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Carpal Tunnel Syndrome


Don Noon
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Do you need that test and how much extra does it cost? Is it just a rip off?

I'll defer to what the physicians here have to say about it, but my understanding is that it enables a more complete diagnosis, and can indicate some conditions aside from carpal tunnel syndrome which might be causing or contributing to the symptoms.

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  • 1 month later...
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Just got a full set of tests completed.

 

1. Visual:  before firing up any equipment, the doctor looked at my hand and pronounced severe carpal tunnel syndrome, due to the caved-in apperance of the palm where a large muscle is supposed to be.  Grip strength has not been a big issue that I've noticed, but apparently it is severely impaired.

post-25192-0-93783400-1372782025_thumb.png

 

2.  NCV (nerve conduction velocity):  the electrode and zapping routine.  Not too bad; just brief shocks, and apparently confirming the initial diagnosis.

 

3.  EMG (electromyography):  the needles in the hand muscles.  Kinda painful, but seemed tolerable.  However, my hardwired internal programming (with no manual override) issued the command, "Stop whatever it is that's going on, or I'll shut down the whole system!"  Fortunately that was at the end of the test, and everything was fine after a brief rest.

 

4.  MRI of the neck:  to see if any nerve impingements in that area are causing any trouble.

 

I can't answer the question about what the EMG is good for, but my impression is that it is normally done along with the NCV for a complete checkout.  It took less than 5 minutes with the same doctor and the same equipment as the NCV.

 

There's still more to go in this story, but at the moment my best guesses are:

Definite carpal tunnel syndrome, most likely needing surgery.

Possible neck nerve impingement, causing intermittent hand numbness at other times.

 

Hand surgeon consultation next week, and referral under way for neck specialist assessment.

 

The whole moral of the story is to avoid getting old.

 

 

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Don,

 

I'm glad you got this properly evaluated and at the same time sorry that the condition is so far advanced.  David Burgess is correct in stating that the addition of EMG to the testing (over just NCV) gives more info about the complete nerve-muscle system, where NCV alone gives info about the location and severity of peripheral nerve damage only.  My guess is that decompressing the median nerve at the carpal tunnel is your first move (hence the hand surgeon) and any other interventions would probably wait to see how much relief you get from that.  It's important to know that the subjective improvements (decreased numbness and pain, increased muscle strength) take what can seem like forever (often several months) to appear so please don't be discouraged if your hand's not feeling a lot better soon after surgery.  Nerves heal slowly.  Good luck.

 

Doug

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Don,

 

Great post in terms of educating the rest of us.

 

Glad you got this looked at by a doctor, and you now know exactly what's going on, and have a path to improvement.

 

I'll admit my doubts about western medicine in general, with its emphasis on medication.

 

But when it comes to structural problems, such as those involving muscles, bones, nerves, where the body can't heal itself on its own -- eg, a tendon torn from its attachment, can't reattach itself on its own -- western medicine is at its best.

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Our medical system is a morass of unfathomable regulations and billing practices, but I can't complain about the results so far.  My metal hip has been fabuous, otherwise I'd be in a wheelchair by now.  I have the utmost confidence that the current problem will get about the best treatment possible, except perhaps for what is reserved for the high-$$ professional athletes.  Unlimited funds can make a difference, I think.

 

Bending plates (or even CNC) does not eliminate carving, but only eliminates the bulk of the hogging.  Hogging forces I transfer to the shoulder and chest with appropriate fittings, so the wrist stress is minimized.  It's the finer work with finger planes and scrapers that's the bigger problem, and that's not going to go away unless I hire slave labor.

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I'm sorry to hear that you are experiencing this problem, but glad that you are taking it seriously.

 

My only piece of advice is to call all of the local high-level professional musicians you know and ask about doctors, surgeries, and outcomes.  Orchestra players can often provide insight because they are part of a pool of nearly 100 professional musicians who know each other pretty well, and there are bound to be some RSI and/or carpal tunnel survivors in the group.

 

I know the physicians here might not be thrilled to hear me espousing finding a surgeon by recommendation (after all, an excellent surgeon can have a poor outcome if the patient's nerves are too far gone, and the opposite scenario can be found as well), but if all of the professional musicians in your area go the same hand surgeon, that's who I'd go to.

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Just got back from an interesting visit with the surgeon. His expressions upon looking at my wrists and related x-rays and test results reminded me of someone who happened upon the scene of a horrific car crash, and was surprised to find survivors. There's not much to be done about the old fractures and arthritis, but he did recommend surgery on both wrists to halt the degradation of the nerves in the carpal tunnel. So that approval mill has been fired up.

Recovery is supposed to be several months. Drat. Maybe I'll have to practice carving with my feet?

I'll update this thread as things happen.

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Good Luck Don...I hope the surgery goes well.  In the last eight weeks I've had two MRI's and two visits with a shoulder specialist for a SLAP tear. He has referred me to a neurosurgeon and an EMG test for three bulging disks in my neck along with severe narrowing of the nerve root canals. Nice to know beforehand what to expect with these tests. I'm definitely looking at neck surgery and that has me very nervous. I have permanent nerve damage from previous spinal injuries and surgeries. Right now my right arm has been tingling from shoulder into my entire hand and all four fingers. I really thought I was indestructible at one time...not anymore.

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Good luck to you too, Ernie. Sounds like your restoration is more serious than mine.

However, based on the results of my neck MRI two weeks ago, they are referring me to another specialist to discuss some things going on there. So I might need more work done.

Now might be a good time to think about the benefits of walking. When he was 65, my Dad started walking 5 miles a day. He's now 87, and we have no idea where he is.

I too have come to appreciate the benefits of long walks, especially when they are taken by people I don't like.

Ba-dump-bump.

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Walking is the best and I absolutely wish I could!!...but my knees are shot. They swell up like grapefruits just walking around the block. Several surgeries already on them.

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  • 3 weeks later...

One down, one to go.
post-25192-0-67429200-1375397483_thumb.jpg
Not too bad. Only gripping/lifting is out, otherwise relatively painless.
However, almost everything involves gripping and lifting, therefore the lights are out in the shop for a while.
Opening the inner plastic packaging of my breakfast cornflakes was an adventure, learning to operate scissors with my left hand.

 

(edit:  the next day was very painful, mostly due to disturbance to the rest of my sorry, fractured, arthritic wrist)

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  • 2 months later...

Update...

 

3 months after the surgery, I'm back to carving, lifting weights, bowling, etc. using the right hand as usual.  Scraping using the forward pull (vs. thumb pushing) is not so good, but a few minutes at a time is OK.

 

Visited the surgeon today for a follow-up, and everything is go for doing the left hand.  He had a laugh at the neurologist's report, saying that a new category had been created for my condition.  Mild, moderate, and severe are the usual designations, but I was listed as "very severe".  I feel so special.

 

I'm not looking forward to another couple of months of restricted activity, but that seems better than permanently restricted activity down the road if I don't do it.

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the most important aspect of tendonitis, treatments, is elimination or diminishing swelling. Carpal tunnel is a complex syndrome which may feature reversible tendon swelling, Irreversible tendon hyperplasia, followed by reversible or irreversible median nerve injury, due to chronic compression in the carpal tunnel which is a closed space. 

the most effective treatment for synovitis, is gentle compression with either an ace warp, or a neoprene wrist sleeve

 

http://www.activeforever.com/banyan-wrist-compression-sleeve?adtype=pla&gclid=COm4jcGduroCFRFo7Aod_TYAUw

 

This is used in conjunction with a cock up wrist splint.

 

http://www.allegromedical.com//orthopedics-orthotics-c528/cock-up-wrist-splint-p556191.html?gclid=CN3Aq-ieuroCFSlo7AodNj8AWg#118B-E997F3C?engine=froogle&utm_source=froogle&utm_medium=feed&CS_003=9164468&CS_010=ff8081811899effd0118be9003750adb&gdftrk=gdfV21244_a_7c477_a_7c4637_a_7c556191

 

 

 

Generally if the swelling is effectively managed, sustained relief can be expected 

 

Conrad Tamea MD

Board certified in Orthopedic Surgery 

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  • 1 year later...

I am re-starting this old topic, mostly for CT and others, and to avoid totally derailing another thread.

 

It has been over a year since I had both wrists operated on, and there are good and not so good results.

 

Good:  none of my fingers have gone numb for any reason... which used to happen quite often after playing fiddle for a while, or scraping plates.  That was the primary symptom of my CTS.  Although muscle atrophy was another obvious symptom, I didn't notice it, as I apparently didn't need that particular muscle for much of anything.  

 

Not so good:  1. There is still some sensitivity to the palm, where the cutting took place.  So I can't bang on stuff with the palm of my hand.  2.  Due to my messed-up wrist joints (multiple old sprains and fractures), the ligament release seems to have allowed the old wrist debris (used to be bones) to move around and loosen up slightly, therefore more prone to random pains during use.

 

Bottom line, for my particular case is that it was a necessary operation.  My hands are more functional now than before, and the outlook for NOT having the surgery was that things would continue to deteriorate beyond any point of recovery.  Not perfect, but what can you do but try to slow down the ravages of time and abuse.  

 

It's nice to be able to play fiddle for indefinite periods of time without losing feeling in my fingers, but playing tennis or volleyball ain't so hot (I should't do those anyway, with my metal hip... but that's another story).  At least bowling is still OK.

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