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Carpal Tunnel Syndrome, what works OTHER than surgery????


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Arthur Torrey · · North Billerica MA · Joined Jul 2015 · Points: 48

I have developed Carpal Tunnel Syndrome in my right wrist, confirmed by EMG testing...   It has been a problem for years to some degree, but has now gotten to the point where it is interfering with my ability to climb or do other exercises to improve my core strength...  My left wrist isn't great, and is often sore as well, but the EMG said it wasn't a problem at that time.

I've had a couple of cortisone injections into my wrist, which helped a lot, but only lasted for about 3 months each.  The ortho surgeon I saw, now says he won't give me any more shots because he thinks there is to much risk of damage due to tendons / nerves letting go completely...  Instead he is pushing really hard for me to get the surgery to release it....  I haven't gotten a second opinion yet (working on finding out what the insurance co. process is for doing this) or seen a PT/OT to see what they suggest.  However the surgeon I've been seeing supposedly has the reputation at the hospital where I do all my care as 'THE hand guy'....  Aside from the concern about the stereotype of surgeons always wanting to reach for a knife, I trust the guy....

My big concern is that as a paraplegic 'down time' is a HUGE concern - climbing aside, I basically have to be load bearing (my full 220+ lb body weight) on my wrists at all times, as I have to boost up on my chair every few minutes for pressure relief on my butt, plus doing transfers to / from bed, between chairs, to the crapper, etc, ALL of which need both hands...  I can't seem to get a decent answer about how much down time to expect, or what to do about it...  Answers range from one spinal cord injury site that says their protocol is 6 weeks of NO load bearing (potentially means being stuck in a nursing home for the duration...) to the surgeon that says they want patients to stay off the involved wrist for a couple weeks, but that while it would be painful, I could "do what I got to do" right out of surgery....  (I am asking other spinal cord info sources about advice on this...)

My question is whether folks have other suggestions that work on ways to avoid having to do the surgery in the first place???

I've seen a wide range of products that claim to help CTS (and many other related hand and elbow issues) by working the 'extensor' muscles - ranging from the relatively expensive Flextend glove, to a bunch of different fairly cheap 'spread the fingers' rubber ring things...  Are these sorts of things any good or are they just rip-offs?  Ditto some of the various 'exercise programs' which at least don't cost anything....

Are there other things that really help?

Thanks

ART

highaltitudeflatulentexpulsion · · Colorado · Joined Oct 2012 · Points: 35

I really think you need the surgery. I don't think anything you do will do much more than delay the inevitable. Spend some time prior to the surgery preparing for the recovery. In your situation, this might involve hiring home care or at least having a few really good friends. It sounds like the biggest concern for a few weeks will be wiping your ass. This is no trivial task. 

Good luck.

Gavin Towey · · Unknown Hometown · Joined Oct 2015 · Points: 0

I survived carpal tunnel in both wrists without surgery.  It took me most of a year to really get over it, which was probably made worse by the fact that I work in software and didn't really take any time off from typing.  The things I did which helped:

  • Wrist braces, the kind with the hard metal/plastic supports on top of and below the wrist.  They really restrict movement and are not comfortable, but it's necessary to take pressure off the joint.  I wore them always while typing, and always at night while sleeping.
  • Ergonomics.  For me it was about figuring out which daily tasks were worst for my wrists and trying to minimize their impact.  For me that was typing, obviously.  I used an ergonomic keyboard and that was critical.  It at least kept me from doing too much damage on a daily basis.
  • Waiting.  Unfortunately I had to give up a lot of activities.  That part sucked like no other.
  • Simple wrist exercises.  After a lot of waiting and you can do wrist exercises with very low weights (1-3 lbs)  Do them a couple times a day, ice after to reduce swelling.  I really only did 3 types of wrist exercises which were like #1 & #2 listed here, but with very very light weights: https://www.wikihow.com/Strengthen-Your-Wrists  The third type was the same type of exercise but with thumb up direction.
  • Avoid too much ibuprofen. It helps reduce swelling but too much risks liver damage.  I think you can get a lot of the same reduction in swelling with ice.  Use it sparingly.
Bruce Morris · · Belmont, CA · Joined Oct 2002 · Points: 3,227

Deep relaxation. CTS is often a symptom of TMS.

Arthur Torrey · · North Billerica MA · Joined Jul 2015 · Points: 48

Thanks, I'm trying to get hooked up with a hand therapist, and looking for advice from other sources about just what I would need in the way of recovery, particularly what the current 'standard of care' is for the combination of spinal cord injury and carpal tunnel surgery...

I don't see ANY way that I could recover at home, simply because of the space limitations we have, among other things.  If I can't transfer, they would need a lift to get me in and out of bed and there is no way a lift would fit in our bedroom - I can barely get in with our manual chair...  (The master suite is on the non-accessible 2nd floor, so we had to squeeze a king-size bed into what would normally be a kid bedroom...)  Bottom line means getting stuck in a nursing home - which totally sucks, been there, done that, hated every minute...

The other thing is trying to figure out how to not strain anything further, but also not lose any more of my strength and condition than I have to - at my age (just turned 60) it's to hard to get it back...

ART

Brian in SLC · · Sandy, Utah · Joined Oct 2003 · Points: 14,449

I've had an EMG test and at the same time, a nerve conduction velocity test.  My two favorite things...needles and electricity (NOT!).

The test results would be difficult for me to decipher, but, what the Dr. indicated was, that, damage could occur at different levels in the nerve...some being minor to permanent.  He cautioned that doing nothing could result in permanent damage that surgery couldn't correct.  My results were worse than mild and well less than severe, so, not currently at risk of permanent nerve damage but, I'll need to consider something if the symptom don't get better...but, I have some time to ponder it all (as well as some PT, stretching, etc).  I'm fortunate because I haven't noticed much strength loss.

A feller I work with apparently let his go too long...he had the surgery,  has use of his hand again, but, with permanent weakness.  That'd be a tough pill if you were a climber or relied on hand strength for a job or recreation. etc.

If you got a printed out report...you could always get a second opinion.  I talked to a number of hand people (PT's, Dr's)...they were all fairly positive on the surgery being the solution.

Tough sleddin'...good luck!

mbk · · Unknown Hometown · Joined Jul 2013 · Points: 0

Gavin's non-surgical recommendations mirror my own.

One additional thing: I am very cautious about anything that puts pressure on the area.   In practice, this means things like taking my phone out of my pocket before letting my hand rest on my thigh.

Bruce Morris · · Belmont, CA · Joined Oct 2002 · Points: 3,227

Sounds like your CTS is an outgrowth of a general condition growing out of your status as a paraplegic. Like a unified field theory that affects your whole central nervous system, including extremities like your wrists. I remember that when I had a herniated disk on my left side in 2002-03, CTS started developing in my left wrist when I was working a wrist rotation weight machine. The two conditions were obviously interactive, but how? I'm sure the trad medicos would have some way to account for the interdependence of the two conditions. Or more likely they would treat them as unrelated symptoms because they haven't yet developed the tools for reading programmed nerve pathways. Despite anything the orthos may say, this kind of stuff is still very much in its infancy.

Arthur Torrey · · North Billerica MA · Joined Jul 2015 · Points: 48
Bruce Morris wrote:

Sounds like your CTS is an outgrowth of a general condition growing out of your status as a paraplegic. Like a unified field theory that affects your whole central nervous system, including extremities like your wrists. I remember that when I had a herniated disk on my left side in 2002-03, CTS started developing in my left wrist when I was working a wrist rotation weight machine. The two conditions were obviously interactive, but how? I'm sure the trad medicos would have some way to account for the interdependence of the two conditions. Or more likely they would treat them as unrelated symptoms because they haven't yet developed the tools for reading programmed nerve pathways. Despite anything the orthos may say, this kind of stuff is still very much in its infancy.

You may well be right about the possible neuro link, Bruce, but in a lot of ways it's far simpler than that...  In essence being a paraplegic means that you get to do everything with your arms and hands that an able bodied person does with their legs and feet, plus the stuff done with your hands....  

Since I refuse to drink the manual chair Kool-Aid, and use a power chair as much as I can, I don't get as much of the strain of propelling a chair as many paras do, but I still have to pick up my full body weight with my hands and arms DOZENS of times a day, ranging from transferring between bed, chairs etc. to doing weight shifts and pressure relief (replaces the squirming an AB does when sitting in a chair, without necessarily even thinking about it...)

This is the big reason I'm so worried about the surgery - I can't get a straight / consistent answer about what happens afterwards in terms of doing my "ADL's" (Activities of Daily Living, the term for all that stuff that everyone needs to do just to get through the day - Bathroom stuff, dressing, eating, etc...)  I'm OK with having to stop climbing and doing other exercise stuff for some time, I'd miss it, but not a big deal.  But the question of whether or not I can transfer from my bed to my shower commode chair and roll into the bathroom to take a crap is a BIG deal..... (and that just starts my day....)

ART

rock-fencer · · Columbia, SC · Joined Dec 2009 · Points: 265

https://www.ncbi.nlm.nih.gov/pubmed/24426964

ask your doctor about ultrasound guided tunnel release. less invasive than surgery. Something i recently heard about while working.  

caesar.salad · · earth · Joined Dec 2012 · Points: 85

Wrist braces at night, cortizone shots, and daily NSAIDs.

Arthur Torrey · · North Billerica MA · Joined Jul 2015 · Points: 48
rock-fencer wrote:

https://www.ncbi.nlm.nih.gov/pubmed/24426964

ask your doctor about ultrasound guided tunnel release. less invasive than surgery. Something i recently heard about while working.  

Interesting, thanks for the link....  The surgeon was talking about a minimally invasive technique, so it might have been this or something similar, not sure...

ART

Arthur Torrey · · North Billerica MA · Joined Jul 2015 · Points: 48
caesar.salad wrote:

Wrist braces at night, cortizone shots, and daily NSAIDs.

Been doing braces at night for over a year...  Had two cortisone shots, each helped for about 3 months, Dr. said he wouldn't give me any more because of risk of nerve / tendon degeneration.  Haven't done NSAID's, as I try to avoid as much medication as I can (I'm on way more stuff than I like anyway) and I worry about long term harm from them....

ART

Yury · · Unknown Hometown · Joined Oct 2014 · Points: 0

Rest.

highaltitudeflatulentexpulsion · · Colorado · Joined Oct 2012 · Points: 35

I'll tell you, I can't imagine having to live in a nursing home. However, if my choice was 2 months in one vs potential lifetime disability, it seems like an easy choice.

Maybe even get both hands done at the same time. Usually this is discouraged because of eating and wiping, but if you're already in the home, why not.

mike again · · Berkeley, CA · Joined Dec 2015 · Points: 40

If you have an open mind, read this, at least as a compliment to other approaches:

https://www.amazon.com/Mindbody-Prescription-Healing-Body-Pain/dp/0446675156

 

Bruce Morris · · Belmont, CA · Joined Oct 2002 · Points: 3,227

Yes, mike again, reading Sarno might pay big dividends. His Divided Mind goes beyond the MBP and gives his theories wider inter-disciplinary support from a range of medical SMEs. Alan Gordon at USC and Howard Schubiner are also working on the interface between programmed pain neural pathways and emotions. It's been my experience from observing an admittedly small cross section of pain patients that CTS has deep emotional roots. For example, I once observed a woman with acute CTS that required surgery who at the same time her symptoms  worsened had her mother with memory loss move back in with her and her husband, both of whom had just lost their jobs and were worrying about losing their house as well. The interactions between the stressed out daughter and her memory impaired mother were truly hair raising to behold. The body-mind interface is definitely where a lot of things go on outside the conceptual framework of modern medicine.

krispyyo · · Ventura, CA · Joined Apr 2006 · Points: 65

Just get the surgery, you've already tried the non-surgical treatments for over a year. Otherwise you'll have more downtime while dealing with your ongoing CTS and you risk lasting denervation and atrophy to the small muscles in your hand. The fact that the cortisone injections worked well is a good prognostic indicator that your surgery will have a good result, and you'll probably be able to get back to climbing and stuff after 3-4 weeks when the incision is healed. It shouldn't significantly affect your ADLs in the meantime. 

Arthur Torrey · · North Billerica MA · Joined Jul 2015 · Points: 48

Some progress - albeit mixed...

I generally try to avoid pain killers out of concern that they would mask body signals that tell me I'm doing something I shouldn't, but I have started doing Ibuprofen and that does seem to help some...

I've gotten an appointment to see a PT person on Dec. 1, not sure if she is a 'Certified Hand Therapist' or not, will find out when I see her....

Still not having a lot of luck finding information on 'standards of care' for recovery after CTS surgery plus  paraplegia, but I did find one document that says 3 weeks for the non-invasive, and 8 weeks for the open palm surgery.

I'm playing phone tag with the insurance company trying to get their take on it and what theiy will cover...

My physiatrist (spinal cord specialist) was out of the office last week, but should be in on Monday...  

ART

Gavin Towey · · Unknown Hometown · Joined Oct 2015 · Points: 0
Arthur Torrey wrote:

Some progress - albeit mixed...

I generally try to avoid pain killers out of concern that they would mask body signals that tell me I'm doing something I shouldn't, but I have started doing Ibuprofen and that does seem to help some...


I'm not a doctor, but my understanding is that NSAIDs like Ibuprofen aren't really pain killers so much as they are anti-inflamation drugs.  Which means if your pain is caused by inflamed, irritated tissue rubbing in places it's not supposed to, then you're actually making the tissue less likely to be irritated.

Which means if you're in pain that's not because of inflammation then taking ibuprofen isn't going to help much and you should instead take something like aspirin or Tylenol.

Arthur Torrey · · North Billerica MA · Joined Jul 2015 · Points: 48
Gavin Towey wrote:

I'm not a doctor, but my understanding is that NSAIDs like Ibuprofen aren't really pain killers so much as they are anti-inflamation drugs.  Which means if your pain is caused by inflamed, irritated tissue rubbing in places it's not supposed to, then you're actually making the tissue less likely to be irritated.

Which means if you're in pain that's not because of inflammation then taking ibuprofen isn't going to help much and you should instead take something like aspirin or Tylenol.

Mixed bag - I agree on the 'anti-inflammatory' part, but the label on my bottle also says 'pain relief' for things like headaches, and as a fever reducer...  At any rate it seems to help to some degree...  

While I agree that it may help reduce irritated tissue rubbing where it shouldn't, the downside is that if it doesn't hurt, do you still keep doing the things that caused the problem in the first place and thus cause further damage...  I don't know...

BTW, when I looked it up, Aspirin is listed as one of the NSAID's while Tylenol explicitly was not....

ART

Guideline #1: Don't be a jerk.

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