Carpal tunnel Release surgery.

Hi Damian. Yes i got checked for a pinched nerve at the beginning. All good. But i will take a lookon the site. Thanks

Ok you did...yeah i have had the surgery in both the wrist and elbow on my right arm...i was still in pain and numb for a couple of years after until I started doing the exercises and believe it or not eating properly. I have carpal tunnel in both hands and I work with them as an electrician. The pain at night was ridiculous. You said you wore splints. How did they work for you? They helped me somewhat when I slept. Honestly everyone responds differently to cts remedies but I tried that ladies ways and its like i got my hands back. Just saying.

Damian

Hi. No the splints didnt work for me unfortunately. I will be getting the other hand done in a few weeks so i hope i have some kind of relief.

I wish you the best. There is a page on that site i sent you that has exercises. Five proven ways for you to use before and after surgery to help with your cts...It really only matters what you mind is set on. Once again good luck and keep me posted. Hope for a speedy recovery.

Damian

I was checked for a pinched nerve and that was ok. I've had CT for 4yrs now and it has definitely got worst in my hand I'm waiting for surgery on. Where as the hand I've had surgery on has improved compared to before the surgery. I'm worried about delaying the op any longer due to it getting worse and this could make the CTS even more unsuccessful.

My points were:

a) being 'checked for a pinched nerve' doesn't mean a lot - it's impossible to exclude mild nerve problems in the neck by any kind of 'check'

b) with normal NCS there is no immediate danger of some delay in surgery leading to the operation being less successful - indeed you actually get better results from surgery if you wait for the NCS to become abnormal, but not too abnormal. You can find the details of this on my website - which unlike many others is not trying to sell you anything

Dr J Bland

Thankyou for your advice. I have read a lot of info on your site.

It's a good idea to run through the symptom questionnaire - though it is really designed to be used before treatment so you might have to answer for the symptoms as they were before surgery. That gives you a fairly objective measure of just how typical of CTS your presentation is. From the details available here I might guess that you would get a middle to high score. You are also welcome to continue the discussion on the forums there, away from the adverts :-)  Dr J Bland

Ok Jerry...first of all the many who are trying to sell something...well its me and you on this thread so nice try...i am also offering advice that well honestly i had to pay for to get but thats not all the site has to offer. And again "adverts"...low blow coming from a Dr...I always thought Dr's actually cared but i guess not...so if someone has to buy something to get help...the problem with this is what?

I did do the symptoms questionnaire. I got 67. Surely if my left hand is 80% better than before the op thats a good thing. Ok 100% would be preferable. It makes me think i should have the op on my right hand because being woken up 4/5 a night in pain for 4yrs can take it's toil on a person. Before i had my 1st op i did see a specialist physio to make sure my symptoms were not because of anything else.

I guess you might be in the USA - in which case you have my sympathy - you are subjected to far too much medical advertising. The more money is involved in medicine the worse it gets usually. Unfortunately the world doesn't function at all without finance - we all have to live - but the more it can be kept out of medicine, and particularly clinical decision making the better. I happen to feel that the sheer amount of advertising here on PUK is irritating which is why I prefer to talk with patients on my own site which is advert free and selling nothing - it is determinedly non-commercial and I do not use it to attract patients to my own practice which, in any case is in the NHS so that my salary is pretty fixed regardless of how many patients come to my clinic.

Believe it or not I actually spend a fair amount of time thinking about financial bias in medicine and despite the above I am not wholly immune. It cannot be denied that my advocacy, for example, of nerve conduction testing before surgery for CTS, tends to enhance the demand for neurophysiology services, which I and my colleagues provide of course, so it can be seen as self-serving, but no more so than orthopaedic surgeons who argue that everyone with CTS needs surgery. I spend more time considering the cost-utility of what I do than you would probably think as I'm interested in ensuring that every patient with CTS gets the same quality service and that is easier if costs are kept down. I also do a very small amount of private practice work, much of it at the request of solicitors managing damages claims who cannot use NHS services and otherwise would not be able to get NCS testing done otherwise (there are very few of us in the UK). That small part of my work does have a direct financial reward and I would prefer to give it up really. I actively discourage people who visit my website from trying to consult me personally unless they live in my natural catchment area.

I have no reliable source of information about you so I am not going to draw any conclusions about you personally but the site you recommend is unquestionably and overtly commercial - it is there to sell it's treatment programme for CTS and to make money. On the other hand you can find out plenty about me - check out the GMC register no 2712789 and check pubmed for my publications on CTS.

So my guess on symptom score was about right and yes I think it's highly likely from the response to surgery that you do have CTS. The tricky question is to figure out why you have residual symptoms in the left hand. There are three main possibilities:

1) The original CTS was so bad that there is some degree of permanent nerve damage despite correctly performed surgery

2) The residual symptoms are a complication of surgery

3) You have a second problem as well as CTS which is responsible tor 20% of the symptoms, and that hasn't been treated yet

It's often genuinely very hard to distinguish these and we all get it wrong sometimes. Before and after surgery nerve conduction studies can help considerably but don't always provide the answers, ultrasound imaging can help, and as always a detailed analysis of the symptoms and signs is the starting point for everything. The response to injection can also be a useful guide and in a few cases injection will effectively solve the problem altogether so it's always worth considering - being considerably safer and less inconvenient than surgery. In the case of your left hand I'm not sure whether you said your recent NCS included the operated hand - if they did and that side was also normal then that would make 1) unlikely. The very short-lived response to injection makes 3) a bit more likely.

For the right side, you don't need to worry about 1) happening as there is clearly not any irreversible damage to the nerve if the tests are normal but apart from that this is just a question of how to best manage mild CTS and over that there remains a good deal of medical argument. My own inclination is to try and avoid surgery until other avenues have been exhausted, but there are other opinions which are equally valid. You can even try damian's exercise program if you want to spend money on it - it's unlikely to do any harm as long as it's only things you do yourself as a 'self-help' approach. Dr J Bland

Cheers mate,

Don't know how the US got mixed up in this and its really apparent that I've struck a chord. Not my intention. Sympathy I don't need either just respect If you want mine. I'm just saying before you go making remarks to think about how other's may feel. I mean you are a doctor who cares about their patients spending money on procedures that they may not need, right? So where does your compassion end? Is it so limited? If so why not do as most mothers tell their children to do which is, " If you have nothing nice to say don't say it at all".

Damian

I'm not interested in a flame war. All I did was hint, quite gently, that the site you recommended might be financially motivated and you then seem to have taken offence. I very carefully did not say anything about you personally because I have no information. When I contribute to this forum I try to provide, so far as possible, unbiassed evidence based advice, just as I would to my own patients. Dr J Bland

I agree...

No flame war. You've been really cool until this thread thats all. I was offended only because i gave advice that worked for me an your unbiased comments may discourage people to take what im saying serious.

Damian

Your experience is your experience, but evidence based medicine doesn't work from anecdotes - which have frequently led in the past to effort being wasted on ineffective or even harmful 'treatments'. Although it can be helpful to share experiences of a condition with other sufferers crowdsourcing diagnoses and treatment ideas is not necessarily a good strategy unfortunately. I have nothing against exercise programmes for CTS which I think are pretty harmless but there isn't actually any high quality trial evidence to support their use and it's always struck me as odd that, on the one hand we have people effectively claiming that exercise of various kinds in the course of your job can cause CTS, while on the other we have people selling exercise as a treatment that can cure it.  Dr J Bland

Granted Dr... but as you know surgery isn't always the answer and physical therapies are even prescribed by doctors before and after surgery. So although you may say anecdotal why is this so then?

Damian

Although the intellectual structure of evidence based medicine can be argued to be one of the great triumphs of science I'm afraid it is also true that probably 90% of ordinary medical practice does not really have a proper evidence base. 'Anecdotal' simply refers however to the fact that it is not safe to draw general conclusions from any single patient's experience. Humanity, and medicine, are too randomly variable for us to know for sure what resulted in improvement, or deterioration, in single patients for certain. That's why we need formal trials to determine what really works and what does not - and all too often there are no good quality trials for commonly used therapies. Only very few things are obvious enough to dispense with proper trials - no randomised study is needed to prove the efficacy of a parachute in preventing injury from falling out of an aircraft - but treatment for CTS is not a situation like that. Dr J Bland

I’m scheduled for both my wrists May 25th.  I work in a deli and the orthopedic surgeon told me I could go back to work in 2 weeks.  I’m concerned because i believe the reason the carpal tunnel started was due to this occupation, but if I don’t go back to work when the doctor says I can, I won’t get my short term disability and my employer may fire me.  I would love to hear any feed-back from you.  Thank you in advance.

2 weeks is a fairly good average recovery time to get back to an occupation that is not heavy manual (digging roads etc). There is a lot of individual variation however - some people will be back in 3 days and others not for 6 weeks and it's impossible to predict with certainty i advance how long it will be. If you can't risk time off work then steroid injection is often a good tactic but it does depend to some extent on how bad your CTS is - best judged from the nerve conduction studies. JB