surgery in the near future. When would steroid injections not be advisable and would it be unwise to just carry on with splints for a few months?

jeremydpbland
Offline

In order to have a guess at what was meant by 'severe' CTS we really need some more information - preferably the actual nerve conduction results, but failing that a clue as to what sort of doctor/technician/therapist did them would help (a variety of different people carry out nerve conduction studies in the UK and elsewhere). Your symptoms sound fairly mild following splinting and it might be interesting to repeat the tests and see which way they are changing - it's not unknown for CTS to resolve even without any treatment. One might also observe that there is hardly any example of CTS in which injection is actually contraindicated. It is just less likely to be successful in some circumstances than others. JB

jaymartin50
Online

The specialism of the doctor who did the nerve conduction studies is "clinical neurophysiology." I'm afraid I do not have the actual results yet but I will ask for them to be explained to me next week when I have a follow up appointment. Thank you.

jeremydpbland
Offline

Well that's a good sign. If you are in the UK then you can ask what grade they were on the Canterbury scale. If whoever is doing the follow-up does not know that then we can usually work it out from the numbers. JB

jaymartin50
Online

No luck with Canterbury scale but results are going to be sent to me. After a brief discussion I agreed to have steroid injections.
However, that's it. In two weeks I have to decide whether my hands are "better." If I still have problems I will be referred to a hand surgeon. I'm a little concerned about such a short time scale. Wearing splints at night for just over three weeks had brought a lot of improvement. I'm still wearing splints at night and so far my symptoms are about the same. I'm in the UK and covered by private health insurance. I would welcome your thoughts.

jeremydpbland
Offline

Steroids usually take efect within 48 hours, with a few people apparently improving up to about 6 weeks later. You should have a pretty good idea how it is doing in a week. Other than that I think we need to see the nerve conduction results. If it does need surgery then there is nothing wrong with doing it fairly quickly. JB

jaymartin50
Online

I have the results of my tests now. Would it be best to email them to you as they seem to be rather complicated to put on here?
Thanks

jeremydpbland
Offline

I'll happily take a look at them for you and try to tell you what severity grade they equate to. My email address is in the contacts page. It's usually possible to translate any decent set of NCS for CTS to my way of grading severity as it was designed to faciltate comparisons between different laboratories but there are a few people who do things so differently that it is awkward. JB

jaymartin50
Online

Thank you for offering to look at my results.
I have just emailed then to you.

jeremydpbland
Offline

I've replied via email as well but they are grade 4 both sides in my terms. JB

jaymartin50
Online

It's now just over two weeks since my wrists were injected and I'm still wearing splints at night. There has been significant improvement in both hands so I was disappointed when I was woken by tingling/numbness in my splinted left hand in the early hours of yesterday morning. All of my arthritic joints including my left thumb were very painful yesterday and I'm wondering if this could be linked to regression in improvement of CTS symptoms. I got through the day on paracetamol but I do have Naproxen prescribed to use when needed. However I'm very reluctant to take it as I don't like the side effects. My joints and CTS symptoms are much better today. I'd appreciate your thoughts on my progress so far.

jeremydpbland
Offline

It sounds as though you did get some response to injection - though I think it had already improved considerably with splinting only hadn't it? It can be hard to disentangle the symptoms of CTS and osteoarthritis of the small hand and wrist joints sometimes and I think in some people there is probably a direct interaction between them when inflammation from the arthritis causes tissue swelling and increases the pressure in the carpal tunnel. It's therefore possible that the episode yesterday may have been primarily an arthritic relapse rather than a CTS relapse, if you see what I mean, with secondary CTS symptoms again. Do we know what dose/steroid was used for injection? If, so far, it has just been one bad day with improvement again afterwards I would keep my finger's crossed that it does not mean things are going to get worse and just await developments for a week or so. JB

jaymartin50
Online

Thank you for your encouraging reply. You are right that my CTS symptoms began to improve as soon as I started to wear splints at night. I was given hydrocortisone injections, however, I do not know the dose. My left hand has been much better again today. In fact, I have only experienced some tingling and slight numbness when I have leaned on it. My right hand is free of CTS symptoms.

jaymartin50
Online

Sorry it posted twice and I can't seem to delete it!

jeremydpbland
Offline

Hydrocortisone is the least potent of the steroids used for CTS so if that is right it may have been a pretty small dose. With such a good initial response to splints and steroids my inclination would probably not be to rush into early surgery but on the other hand those were quite bad nerve conduction studies. The counsel of perfection is probably to repeat the NCS about 6-12 weeks post injection if symptoms remain under control just to check that the results really have improved - but not many places have the resources to do that routinely - even here in my own department we could not routinely check every patient whose symptoms remit after injection with further NCS. JB

jaymartin50
Online

What you say makes sense but I'm still a little confused about the link between my NCS, my improvement since splinting and injections and the possibility of nerve damage. What you seem to be saying is even if the improvement in my symptoms continues there is still a possibility that there could be cause for concern about the state of my nerves in light of my severe NCS.
I doubt my health insurance would fund another NCS and from what you say it isn't likely to be available on the NHS. I would like to avoid surgery if possible but I am concerned about future problems. I can see that at the moment all I can do is wait and see what happens in the next few weeks. Thank you for your thoughts.

jeremydpbland
Offline

One useful thing to know in these circumstances is that there is a pretty strong correlation between improvement in symptoms and improvement in NCS, or to put it conversely, deterioration in symptoms and deterioration in NCS. That is, if the patient thinks that CTS is getting worse then most of the time the NCS will be worse, and vice versa. However this is not a perfect correlation and there are exceptions, most noticeably in patients whose symptoms are relapsing after a good response to injection - it sometimes feels worse when it comes back even though the NCS results are less severely abnormal than they were originally. Thus, if you feel better at present, I think one could say that you probably are, but if I were in this situation myself, with an EMG machine to hand which I could use to test weekly - I probably would! JB

jaymartin50
Online

Certainly, it would be very comforting to be able to monitor improvement quantitively. Both of my hands have improved greatly and I feel hopeful. It's a frustrating situation though because as I don't know what caused the CTS to develop I equally don't know what to do to prevent it returning. Leaning heavily on my left hand and using it to rub trigger tinkling still. For the last two nights I have woken with very hot splinted hands around 5am and taken the splints off until getting up. Both times my hands have been fine. I regularly exercise/ stretch and massage my hands and wrists and this does seem to help. I've been told that my hands look different now they are certainly much more flexible. Is there anything more that I could be doing? I don't really understand how nerves "heal." Is there any sort of qualitative self assessment I could do on my hands to monitor their progress? Thank you for all your help and advice so far. I think this is an excellent web site giving clear information and support.

jeremydpbland
Offline

It's probably beyond the scope of this forum to do a comprehensive explanation of nerve healing but most tissues in the body are capable of self repair given a chance. Only the brain and spinal cord seem to be more or less irreparable. Peripheral nerves can regrow if cut and their insulating myelin layers can both degenerate and re-form. These processes are essentially automatic and there is little you can do to influence them apart from avoiding further injury.

The 'cause' of carpal tunnel syndrome is almost always multifactorial and not solely due to some action of the patient's. It is often not possible to clearly determine what the relative parts played by different factors are but family history/genetics, gender, endocrine abnormalities like diabetes and thyroid disease, obesity, aging, arthritis and activity can all play a part - and quite a few of those things are not factors which you can do anything about.

If you want to try a semi-quantitative way of tracking how much impairment of nerve function there is then measuring 2-point discrimination is something that can be done at home with the aid of a helper - see the thread posted here by Linda5 for details. The other thing to watch out for is weakness of the thumb muscles but you and the assessor really need to be taught how to do that properly - we might create a video for the website at some point - and by the time marked weakness has developed it's actually a bit late to be treating the CTS. JB

jaymartin50
Online

Six weeks post injections and right hand virtually no CTS symptoms but left hand sometimes fingers tingle and feel numb, no pain though.
I feel as if I'm holding my breath waiting for return of symptoms. I'm still wearing splints at night, regularly exercise and massage
hands/wrists and have modified how I use my hands, where possible. Now I'm thinking about trying CTRAC. I've seen it mentioned by other forum members and have researched it on the internet. Do you think this would be a useful next step? I'm determined that surgery will be my very last resort. The distributors of CTRAC in the UK are suggesting that taking 250mg of vitamin B6 a day will have a positive impact on the treatment. Do you know of any evidence to support this?
Id appreciate your thoughts. Thank you.

jeremydpbland
Offline

There is no valid scientific evidence that C-trac has any effect on CTS and it is fairly expensive. I am not encouraged by the fact that the distributors are also peddling the myth about vitamin B6 which has been fairly comprehensively debunked  - it has no detectable effect on CTS in properly randomised clinical trials. The C-trac people used to offer a money back if not satisfied option and for people who have significant symptoms it is not too unreasonable to try it out on that basis - with perhaps the ideal self-trial being a conventional splint on one hand and C-trac on the other in a situation with similar bilateral CTS - you would then send back the C-trac for a refund unless the C_trac'ed hand did better than the ordinary splinted one. That would not work for you however because your symptoms have pretty much resolved anyway so you would not really be able to tell whether it was having any effect. Much the same issue arises with operating on it at present - how do you know it has worked? If you do decide to give it a try then I would be interested to hear how you get on. So far we seem to have one satisfied user here on the site and one who sent it back and I have one patient of my own who has been using one but is still requiring further treatment now - so more reports wil be welcome. Eventually someone will carry out a proper study of the device but for now there is just not the evidence. JB

jaymartin50
Online

After some deliberation I have decided to order the CTRAC device. My CTS symptoms seem to be on a plateau. My left hand is virtually the same as my right hand now, just occasional numbness and tingling in fingers. I am however still wearing splints at night and sometimes my hands get very warm. When I have taken the splints off for part of the night I have had some numbness and tingling but nothing like I used to get pre splints and injections. I'm wondering what would be the best way to test the CTRAC device out. Should I keep wearing splints and use it as instructed in the day time or discard the splints and see what happens. I suppose what I'm most concerned about is my condition worsening. I'd be interested to hear your thoughts on this. Thank you.

jeremydpbland
Offline

I guess the obvious thing to do is try C-trac on one hand and a simple splint on the other as suggested above. You can monitor the results with serial boston scores which you can save on the website here, probably every two weeks and you could also use a timed Phalen test and a check on two point discrimnation as semi-objective ways of checking progress (given that we can't do the desirable thing and repeat your nerve conduction studies serially). You could even do a 'crossover' n-of-1 study, using C-trac on the right and ordinary splint on the left for 6 weeks and then C-trac on the left and ordinary splint on the right for 6 if you are feeling truly experimental. JB 

jaymartin50
Online

I have been trying to follow your suggestion. I decided to try CTRAC on my left hand and continue with a splint on my right hand. My right hand is much the same, mild numbness and tingling occasionally, sometimes in the day sometimes in the night even when splinted.
When I used just CTRAC on my left hand and no splint in the night I found I was waking several times with numbness and tingling. After a week I decided to return to splinting it but still have continued to use CTRAC. Apart from pain at the base of my thumb which has been diagnosed as osteoarthritis, my left hand is now much the same as my right hand.
The supplier of CTRAC has suggested it can take up to 60 days for it to make a difference.
When I saw my GP recently he said he saw no reason why I shouldn't have more injections as they had helped, as long as I didn't have them too often. Whereas, the rheumatologist said to contact him to arrange surgery if the CTS symptoms continued. I do feel rather confused. I'm wondering what the best way forward is. I seem to be on rather a plateau. Apart from the splints getting hot to wear at night they do seem to help the most. My CTS is not cured but isn't having anything like such a negative impact on my life as it was.
My severity score has dropped and the two point discrimination test is fine.
I would be very grateful for your thoughts on next steps?

jeremydpbland
Offline

That doesn't sound like a very impressive response to c-trac. I hope the distributors are still prepared to hnour their money back if it doesn't work promise after 60 days if there has been no improvement - though in this case as you have been treated with injection and conventional splinting as well it is hard to tell what is making the difference,

I think in these circumstances I personally really would like to know what repeat nerve conduction studies look like before making a decision between further injection and surgery. JB

jaymartin50
Online

Thank you for your thoughts. I'm afraid I can't see how I can get further nerve studies done unless I go privately. Whilst this isn't totally out of the question it's something I would have to consider carefully.
I have read a lot about CTS both on your forum and on the web in general. Compared with many other people my symptoms even at their worst don't seem nearly as bad and yet my nerve conduction results indicated severe CTS. Now, compared with the pain and stiffness of osteoarthritis, I battle with daily, my CTS symptoms seem low level.
Obviously I would be happiest if they had gone completely but I do seem to be coping pretty well, partly by making simple changes to what I do as well as wearing splints and of course having injections. I think what worries me most is the uncertainty. The rheumatologist inferred that I would regret not having surgery as I don't realise how bad it would be, I gather he means if the median nerve was permanently damaged.
When I read the very mixed reports of life after CTS release surgery I feel very concerned. Loss of power in the grip of an already arthritic hand does not sound good and that's only one problem reported.
So at least in the short term I would like to avoid surgery and give alternative methods a chance.
Would serious deterioration of the nerve happen without warning? Is this why you are suggesting further studies?
I think I will keep going with the CTRAC for a bit longer and try to be more relaxed, if I can.
Thank you for all your support and advice about this very confusing condition. It is very much appreciated.

jeremydpbland
Offline

I think there are a few things to bear in mind. Remember that patient experiences you read on the web, including here, are heavily biassed towards bad outcomes as it is the people with continuing problems who are motivated to search the net and post their experiences online. The majprity of patients are very happy with the outcome of surgery.

Secondly - the relatinship between symptom severity and measurable nerve impairment is a very poor one - technically it has a correlation coefficient of about 0.3 - which means that an individual patient with a given degree of measurable nerve impairment on nerve conduction studies can have a wide range of symptom severity varying from no symptoms at all to constant daily pain. The reasons for this are not fully understood but it is one of the reasons why NCS are better then subjective symptom severity as a predictor of the outcome of surgery.

Thirdly, although the correlation between NCS and symptom severity is poor, the correlation between changes in these two variables is much better. ie, when symptoms feel better, NCS are usually better and vice versa. There are two caveats to this: a) patients with diabetes are odd and in them all bets are off - both symptoms and NCS can do anything independently of each other. b) on relapse after injection there often seems to be more pain than in the original presentation even though the NCS are the same or better when repeated, though this is only an anecdotal impression which I have been unable to verify with hard data so far. As long as you are not diabetic, and with slight reservations over the confusion caused by the arthritis, I would guess that your NCS would actually be better if repeated and that that would then provide confidence for continuing to treat without surgery.

If NCS were done on the NHS last time it should be no great problem to get them done again on the grounds that the clinical situation has changed. JB

jaymartin50
Online

It's now just over 5 months since my wrists were injected. I continue to wear splints at night. I have tried sleeping without them but have had some numbness so decided to keep on with them.
Generally, in the day, I forget I have CTS. I think a combination of things are helping me.
CTRAC is a part of my strategy but not quite in the way the suppliers suggested. Manipulation of my worst arthritic hand by a physiotherapist and daily stretching exercises now go alongside the CTRAC stretching. I gave up the timed CTRAC programme as it was difficult to keep to and it hasn't made any difference.
I massage my arms and wrists several times a day and give them breaks from activities like writing and mouse control.
My NCS were done privately. I was referred by a rheumatologist and his next step is surgery if my CTS is not resolved.
My GP. Says I can have more injections if I like but no details as to how I would get them.
I regularly do the tests that I can to check for feeling and grip. All good.
So live goes on and I remain hopeful. I still would rather not have surgery unless it is vital.
I would appreciate your view of how things are now. Thank you .

jeremydpbland
Offline

So far as on can judge from a conversation on the internet it sounds as though you have things reasonably under control. If you were my patient and you were still having to wear splints at night at this point I would be thinking about further nerve conduction studies and the possibility of re-injection (or surgery if the NCS were clearly worse - but I think that is unlikely to be the case given your symptoms) - but then I am a neurophysiologist so I would say that wouldn't I! - I use nerve conduction studies as an extension of my ability to talk to and examine the patient giving a bit of information which my unaided senses can't - and I am increasingly using ultrasound imaging in the same way. JB

jaymartin50
Online

Seven months plus after injections I'm still feeling positive but of course have concerns about risking permanent nerve damage .
As my CTS symptoms are mixed with those of osteoarthritis its sometimes difficult to know what causes what.
Where would you typically get pain from CTS? Would it radiate from the wrist up the inside of the arm? Is there any evidence to suggest cold makes CTS symptoms worse?
Stretching and flattening my curving arthritic hands seems to have helped considerably. Again is there any evidence to suggest night time taping of the hands is successful. I've tried CTRAC and although it didn't cure me as the supplier suggested it would, I did feel the stretching had a positive impact. I'm still wearing splints at night and find firm strapping links with the best nights sleep.
Sorry for so many questions. I'm seeing my GP soon and intend to ask him about the availability of nerve conduction testing.
I'm not sure whether the rheumatologist who I saw under my private Health Care plan would let me have more as he has said surgery would be the next step.
Thanks in anticipation for your help.

jeremydpbland
Offline

Pain from CTS can spread to anywhere in the arm up to the shoulder and possibly neck.  Reports on it being worse in hot or cold conditions are mixed and it may be more tied up with how your activities vary with the seasons than with the weather as such. There are no reports that I know of relating to taping - a splint seems less hassle overall. JB

jaymartin50
Online

It was three months since I'd done a severity test so I thought it might be interesting to redo it. How significant are small increases in every area? i think a combination of three factors , in the past two weeks, may have caused the increases, notably arthritis flaring up, attempting to carry shopping bags and holding books to read stories. As far as possible I try to avoid doing things I know will irritate CTS. The more I read about and hear about surgery, the more determined I am to manage CTS in other ways. I'm now 8 months post steroid injections. Splinting, physiotherapy, daily stretching and massage seem to keep my symptoms under control. I know ideally you suggested further nerve conduction studies but I'm not sure how to get more done.

jeremydpbland
Offline

That looks to me as though it has been fairly stable overall for the last 8 months or so. Small ups and downs in the scores are probably not significant. There are suggestions in the literature as to what consitutes the minimal clinically significant change in the Boston Scores and we've been thinking of trying to do a similar calculation. At present a change in SSS of about 1 whole unit is felt to be significant. JB

jaymartin50
Online

Is there any evidence to suggest that a low dose (10mg) of amitriptyline could have a beneficial effect on the symptoms of CTS.
I seem to be on a plateau. As long as I sleep with splints on and regularly stretch and massage my hands together with avoiding things that I know will aggravate the condition, I cope pretty well.
However, at the back of my mind is always the risk of permanent nerve damage.

jeremydpbland
Offline

Amitriptyline is sometimes used for nerve related pain and logically it might alleviate the symptoms of CTS, though it is unlikely to alter the underlying process. However there is no decent randomised controlled trial of amitriptyline in CTS. Another agent used for nerve pain is gabapentin and that has been the subject of two controlled trials in CTS, in neither of which was it any better than placebo. JB

jaymartin50
Online

I'm trying to work out if there are links between different symptoms I am experiencing, splinting or not splinting and very hot weather. Even if they are CTS related at all. Over the last few months I've been coping pretty well managing a heavy work load with minimal CTS symptoms. Same pattern splinting every night, physiotherapy once a month and stretching exercises as often as possible throughout the day. However, I've found it very hard to wear splints at night in this very hot weather. I've found myself taking them off in my sleep. My right arm wrist to elbow doesn't feel right. Sometimes it seems directly related to clasping something like a coffee mug at other times not. At the moment I have a dull throbbing feel in it. The osteoarthritis In my jaw seems to be worse in heat as does the pain I get in my shoulders. Fibromyalgia, arthritis or CTS I just don't know! Any advice would be much appreciated.

jeremydpbland
Offline

I think that's a very difficult one to answer given a patient with both known arthritis and known CTS. Either condition could be influenced by the temperature, either directly or via the secondary effect of making it uncomfortable to wear splints at night. It seems to be cooling off now so perhaps things will improve. JB

jaymartin50
Online

Although I continue to manage my CTS symptoms relatively well, I'm a little puzzled by what has happened recently.
When I take my splints off in the morning, partcularly the middle and ring finger of my left hand become numb and tingly. This can last for anything up to an hour. Is this significant?

jeremydpbland
Offline

Meaning they are not numb and tingling before you take the splints off? It's hard to know quite what to make of that if it is the case. I can imagine the splint, especially an old and worn one, allowing the hand to rest overnight in a position where soem nerve fasicles become compromised and you wake up with a couple of numb fingers which then wear off over an hour or so - but I can't quite think of a mechanism which would lead to the development of sensory symptoms after taking the splints off, unless you are doing something very odd with your hands once you remove them. JB

jaymartin50
Online

Thank you for your reply. Apart from a physiotherapist who suggested splints when I was first diagnosed with CTS, I haven't had any advice about splints. I'm still wearing the pair I purchased in a random mobility shop but they are getting old now. I have ordered and returned several pairs as they were uncomfortable so maybe I need to make a real effort to find some new ones as I do sometimes get problems with numbness and tingling in the night whilst wearing them.
I wonder if the problems when I take them off in the morning could be due to the cold. In the week I get up before the heating comes on. I have noticed that cold and worsening symptoms seem to be linked in the daytime.
In some ways I feel I'm living in no man's land. My consultant says surgery is the only way forward. My GP suggests more steroid injections. I just try to ignore/manage my symptoms with exercises and splints and hope for the best. Another forum I have a link to seems full of gloom and doom about surgery. I know of several cases, on a persoanal level, where people with osteoarthritis have really regretted having surgery.Recently I answered your severity questionaire and from the score it seems I'm not getting significantly worse. I know you mentioned having another nreve conduction study but I have no idea how I could get one done.
It's a pity similar clinics to yours in Canterbury aren't available nation wide.

jeremydpbland
Offline

The splint page of the site has a set of illustrations on how to adjust an off the peg splint to shape. They should be fairly comfortable. Don't worry too much about the doom and gloom on the net - that is a very highly selected group of patients who are not at all representative of the average CTS case. If those morning symptoms are cold related then perhaps an experiment with a pair of warm gloves is in order? It must be quite a while since your original nerve conduction studies were done now so it ought to be possible to get them updated - where are you roughly? JB

jaymartin50
Online

Thanks for your reply. I live in the East of England but a doctor came from Nottingham to do my nerve conduction study 20 months ago. Would another study be something that I could request on the NHS? Which department would it come under?
Getting cold and lifting heavy things seem to trigger tingling and numbness so Im trying to avoid both but sometimes not easy.
Splinting at night is still reasonably successful although I've had numbness from my shoulder to hand recently. I'm not sure if it's related or a bad sign. Apart from positive advice and encouragement from a physiotherapist and your helpful website, I feel that I have no support.

jeremydpbland
Offline

Norwich and Cambridge both have decent neurophysiology departments. I don't know what their referral policies are though. Many departments take direct access referrals from general practitioners though not all. Where there is no direct access you have to go through neurology, orthopaedics or rheumatology. JB

jaymartin50
Online

I understand that you have made a study of patients who are managing CTS with steroid injections / non-surgical methods, that is about to be published.
When is this likely to be and how can I access it.
Thank you

jeremydpbland
Offline

We published a study of second injections a year or two back (see Ashworth in the reference list here). I'm currently planning a prospective study looking at the issue but that will not be available for some time, even if we manage to get it started. I think patients can download copies for personal use from the Wiley website but if you can't get hold of the Ashworth paper I can email you a copy. I have another observational study which should become available in a few weeks time I hope - can't really discuss it in public while it is still under review. JB

jaymartin50
Online

I think it must be the observational study that you mentioned in a reply on another patient website that I thought might be helpful to me. I find myself in No Mans Land where apart from a very supportive physiotherapist I have no medical support. My symptoms aren't bad enough for me to be seeking second steroid injections nor surgery at the moment. However I do have things that I'm not sure about. My left wrist has virtually no symptoms now and I find that I can sleep without a splint on but is this a good idea? My right wrist reacts strongly to weight bearing and using a computer mouse even after splinting. Manipulation of my neck and shoulders along with specific exercises seems to help a lot. There seem to be a lot of people discussing problems after surgery but few in the position I'm in. Will you make it known when your observational study is available on here? Thank you for always giving me positive support.

jeremydpbland
Offline

I will of course reference each new study that I think contributes something useful to the management of CTS on here as I come across it (and get time to read). In the case of my own studies of course I wouldn't publish them if I didn't think they were useful in some way but others may feel differently. I get sent a lot of papers for peer review so I also have to be a little careful not divulge material that I have been sent in confidence.

So far as the progressin of your case is concerned, if there are no left hand symptoms now I would be inclined to leave the night splint off for a while. For the right side I have to say, as usual, that I would really like to see what is happening to your NCS results. If you email me your location I'll try to find out where your nearest NHS neurophysiology department is and what their access policy is. I've just been looking at some NHS England figures which suggest that England is now pretty well covered. JB

This site uses cookies. By continuing to browse the site you are agreeing to our use of cookies. Find out more here.

close