General advice about next steps with CTS diagnosis
I'm really looking for some more advice on what to do please- I'm not based in your area but would appreciate your help.
I visited my GP on a couple of occasions about pain in my left thumb ( I am right-handed). She did some standard checks on my wrist and hand , suggesting that it could be CTS. I have subsequently been for a Nerve Conduction Test and GP says results show I have CTS in both wrists and some compression of the nerve in my right elbow? I do not have a copy of the results so I am not 100% certain exactly what the issue is with the elbow.
I suffer from some numbness in both hands at night but this is not painful generally, the main issue is my left thumb which is causing me problems driving ( gear change was when I first notice the problem really), dressing ( putting on a bra), gripping things especially undoing jars.
I have opted to have the steroid injections as a first step and have started wearing a splint at night- which seems to make my thumb more painful in the morning when I take it off.
Will this injection cause me a problem driving home from the health centre? How many injections ( in one wrist) are advised?
My GP suggested that if there is no improvement in 6 weeks after the injection then surgery would be the next step- would that be your advice, obviously you don't know what my symptoms are but is that a general approach?
I have searched for information on the relative success rates of surgery and, obviously, the majority of people who post on forums do so because they have had issues subsequently. Is there information out there on the success rates for the surgery?
Finally, if I opt for surgery, how long would I be unable to work? I am a teacher ( ICT & Computing) so use a keyboard a lot and have a 40 minute drive to work- just thinking ahead! Thanks for any advice.
Thanks very much for your speedy reply- much appreciated. I have done the diagnostic page on the site and it comes up with an ANN of 42% and LRP of 10%, with a score of 2.8/2.9 for the left and 1 for the right.
Your comments about isolated thumb pain are interesting- I suffer from swelling in my hand when I use the thumb a lot in the abductor pollis brevis area ( I think that is the right muscle)- its the large one around the base of the thumb. My thumb is increasingly weak and painful when trying to do tasks that involve pushing with the thumbs/ try to grip things using my hand generally, pushing the gear stick into place etc.
In your opinion, should I ask for some further investigation just related to my thumb, regardless of the Nerve Conduction tests results? I don't want to go down the wrong route - is it more symptomatic of arthritis? I have no other joint pain that bothers me apart from the general aches and pains of getting older - is it likely to start here?
I think that what you are saying is that if the issue is mainly CTS then the injections should relieve the problem, if not then I should ask for more investigation? Can you suggest what that might be?
I have also looked at the information about treatments and surgery, which is very useful and gives me the answers that I was looking for. I assume that the experience of patients in East Kent is similar to most other places in the UK. Any other advice or suggestions would be very helpful, thanks in advance.
42% is a moderately high diagnostic score so it is reasonably likely that you do have some element of CTS and it is probably CTS which makes your fingers tingle at night. The thumb pain however is a different matter. CTS does not generally cause localised swelling at the thumb base on use so I would be suspicious of the joints there - at least so far as one can be just from the story online, being able to see and examine them is a lot more useful for this. Apart from physical examination a plain x-ray will help to establish whether there is arthritic change at the thumb base.
East Kent patients seem to be fairly typical as far as CTS goes. If you can get hold of a copy of your nerve conduction results that would be useful. JB
Hello Jeremy
I have got a copy of my results here . Do these tell you any more please?
Sensory Nerve Conduction
Nerve Distance Lats CV Amp
mm ms m/s
Combined Sensories Sensory Left
Dig III- Wrist M 119 2.71 43.9 20.8
Dig I- Wrist M 81 2.46 32.9 10.4
Dig I-Radial 81 1.46 55.5 4.8
Dig V-Wrist U 81 1.54 52.6 13.8
Dig V-Wrist U Repeat
97 1.75 55.4 11
Combined Sensories Sensory Right
Dig III- Wrist M 119 2.64 44.6 22.6
Dig I- Wrist M 90 2.29 39.3 15.2
Dig I-Radial 90 1.69 53.3 4.3
Dig V-Wrist U 90 1.38 65.2 18.3
Motor Nerve Conduction Studies
Nerve Lat Amp % Amp Diff CV F-M Lat
ms mV % m/s ms
Median Motor Left
Wrist-APB 4.29 5.7 18.5
Elbow-Wrist 7.88 5.7 0
Median Motor Right
Wrist-APB 3.88 6.7 19.7
Elbow-Wrist 7.17 6.3 -6 63.5
Ulnar Motor Left
Wrist-ADM 2.26 10.2
Bl. elbow-wrist 5.43 8.7 -14.7 62.5
Ab. Elbow-Bl.elbow 7.19 8.3 -4.6 56.8
Ulnar Motor Right
Wrist-ADM 2.32 7.3
Bl. elbow-wrist 5.39 6.8 -6.8 63.5
Ab. Elbow-Bl.elbow 7.27 6.6 -2.9 53.2
Ulnar FDI Motor Left
Wrist U- FDI 3.81 15.1
Bl. elbow-wrist U 7.14 12.9 -14.6 59.5
Ab. Elbow-Bl.elbow 8.93 12.3 -4.7 55.9
Ulnar FDI Motor Right
Wrist U- FDI 4.03 17.1
Bl. elbow-wrist U 7.06 16.3 -4.7 64.4
Ab. Elbow-Bl.elbow 8.9 15.5 -4.9 54.3
Probably grade 1 (maybe 2) bilateral CTS. I'm not convinced by the right ulnar nerve abnormality at the elbow on those results but they have not given us their normal values so it's hard to be sure. Did they provide an interpretation too? I would not be happy attributing thumb pain and swelling to anything shown by those NCS results. It will be interesting to see how it responds to steroids. JB
Most of the answers you are looking for, in so far as they exist in the scientific literature at all, are on this website - in particular you will find the best available figures for the outcome of surgery as generally performed in the NHS on the surgical prognosis page and you will find a detailed discussion of injection, including the issue of repeating it, on the injection page.
It is not that uncommon to have multiple nerve entrapments and it sounds as though they may be suggesting that you have problems with the ulnar nerve at the elbow as well as CTS. By the same logic however, there is no law stating that you cannot have multiple other problems as well as nerve entrapments and the interesting thing to speculate on here is really whether your thumb pain is due to pressure on the median neve at the wrist (CTS) or something else. Isolated pain in the thumb only is not a very typical presentation for CTS, and arthritic problems in the joints at the base of the thumb are also common so inevitably they sometimes coexist with CTS. In such situations injection is often very helpful diagnostically as any symptoms which resolve, even for only a few weeks, after injection are more likely to be due to CTS.
Injection rarely stops people driving home (we have not had one yet in over 500 injections) but it is a theoretical risk. it probably makes most sense just to inject the left one to start with as that is the hand you are actually concerned about. I worry slightly about surgery after failed injections - if the symptoms resolve and then recur a few weeks later with injection then the outcome of surgery tends to be good but cases where there is no change in symptoms at all after injection make me worry about whether the CTS really is the problem or not so I'm not sure that surgery should be 'automatic' in those circumstances - especially if the symptoms are not wholly typical of CTS. It would be worth doing the diagnostic questionnaire here to get an idea of just how typical your symptoms are.
Let me know what you think of the surgery and injection pages please - we don't get as much feedback as we would like about the general aspects of the site. JB