Short Term relief from Carpal Tunnel?

Hi Chaps,

My missus has pretty sever Carpal Tunnel at the moment, to the point where she’s in constant pain. She’s booked in for surgery in late December, but it looks like another 3 month wait for the other wrist to get done.

We’re exploring going private, although it’s £3k – and we move house in Jan.

Are there any therapies that people have used that work? Acupuncture, Ultrasound?

She’s on 60mg of codeine and Tramadol, but can’t take anti-inflammatories, and steriod injections are out of the question too.

She needs short term relief that’ll last a month or so, even if she can get past the next couple of weeks.

Cheers for the help,

Ricks

Unable to, or just not keen on steroid injection?
That would be my suggestion for quick, sort term advice.

Or a wrist splint.

DrP

Wrist splints, worn at night & rest as often as possible.

I can’t remember if you’d identified the cause or not? For me it was mouse related and I learnt to use my other hand.

I could ask my sister, she had serious problems when she was a musician from practicing 8 hours a day.

With my ‘bloody hippy’ hat on I’d have to say many people use cannabis for pain relief, sadly not legal here yet, but many chronic pain sufferers do gain benefits from it. I found it as good as dihydrocodeine anyway. Of course, the possibly undesirable side effect is you get stoned, which many people won’t want.

Unable to, or just not keen on steroid injection?
That would be my suggestion for quick, sort term advice.

Or a wrist splint.

Medical reasons for not having the steriods, unfortunetly.

She’s been wrist splinted on both wrists for about 3 months now.

She’s in constant pain, to the point of not being able to cope with it. It’s now not related to doing anything, she’s in pain 24/7 and can’t sleep.

Doctors are being great but the hospital is a joke, 8 weeks ago they said she was an Urgent case, and will be operated on within 6 weeks. They’ve yet to schedule her appointment, and say she’s likely get an Xmas time appointment as people drop out around then.

I assume that you have tried physio?

shame injection not an option. Would be ideal I think situation.
Are there any other providers of surgery? In the wonderful world of choose and book and any qualified provider there are often other options, in my locality there are 2 GPs that do carpal tunnel surgery and they have much shorter waits than the hospital

n my locality there are 2 GPs that do carpal tunnel surgery

How would I go about finding that out? I’d be very keen to explore that.

I assume that you have tried physio?

We’re in conversation with the Doctor about this, and have an appointment to discuss tomorrow – as I was keen to explore Ultrasound, Acupuncture etc…

n my locality there are 2 GPs that do carpal tunnel surgery

Actually, I’m not sure it’s an option. She’s on Warfarin, so the risk of her bleeding out is far greater than normal people – so suspect she’d need to be in a hospital.

My sister says “Acupuncture, myofascial massage and chiropractic and wearing splints at night are good” though she says she now doesn’t think she does have carpal tunnel syndrome herself.

We’re in conversation with the Doctor about this, and have an appointment to discuss tomorrow – as I was keen to explore Ultrasound, Acupuncture etc…

I’ve had reasonably good results with joint mobilisation and retinaculum stretches for people with carpal tunnel. TENS works pretty well too in some people – you can get a machine pretty cheaply from Boots.

Never suffered much from CTS when cycling, but have just moved house and used an electric sander on all the woodwork which has left my hands numb and tingly for the last 4 days!!

Rickon- Ask your gp, they’d know. But as you say warfarin might preclude that option.

“Carpal Tunnel Syndrome” (often misdiagnosed) surgery is just about the most popular, and least successful surgical intervention in America.

More often than not, nerves are impinged higher up the chain, typically between anterior and medial scalenes or under Pec Minor. I have had a couple of clients with triple crush…

If she has bilateral “Carpal Tunnel” symptoms the issue will be core/spinal.

Also, the wrist is a Master Driver for gait, so you might need to investigate various subsystems.

If she has the above she would need a proper assessment by someone trained to figure out the underlying cause of the neuromuscular compensation patterns.

Not saying that she doesn’t have true CTS, just that I rarely see it with clients. If she doesn’t, surgery would be a waste of time and there will be a neuromuscular price to pay.

Mine is caused by impingement in the brachial plexus complicated with C6/7 disc bulging.
All the tests they do says it is the wrists until I point out the paresthesia in both hands and the ability to transfer pain across the knuckles by manipulating the Radial nerve.

Get her to check the areas along the forearm, elbow, etc first.

http://www.eorthopod.com/wrist-anatomy/topic/158 – scroll down for the pathways

Carpal Tunnel Syndrome” (often misdiagnosed) surgery is just about the most popular, and least successful surgical intervention in America.

This confuses me. All the case studies I’ve seen states that the operation has a 9 in 10 success rate.

Where are you getting your data from? Is it anecdotal? And why would various neuro specialists she’s seen say its CTS when its entirely something different? Are they incompetent?

Should also say that she’s seen three separate physios, with the same diagnosis too.

Nerve compression elsewhere (TOS) can cause CTS symptoms.
TPs from the scalenes can mimic CTS symptoms.
Plus nerve root compression, as mentioned above.

She may very well have have defacto CTS. Not saying that she doesn’t.

All I am saying is that 90% + of the clients I (and many colleagues) treat for CTS symptoms, the root cause is elsewhere, so I fix the “elsewhere”

Hope she finds a solution.

My sister is fairly sure that after 10 years down the line she didn’t in fact have carpal tunnel syndrome in the first place. Which is nice.

Thanks Podium – what work do you do? Are you physio? Chiro?

If you watch the 2nd episode of Dr In The House on iPlayer (featuring Ray, the body builder)

That’s what I do.

The chap who fixed Ray’s shoulder, soon after he went back to the pain killers, is my mentor.

Because we know what to look for and how to assess the compensation patterns, it’s a very simple thing to fix.

Is there anyone in the Edinburgh area that you know who does the same thing?

The first question I would ask is:

“Have you suffered a whiplash type incident just prior to your symptoms starting?”

Nearest is Chester, I think. But he has a 2 month waiting list.

From a French point of view:

After years of pain, slowly losing the use of my left hand and the right one starting to get painful too I went see my doc. He diagnosed carpal tunnel syndrome and sent me to see a nerve specialist

The nerve specialist tortured me, electrically measuring signal speed and intensity all down the median nerve. This showed that everything was fine as far as the wrist. He reckoned a steroid jab wouldn’t work and that the sooner I had the op on the left hand the better as the nerve damage would become permanent if I waited. So despite the the negative news in the press about the op I went to a carpal tunnel syndrome specialist who does them almost production line style with a remote probe thing with a camera and cutter on the end to chop the ligament.

Within 24 hours of the op I was in less pain than before and 18 months on it’s like having a new hand. I’d stopped playing guitar as it was painful and frustrating as the fingers didn’t respond fast enough, I’m now playing stuff I found fast in my twenties. I’m being really careful with my right hand avoiding things that cause pain and it seems to be fairly stable, the day I can no longer accurately wield a guitar pick I’ll go through the system again.

Edit: the right hand is less painful at night too. The doc reckons that you can get pain in both hands even though only one nerve is being crushed. The electrical test on the right hand was borderline so I had just one done on the basis that I would be able to wipe my own bum and have it done later if I was happy with the op on the left hand.

“Carpal Tunnel Syndrome” (often misdiagnosed) surgery is just about the most popular, and least successful surgical intervention in America

I’m sorry but none of that is accurate in the slightest. None of the figures I’ve seen has carpal tunnel anywhere near the top of the list of procedure numbers. As for its success rate, there’s many large number studies showing good clinical outcome from surgery.

Rickon, from the sounds of things your wife has been examined by serval specialists – who have all agreed on their diagnosis. As podium says, symptoms can be caused by higher intrapments but they aren’t as common, and I’m sure the specialists will have considered that. It’s perfectly common to have it bilaterally due to genuine CTS rather than central cause.

The two treatments that there’s good evidence for are surgery and steroid injection, the rest have minimal evidence unfortunately.

That torture device is a proper bastid!
Lost count of the number of times I’ve had it done now.
For me they use it as a baseline to measure degradation – doesn’t make it any nicer though 😯

The first question I would ask is:

“Have you suffered a whiplash type incident just prior to your symptoms starting?”

Now there’s a leading question if ever there was.

A simple “any neck or back problems?” tells you all you need to know.

Yep, she’s been to the nerve specialist, and had the tests. She’s got muscle wastage in the one hand, and a bit in the other.

The NHS really do suck. 8 weeks ago was told it’ll be within 6 weeks for the OP, its 1 week from the day that they start the pre op when she will go in for surgery, so its at the very least 9 weeks, but looks to be over 12 weeks. If they’d been honest up front, we would have gone private straight away, my concern is that theyve screwed us around for so long that the nerve damage will be permanent.

Can you ask to be seen in Fife? They have some of the best hand surgeons you’ll find anywhere.

I’m not sure if it’s the same thing, but working in IT, a few years back I started having serious discomfort in my mouse hand and wrist, numbness of my little finger on that hand and occasional shooting pains up to my elbow.

Proper wrist support (a gel cushion mouse mat) and using a power ball daily for a month and I’m fine now.

Do you know what the cause might be? Bad arm/wrist posture at work?

Anyway get one of these, they are fun if nothing else and it worked a treat for me:

Powerball

Numbness in the little finger isn’t the median nerve that goes through the carpal tunnel. It’s the nerve that goes through a tunnel in the elbow (ulnar I think). The little finger is ulnar and the third (ring) finger both ulnar and median. The thumb, index and middle fingers are the ones that are affected by carpal tunnel syndrome.

Cool, but we know carpel tunnel is massively miss diagnosed.. What’s the harm in doing some low impact physiotherapy?

Can you ask to be seen in Fife? They have some of the best hand surgeons you’ll find anywhere.

Possibly, how do you know they’re the best? Which hosptial are you talking about too?

It would be Queen Margaret at Dunfermline. The surgeons were part of the department that I worked in.

Jane McEachan is the best out of them. She also does private work in Edinburgh if you’re interested in that.

http://www.edinburghhandclinic.com

What position are the splints? If they hold the wrist pushed back as many do will make it worse.

We bend the metal in our splits to make it straight so wrist held neutral – makes a big difference.

James (orthopod)