carpal tunnel syndrom

had it last monday, dnt feel anything at the time, cant move them as when i try my fingers just wont move

We have never seen that happen in over 11,000 injections so yes this is very unusual and you should see a doctor and get it examined. Whoever did the injection is the obvious first port of call. Dr J Bland

Hi Dr Blend. I did 3 shots within 3 months. And they did not clear out CTS. Just made it better, but still my hands hurt. Could it be that these shots do not help? Only ease symptoms. Thank you!

Responses vary from patient to patient - about 20% of patients with CTS do not respond well to steroids or relapse very quickly. A complete lack of response - ie absolutely no effect at all on symptoms, even briefly, always makes one worry that the symptoms may be due to something else, at least as long as it is not grade 6 CTS to start off with. A few studies have suggested that patients who do not respond to steroids have a less good prognosis surgically too. 3 injections in 3 months is unusual. It's worth checking the dose and steroid used - some people use homeopathic doses of steroids and a lack of response is then not unexpected really. One should also give a little thought to the possibility of other diagnoses - some patients have CTS combined with other hand problems too. Dr J Bland

Understood, thank you! That was betamethasone 5mg. I'm not sure if it's used abroad. I'm from the East. They told me that effect works up to 14 days and then you can repeat. It got better but did not clear up. Maybe because I constantly use my hands.

5mg betamethasone is a resonable dose - the equivalent of about 30mg of triamcinolone (we use 40mg of triamcinolone). In patients who respond well to steroids the effect of one dose can last anything from a few weeks to 50 years and is almost wholly unpredictable in duration. If trying to decide what to do next the most useful bit of information at this point is how bad were your nerve conduction studies (if done) before injection.

Dear J Bland thank you for your kind feedback. I'm going to another study on Saturday which is EMG. Ultrasound specialist told me that my nerve was still swollen, that was last week. He wrote that cross area was 5.4x2.2 mm. But he did not write normal size, so I don't know how bad it is swollen consideting these two figures.

If one assumes the nerve is elliptical, as is usually done when measured that way, and if those are the two diameters then the cross sectional area would be estimated as 9.33 mmsq. In most ultrasound labs that would be normal for the median nerve, but most of don't measure that way any more, and to make life even more complicated normal ranges vary a lot from place to place, for reasons which are not entirely clear as yet. On my scanners, measured by tracing the nerve outline, the upper limit of normal cross sectional area is about 10 mmsq. Dr J Bland

Hi Dr J Bland, thank you!

Could there be a CTS if your nerve is on the upper normal level?

Yes, no test is absolutely reliable in detecting CTS - however it's probably fairly safe to say that if the NCS and ultrasound are both normal then it's probably a CTS which does not need urgent surgery - one can afford to experiment with less aggressive treatment and to think about the diagnosis a bit more. JB

You should call your doctor.