Carpal Tunnel treatment questions

[Ditto]

I developed carpal tunnel in both hands about 2 months ago.  It only acts up at night.  I was sent to an ortho hand specialist and had my first appointment 2 weeks ago.  At that time I got steroid shots in both hands and splints for both to wear at night..  I go back in just over a week.  At the appointment my dr mentioned the possibility of surgery, and acted like it wasn't a big deal (and is an office surgery and both hands could be done at the same time).   FYI: my carpal tunnel was caused by the med I take to keep cancer away. 

Since that appointment I have faithfully done the exercises they recommended and worn the splint on the worst hand at night.  Wearing both makes it impossible for me to sleep.   The splint doesn't really seem to be doing its job.  Sometimes I wake up in severe pain just like I did when I didn't wear it.  As soon as I take it off in the morning my hand goes to sleep/numb for around 30 min.  The hand I don't wear a splint on seems to be doing a bit better.

I am concerned my dr is going to recommend surgery since this treatment just doesn't seem to be working.  How bad is the surgery?  Is it worth it to have it?  What do I need to know?   How have you successfully treated your carpal tunnel?

[Kassia]

The surgery changed my life.  It was no big deal, but the first few days were challenging since I was pretty helpless.  I had carpal tunnel in both hands for 17 years and kept putting off surgery because of family commitments, but it was finally a good time and my hands/wrists were getting worse and I was worried about permanent nerve damage.  

Would you have both done at once?  That would be nice to get done and over with, but the recovery would be much harder in terms of not having your hands to use.  I had mine done two weeks apart.  The first few days after the second surgery, I was more helpless than I expected, but after that I could function pretty well.  No pain and I only had swelling for really the first 24 hours or so.  I did have to rest it and keep it elevated for 48-72 hours after surgery.  Elevation really helped with the swelling.  

I know you have a dd at home to help you with things, so that will make things easier.  I remember not being able to open anything (jars, bottles, etc. - the Listerene bottle was impossible for a long time!), opening doors was a challenge due to turning the doorknob, couldn't do hair or make-up (don't wear make-up anyway).  Anything that takes two hands was tough.  I got something to cover my arm when I showered to keep the surgical site dry, no lifting anything heavy for a while, too.

But the effects of the surgery were instant - I never had symptoms again (my surgeries were almost two years ago).  Everyone told me they wished they had theirs sooner and I feel the same way.

Good luck!  

 

ETA - I wanted to have both hands done at once because it would be much less expensive that way, but insurance wouldn't cover it.  It would have been difficult, though - think about using the bathroom with no usable hands.  😛  Also, you'd want slip on shoes if you don't have anyone to help you put your shoes on, and easy clothes - no buttons/zippers - for a while.  Leggings and t-shirts/dresses are good.  

 

Edited December 20, 2020 by Kassia

[Kassia]

One more thing - your carpal tunnel could be temporary since it's caused by the meds.  If that's the case, I would hold off just to avoid unnecessary surgery unless it's really affecting your quality of life and/or causing nerve damage, which is permanent.

 

[Pawz4me]

My MIL had carpal tunnel surgery a few years ago. She would have been around 82 at the time. It was no big deal at all, even at her age.* She recovered quickly and, other than some nerve damage from putting the surgery off for way too long, she felt better immediately and hasn't had any problem at all since then.

*Her recovery may have seemed very simple because at her age she'd already made a lot of lifestyle adaptations due to arthritis--like easy on/off clothing, already being pro-active about having family members open difficult containers and switching them to other containers, etc.

[DrC]

Hello

Just a couple of things to consider. Pain is not usually a part of the symptoms of CT. I hope the pain you experience when waking has only started since you started wearing the brace(S). If pain predates the Brace(S) I would question the completeness of the diagnosis. As a rule numbness/Tingling and weakness are the cardinal symptoms. If there is any doubt make sure a nerve conduction study was part of your diagnosis work up. If the pain has only occurred since the bracing then the braces need to be reworked as they are causing a nerve impingement most likely in the recurrent radial nerve.

The real down side of CT is the weakness. The the article eminence (the big muscle in the hand that allows us to oppose our thumbs needs the trophies factors from the median nerve to survive (the median nerve is the one compressed in CT). If CT is left too long the muscle can permanently atrophy and cause permanent loss of function, hence the need for a solution.

Kassia is spot on in the need to assess carefully the long term need for cancer prophylaxis vs surgery.

That said if all other non surgical remedies have been exhausted then surgery should definitely be a consideration to prevent long term grip weakness.

In the old days we used to do this surgery “open” which meant a long incision on the wrist to access and cut the carpal ligament. While this approach worked well it meant long recovery times. Now a days we do this procedure endoscopically with not more than a nick in the skin. This has decreased recovery time dramatically. They surgery is definitive as others have mentioned. The complications of infection and nerve damage are very very low. I can’t actually remember the last time I saw a complication.

[Kassia]

49 minutes ago, DrC said:

Pain is not usually a part of the symptoms of CT.

In the old days we used to do this surgery “open” which meant a long incision on the wrist to access and cut the carpal ligament. While this approach worked well it meant long recovery times. Now a days we do this procedure endoscopically with not more than a nick in the skin. This has decreased recovery time dramatically. They surgery is definitive as others have mentioned. The complications of infection and nerve damage are very very low. I can’t actually remember the last time I saw a complication.

I had excruciating pain at times due to CT.  That would mostly happen at night when I was in the same position for a long period of time.  The pain would continue until I could get the blood flow going again.

I had my surgeries two years ago and both hands were done using open surgery.  

ETA - this link mentions pain several times.  https://orthoinfo.aaos.org/en/diseases--conditions/carpal-tunnel-syndrome/

 

Edited December 20, 2020 by Kassia

[DrC]

Quite right pain Can be a symptom of CT however it is not Usually a symptom. Please do not misunderstand I was not implying pain cannot be a symptom however in is not the usual. Of the thousands off patients I have treated for CT I would say pain occurs in far less than 1%. Pain is always difficult to quantitate as it means different things to different people. Sometimes the extreme numbness CT can cause is perceived as pain when the blood supply to the median nerve is established upon waking and the numbness transitions to feeling again. 

The presence of Pain should make any responsible physician question if the diagnosis of CT is the only thing at play.

Edited December 20, 2020 by DrC

[Bootsie]

I too had excrutiating pain from Carpal Tunnel.  It is a nerve pain that is unlike any other pain I have experienced in my life.  I had surgery and came out of surgery feeling immediately better.  

I was to the point that I could not sleep more than five minutes to ten minutes at a time without waking with both hands numb but hurting (I know to someone who hasn't experienced it that it seems impossible to have something numb and in pain).  The only thing that would relieve the pain was getting up and shaking my hands/arms--but that relief lasted for only a couple of minutes.  I spent my days and nights pacing the floors shaking my hands, in a zombie-like state  I was to the point that I could not function.  Lack of sleep was impacting my health.  It was impacting what I could eat--I couldn't hold a sandwich, I couldn't cut meat.  Holding a fork to eat mashed potatoes was painful enough.  I would have to put my utensil down between every bite and shake my hands.  I was at a dinner with a group of college students; DD was sitting next to me and said "Mom do you realize you just asked me to cut your food in front of all of your students--this is getting really serious."  

Looking back, I had some mild, manageable symptoms for years.  But, this flared up all of a sudden to intense pain.  I woke up one night with both hands hurting so bad.  I am not one to take much pain medicine but happened to have some because I had recently broken my foot (and using the crutches is probably a contributing factor to the flare up).  But, the pain medicine did nothing for the nerve pain.  I am usually knocked out if I take an pain medicine--and I still could not sleep when I took it.  I tried different splints but would rip them off so I could shake my hands.  I tried dietary changes, massage, yoga, Tibetan bowl vibration therapy--anything possible and got no relief.  I was desperate.  

I did have a nerve test done to confirm carpal tunnel and rule out other causes.  I was in so much pain that the doctor did both surgeries at the same time.  He said that I had one of the worst five cases he had ever seen.  He didn't like to do both at the same time, not only because you are incapacitated (I already was so bad I couldn't use my hands much) but because it is hard to do any basic hygiene and keep the incision clean.  You can't use one hand to do a sponge bath, etc.  

The surgery itself was not bad.  I felt so much better when it was over than when it began.  I moved and started a new job five days after the surgery (which was another reason for doing both hands at the same time).  Besides keeping the incision area clean, most of the recovery was about regaining strength in my hands that I had lost.  My hands were not immobilized, in fact I was encouraged to use my fingers and exercise right after the surgery.  

My mother had carpal tunnel surgery when I was is in high school; for some people there is a genetic predisposition.  

 

[Kassia]

@Bootsiemy experience was very much like yours at night, but I was able to function pretty well during the day (although I was noticing a rapid decrease at the end before surgery to the point where I was getting scared the damage was permanent).  I also remember that pacing all night trying to shake my arms out and relieve the numbness/pain.  I'm a runner and had to run with my arms dangling like Frankenstein at times because having my arms bent while running would trigger the CT. I do think hormones made it worse at times for me - maybe water retention causing more pressure?  Another reason I've heard that you shouldn't have both hands done at the same time is because you don't have a healthy hand to compensate for the hand that was operated on to give it time to heal.  It doesn't sound like you had a healthy hand anyway, though.  

[kbutton]

DH had surgery, and he sought out a hand surgeon specifically. He was in pain before the surgery, and he had nerve testing to confirm the diagnosis. His experience and recovery were excellent.

I am stunned that anyone does open surgery anymore.

My mother also had CT surgery—both of hers were done at once, but that was because she had to drive several hours away to find someone that did open surgery as it was brand new at that point. Her recovery was also excellent, and her diagnosis confirmed. She had pain in addition to the tingling and numbness.

[Kassia]

Maybe I didn't have open surgery?  My incisions are about a 1 1/2 inches long - I can't remember how many stitches.  Six or more.  I also had trigger finger surgery on one hand, but that is a tiny incision.  

 

ETA - I checked google images and definitely had open surgery

 

Edited December 21, 2020 by Kassia

[Ditto]

Thank you all for the replies and personal experiences.  A couple of things:  pain is most definitely a part of carpal tunnel.  @Bootsie  described it perfectly.  In fact her experience is very much the same as mine.   My dr is a hand surgeon and uses open surgery as he feels the risk/benefit is much better with open surgery.  My diagnosis is correct.   I am on the med for many many years and will not tolerate this for that long, so I really don't care if it would get better off the med, I can't live with this pain and sleep disruption for that long, therefore I will get this taken care of.  Plus the longer this goes on the more risk of permanent loss of function of my hands.   It is extremely frustrating my treatment for cancer (chemo, radiation, surgery, med) has caused many other problems.  The cure for one thing breaks something else.  I really do appreciate all the input and help.  Thank you!

[kbutton]

20 hours ago, Kassia said:

Maybe I didn't have open surgery?  My incisions are about a 1 1/2 inches long - I can't remember how many stitches.  Six or more.  I also had trigger finger surgery on one hand, but that is a tiny incision.  

 

ETA - I checked google images and definitely had open surgery

 

Open surgery might be modified from what is was when my mom had the less invasive one. Open surgery at that point was several inches.

Good luck, Ditto! 

[Bootsie]

8 hours ago, Ditto said:

Thank you all for the replies and personal experiences.  A couple of things:  pain is most definitely a part of carpal tunnel.  @Bootsie  described it perfectly.  In fact her experience is very much the same as mine.   My dr is a hand surgeon and uses open surgery as he feels the risk/benefit is much better with open surgery.  My diagnosis is correct.   I am on the med for many many years and will not tolerate this for that long, so I really don't care if it would get better off the med, I can't live with this pain and sleep disruption for that long, therefore I will get this taken care of.  Plus the longer this goes on the more risk of permanent loss of function of my hands.   It is extremely frustrating my treatment for cancer (chemo, radiation, surgery, med) has caused many other problems.  The cure for one thing breaks something else.  I really do appreciate all the input and help.  Thank you!

I had open surgery; it was done about five years ago.  Because I was having both hands done, it was done under general anesthesia.   

  My mom had the surgery in 1979 and her incisions are much larger than mine.  My mom had one hand done, with plans to have the other hand done weeks later.  Within a week my father was calling the surgeon saying that he had to go ahead and do the second hand because no one in the house was sleeping due to my mom's pain.  She couldn't use the hand anyway she was in so much pain. 

In my case, there was nothing that made the pain tolerable, but the yoga stretch below was the one that would give me the most relief (when I say relief it was for a few minutes).  Gabapentin helped some--more than any other medication, and did allow me to sleep a bit.  

  

[Ditto]

On 12/21/2020 at 7:18 PM, Bootsie said:

I had open surgery; it was done about five years ago.  Because I was having both hands done, it was done under general anesthesia.   

  My mom had the surgery in 1979 and her incisions are much larger than mine.  My mom had one hand done, with plans to have the other hand done weeks later.  Within a week my father was calling the surgeon saying that he had to go ahead and do the second hand because no one in the house was sleeping due to my mom's pain.  She couldn't use the hand anyway she was in so much pain. 

In my case, there was nothing that made the pain tolerable, but the yoga stretch below was the one that would give me the most relief (when I say relief it was for a few minutes).  Gabapentin helped some--more than any other medication, and did allow me to sleep a bit.  

  

Thank you for the exercise.  I am on gabapentin, it doesn't seem to be helping, but maybe my pain would be far worse if I wasn't on it?  Who knows.  Your poor mom!  I hope she got relief after her second hand was done.   I would have thought it was a general anesthesia surgery too, if both hands were done at the same time, but it must not be since they are doing it in the office in a treatment room.  I will get more info at my next appointment.   I hope you also have gotten a lot of relief since your surgery.   It does seem like it is becoming a more common surgery to have now.