Carpal Tunnel Syndrome

...all joking aside...

I'm wondering if anyone can comment on carpal tunnel syndrome and climbing. Primarily, has anyone had tendon release surgery in his/her wrists for CTS, and can he/she comment on its effects on climbing? Or does anyone have other experience or advice with the condition? I've done a search and can't find any threads on this.

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The story:

I developed pain in both hands, in the muscles between the thumb and forefinger about 11 years ago, when I played a lot of cello. The pain was brought on mostly by playing and writing, and was severe enough that I stopped playing for several months, and eventually made playing cello professionally an impossibility. I saw a sports and instrumentalists' therapist, and underwent PT, but came out of the experience a year or so later with little help. The official diagnosis back then was something along the lines of tendinitis, Carpal Tunnel Syndrome, but the doctors were unsure.

The pain reoccurred since, mostly when writing, but it wasn't until I started climbing last year that it came back seriously. I can't get more than half the way up our lead wall without my hands losing strength, and I can't get more than 15 feet up a vertical crack before the spasms, pain, and general muscle failure cause me to have to stop. My hands don't really recover for 10-15 minutes, and they feel swollen, sore, and very weak. They sometimes even look swollen when I'm climbing cracks.

My latest trip to my GP, and to a neurologist, have them suggesting that this is a form of CTS, and I'm going in for an Electromyogram, EMG, this Friday. Depending on the results, and because PT hasn't helped in the past, the most likely recommendation will be a "tendon release" surgery that cuts through the tendon in the wrist to remove the constriction on the nerves.

So, back to the original question... Does anyone know to what extent this surgery would affect/inhibit my climbing? I read on line that some amount of PT is usually required to restore full strength in the hands, but I'm concerned that this definition of "full strength" isn't a climber's definition, and that the surgery could forever limit my climbing.

I'm adding links to a couple of medhelp threads in which I've posted questions about my condition, since these give a bit more info on my problem, and on possible causes/solutions.

medhelp.org/posts/Chronic-P…
medhelp.org/posts/Pain-Mana…

Any help or advice is HUGELY appreciated!!!

J,

Your symptoms do not sound like MOST CTS, but that may be because your case is more severe than most. Sounds as if your docs have it pegged though. If the EMG shows CTS, I would get the surgery as fast as possible.

I had CTS in my right hand, maybe from biking, maybe from my work as a geologist (drilling, lots of screwing and unscrewing pipe together), or who knows what. During climbing I was OK, but after the wrist hurt like a mofo, my hand would fall asleep, and I would need to take NSAIDS and ice just to get to sleep.

The surgery did not affect my climbing, other than to provide relief from the post climbing pain and numbness. No loss of strength. The tendon that is cut has nothing to do with grip strength or pulling strength.

Relief after the surgery was instantaneous. I had no pain, either from the surgery or during recovery. Never even took an NSAID or aspirin. Of course, YMMV. I was able to resumed biking within 2 weeks, with some limitations, and climbing in a month. Full recovery was about 2-3 months, max.

2 caveats:

1) Be sure your neurologist is good at performing the EMG. Operator skill will play a large role in the degree of discomfort. You might want to google it, but do not be discouraged by the many people who had horrible experiences. It really was only mildly painful. As usual YMMV.

2) Be sure your surgeon is the top guy in town. Ask around. This a a common procedure and there should be lots of folks with recommendations. The surgery is simple with a small incision, but there are a lot of nerves, etc scrunched into a small place, all contained by the tendon to be released.

Finally, there is a lot of negative stuff on the iternet about the surgery. Most of it is old. Procedures/techniques are way better now and the surgery is almost a almost a "no brainer".

Good Luck

Tim S

Hi Tim. Thanks so much for your response, and thanks for making it so comprehensive!

Which version of the surgery did you have? The arthroscopic, non-invasive version? I head to the neurologist again for the EMG in a few hours, and I'll give a report since then.

I actually haven't seen many negative reviews of the surgery online, but I'm glad to know that there have been mixed results, and to be careful about approaching the surgery. If the EMG and follow-up consult result in a recommendation of surgery, I will be sure to follow your advice and do my research on surgeons!

Thanks again!

Latest update: NOT Carpal Tunnel Syndrome. My EMG came back completely normal. The neurologist who oversaw the EMG said he thought the problem sounded more like a muscle control disorder along the lines of a mild dystonia, but agreed that it is nebulous. Whereas there are muscle relaxants intended to address such issues (e.g. clonazepam), he thinks these are probably overkill for my condition, as they're really meant for more severe conditions such as epilepsy, and relax the brain as well as the general musculature. Interestingly, though they're also indicated for Restless Leg Syndrome, which is a BIG problem for me, and has been for years, so there may be an underlying, more widespread muscle condition.

I have another appointment with the original neurologist next Friday to discuss possible referrals, further diagnoses, and medications... Looks like my hope of a definite diagnosis is once again squashed!

I guess this is no longer a CTS thread :) If anyone has had a similar experience, though, I welcome any comments!

Hey Jonathan,

Sorry to hear about the issues; I feel for you. I've been through multiple nerve issues in the upper extremity in the past 5 years. Though never diagnosed with Carpal Tunnel Syndrome, I've seen mutiple hand surgeons, had lots of PT, multiple EMGs, surgeries, etc. I don't have any answers for you, but do have a couple thoughts.

First off, during my treatments, I never saw a neurologist. I worked with physiatrists, certified hand therapists, and hand surgeons.

I'm not a medical professional, but am guessing you might have some level of nerve issues... and it could be more complicated -- such as multiple nerve issues or combined with tendonitis, muscular issues, etc. This can be known as Cumlative Trauma Disorder (CTD), and is kind of a catch-all term when they can't pinpoint any single cause.

DX: The best diagnoses I've ever received came from a very seasoned certified hand therapist (CHT). CHTs are PTs that deal exclusively with the upper extremity. Each time I've gone in for a diagnosis, my CHT's diagnosis was spot-on, and their evaluation is much more technical. Measuring range of motion, measuring strength, etc. Based on my experience, with physicians, you usually will only get a Tinnel's test or an order for an EMG. So, consider finding a well-respected certified hand therapist to talk with and have an evaluation. Many insurance plans allow you to self-refer for physical therapy (I've never needed a prescription or pre-approval).

EMG's: In my case, both of my EMGs came back with fantastic results -- though I certainly had issues. Because the nerves are conduting well does not mean that you can't have related issues!

Surgery: I've heard that the Carpal Tunnel release surgery is highly successful. However, I think most other surgeries for nerve related issues tend to be pretty hit and miss. For that reason, I would be sure to exhaust all the non-surgical options, first.

Non-surgical options: Some things that your physician and/or physical therapist may recommend (and are frequently covered by insurance) include accupuncture, myofacial massage, biofeedback, etc. These may take multiple sessions for you to see any effect, and may or may not help. Also, do consider hydration, nutrition, etc.

What do you do for work? Do you sit in a chair, at a computer, or do any repetitive motions? What else triggers it, besides writing (I have that issue, too)? How about sleeping? Any numbness?

Hey Avery,

Thanks for your careful response. I think your recommendation to see a hand therapist must be my next step. The neurologist seems to be out of his league at this point, and I don't anticipate getting much out of this follow-up session except, perhaps, a referral to (or recommendation to see) one of the specialists you mention.

The term Cumulative Trauma Disorder sounds about right. I think after all this reading and discussing, and after seeing the doctors, I have a better sense for what has caused this trauma. I think I've been overcompensating for inadequate grip most of my life because my hands sweat really badly. Though the condition hasn't improved yet, I've noticed I'm able to get up climbs with a lot more ease now that I'm using drysol on my hands. Also, I played cello last night for three hours and thought about my hands the whole time. With drysol on, and with a thought to relaxing my thumbs whenever my hands started to overgrip, I had much less pain than usual.

So, with this theory in mind, I think I should go to a CHT and see what he or she can propose to relax the muscles and restore strength so that my hands can return to a more normal state, and hope that using drysol on a regular basis will allow me to overgrip less.

Also, I've once had acupuncture, and the needles in my hands hurt a lot. I think I will try that again in the hope that the pain was the "good" restorative/curative type.

Thanks again for your thoughts. Jonathan

Hey I battled Carpal tunnel sundrome for 10 years. I didn't want to have surgery and tried multiple other treatments. But I eventually had to have the surgery.

I wish I'd had it sooner! It worked wonder's and is really no big deal.

Anyway I realise that this thread has gotten away from discussion on CTS...however I wanted to put this out there and tell anyone with questions about CTS the Surgery (aka "release") and how it all relate's to climbing...to feel free to email me through this site.

Carry on!

josh

As an FYI -- for what you are describing, Biofeedback may help. For instance, they can train you to essentially control bloodflow to your hands (warm versus cold). Also, a pain management technique. So, perhaps it might be worth inquiring about.

My personal findings are that it can largely be about learning to manage the condition and pain, things that set it off, muscle relaxation etc. (versus fully resolving it altogether).

Keep us posted on how it goes. Good luck, Jonathan.