As you have probably gathered from the bulk of this site, my speciality, and previous discussion in this thread I am a strong believer in the utility of nerve conduction studies in helping to manage this condition. They are the only investigation which has been conclusively shown to be an indicator of surgical outcome and they provide the only fully objective measure of nerve function which can be used to track progress of the condition in terms of damage to the nerve cells within the median nerve, even though they are not perfect. Ultrasound imaging is interesting for other reasons but does not yet have the wealth of experience behind it that NCS have. I would therefore absolutely want to know what your NCS results look like at this point before reaching any decision on what to do next. JB
I understand what you are saying and it makes sense.
However, I can see that I need to be more assertive.
Is it nationally accepted that NCS results are known before surgery is undertaken?
Thank you for your prompt reply.
There is not really much in the way of nationally enforced policy on anything. There are wide geographical variations and there are for example CCGs who mistakenly restrict access to carapl tunnel surgery when it is clearly needed, for essentially financial reasons. It is possible if you search around to find people who will provide virtually any 'treatment' under any circumstances and there are plenty of UK surgeons who are happy to operate on CTS with no investigation whatsoever. I have seen many of their failures over the years and I think they are wrong to do this, principally because it is often very hard to work out what the problem is after unsuccessful surgery without pre-operative studies for comparison. I try to practice evidence based medicine and the reasons for my opinions are set out extensively on this site in a form which I hope is accessible to the interested layman. Worldwide I think opinion is gradually swinging in my direction but medicine in general is quite slow to change unless something truly revolutionary comes along and in the case of CTS treatment there is plenty of room for differences of opinion especially when it comes to the use of steroid injection which many surgeons rather disapprove of.JB
In your experience, is there any evidence linking reduction in intake of salt/fat/sugar to improvement in CTS symptoms?
After being ill recently and eating nothing for days, my right hand in particular has improved dramatically.
I'm not aware of any scientifc studies of specific modifications to diet but there is a link between CTS and obesity and weight loss might therefore plausibly have an effect on CTS. Another possible thought is that the stress reponse to another illness might result in an increase in endogenous corticosteroid production and that might effectively treat your CTS. JB
It’s now 4 years since i was diagnosed with CTS in both hands. Ive just taken the severity test again and whilst the left hand is scoring lower my right hand has scored higher than a year ago and higher than most tests. These results fit with how my hands seem to be. For the past 4 months i havent splinted my left hand at night and most of the time it really doesnt bother me. My right hand is usually splinted at night and although leaving the splint off causes more problems I do get pain numbness and tingling with it on. Undoubtedly using a computer mouse and copious writing as part of my job does make my right hand worse in the daytime.
Is it ok to carry on as i am or should i try to get nerve conduction studies done privately? Im going to try to do less of the things i know make my hand worse. Im wondering why my left hand seems to have returned more or less back to normal.
I was advised to have surgery on both hands in 2014. I feel rather confused. Your thoughts would be greatly appreciated.
It's always 'OK to carry on' in the sense that they are your hands and only you can balance the amount of discomfort they cause you against the risks and inconvenience of treatment n order to decide when to go ahead and do soemthing about it. It's not as though CTS were a life threatening condition that has to be treated. Cases of uncertainty like this are often helped in my experience by knowing just how bad the nerve damage is on testing so of course I would definitely get them tested again and the NHS should be able to do that if you are in the UK (I can't remember offhand). JB
It's nearly three years since I was diagnosed as having CTS in both wrists.After initial steroid injections I have managed my condition with splinting and physiotherapy/stretching and exercises. I no longer splint my left wrist at night and apart from if I hold a phone for too long or carry a heavy bag I don't have any symptoms.
My right hand is very different though. The splint I was using is very similar to the one pictured on this site. It had been fine but a few months ago I was waking with numb sausage fingers curled over the top of the splint. I decided to try a different type of splint called a Pilo O Splint which is designed to keep fingers straight. It was blissful in the night but in the morning when I took it off my fingers were extremely stiff and painful. It took the best part of an hour to get them back to normal, time I can't spare on the days I'm working. So, back to square one. I've gone back to the very first splint I ever had which I had discarded because it was very worn, with limited success. During the day I manage my right wrist reasonably well. Recently I have started to use an ergo metric mouse which is very helpful.
As yet I haven't been able to arrange more nerve conduction studies but have been offered more injections or even surgeryif I wanted it.I see surgery as a last resort.
I do find that there is a link between my arthritic joints feeling sore, greater senstivity to touch (fibromyalgia) and worsening right wrist problems.
I'd be very interested to hear what your thoughts are at this stage. Thank you