carpal tunnel 'cured'

turbodog

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Of interest to all....

Have had bouts of carpal tunnel for ~20 years off and on. Learned to avoid aggravating activities lest I end up with numb hands for the next ~2 weeks.

Then, about a month ago, I had disc fusion at c6/c7 for a blown out disc. As I recovered from that... learned that my CTS is gone, along with all the acute disc issues as well.

_NOBODY_ ever diagnosed that the CTS was disc related in 20 years.
 

Poppy

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I wouldn't be too harsh on those who made the original diagnosis 20 years ago.

I'll go into more detail, than you will need, but I will do so, so that others will understand.

Carpal tunnel syndrome CTS has symptoms of numbness, or tingly sensations, and later of weakness (when advanced) of the first three fingers of the affected hand, including the thumb. It is suspected, but never quite proven that it is caused by repetitive hand motion such as doing a lot of keyboarding.

The median nerve carries both motor and sensory fibers. It passes through the carpal tunnel in the wrist.

1662328212560.png


between the little bones of the wrist and the transverse carpal ligament. If that ligament thickens, it can put pressure on the median nerve, and cause the symptoms of CTS. Numbness, tingly, loss of grip strength, pain. This is similar to when one strikes his funny bone, except he is catching the Ulnar nerve.

The clinical diagnosis of CTS, is pretty simple. If the patient has the classical symptoms, and the examiner can elicit those symptoms by stretching the median nerve: have the patient rotate the head away from the affected side, and lean his head away from the affected side, then straighten the arm out to the side, hyper extend the wrist, and then tap on the median nerve on the inside of the wrist (as seen in the above picture). If the patient states that he gets the same tingly sensation, and or more intense, then clinically the patient has CTS.

A more advanced tool for the diagnosis is to do electrodiagnostic nerve testing. Electromyelograph / Nerve conduction Velocity tests are typically done together. The EMG tells how well the nerve and muscle are working together, and if the muscle is somewhat disconnected from the nerve.

The NCV tests the speed at which the nerve will carry an impulse, and to a certain extent, how many nerve fibers are firing. If there is pressure on a nerve, the speed of the impulse will slow at that point, and if severe enough not all of the impulses will get past the pressure point, and the tester will see a drop off in the number of fibers firing. The NCV is a terrific advanced tool for locating peripheral nerve entrapments.

The surgical solution is to cut that Transverse Carpal ligament to release the pressure on the nerve. Most people do pretty well with that. Especially if they have the correct diagnosis.

The median nerve can also get trapped in the forearm as it passes under the pronator teres muscle. IIRC studies have shown 30% of those with CTS also have entrapment under the pronator teres. If you have entrapment at more than one place, it is called a "Double Crush" syndrome. One can make a clinical diagnosis of entrapment of the median nerve under the pronator teres but with an NCV it would be definitive.

The median nerve is made of nerve fibers from three levels in the neck but most of them come from between the neck bones numbered C6-C7. With a bad disc, one can have pressure put on it all the way up in the neck and one can get shooting pains all the way to the hand, or the symptoms of CTS. Entrapment in the neck due to a bad disc would be seen on a MRI, and be evidenced with a EMG study. Not so much with an NCV.

Since the sensory fibers are more sensitive to pressure than the motor fibers, a patient may experience sensory deficits, or tingly sensations sooner than when the equipment will be able to pick up the neural deficits. Also, the NCV may pick up slowing of the impulse due to pressure, but there may not yet be conduction BLOCK, and the muscle may still behave normally when studied by the EMG.


Whew... with all that said:
@turbodog
It's possible that you have a double crush, one in the cervical spine, and one in the wrist and or forearm. IF CTS was confirmed with a NCV, and fusion of the C6-7 relieved you of your symptoms, then IMO you most likely have, or had a double crush.

You quite possibly still have a subclinical CTS.

Good luck my friend, I hope that your symptoms do not return.

Poppy
 

jtr1962

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This is interesting to me as it runs in the family. My mother had to go out on permanent disability in her mid 40s. When her doctor examined her, he said it was the worst case of CTS he ever saw. Some of her nerves were dead. She got a carpal tunnel release on both hands but the results were mixed. My sister had the same operation about ten years ago. She said her CTS is coming back. I've had severe CTS since my late 20s. It hurts to close my hand completely, I'm prone to dropping things. I have to limit certain activities, or I'll be dealing with weeks of pain or numbness. As it is my hands start to go numb about 15 minutes into a bike ride. By the end of the ride, I often can barely squeeze the brakes.

I'll mention this to my sister so her doctor can check for possible spinal issues.
 

KITROBASKIN

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Thinking it was in the early 90's when I had a bilateral release. Takes time to heal, and I was doing fancy landscape work then (also the cause of it; hard-pull weeding, etc.) First one healed pretty well but I got antsy wanting to contribute in the jobs, so my left hand scar shows how I somewhat opened the scar and slightly tore the suture holes in the skin. After that healing, I thought I could go to the next level with hand strength but the finger connectors started wearing out and hurting. Continued to do physical labor and plum wore out my thumb connections, resulting in having to minimize their use; quite painful when overdoing it.
 

KITROBASKIN

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Just read member jtr1962's post: Super key is if you get the pain/numbness with your wrists in bed, make sure you are not hyper-articulating your wrists. Try to keep the wrist in a neutral position when sleeping. Also, hanging one's hands on the upper part of the motor vehicle steering wheel can be bad news.
 

Poppy

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The median nerve can be entrapped at four locations around the elbow: distal hu- merus by the ligament of Struthers; proximal elbow by a thickened biceps aponeurosis; el- bow joint between the superficial and deep heads of the pronator teres muscle, which is the most common cause of median nerve compression; and ...Apr 28, 2010

Nerve Entrapment Syndromes of the Elbow, Forearm, and Wrist

https://www.ajronline.org › doi › pdf › AJR.10.4817


PDF​

@jtr1962 I suggest that you follow the science, and don't jump to the spinal surgery solution.

@KITROBASKIN @jtr1962
I am pretty sure that once surgical release is done, that CTS does not recur. The symptoms may return, due to compression/entrapment, of the median nerve, somewhere else, but not entrapment at/through the carpal tunnel. The symptoms may not be relieved with a release if there was enough damage caused to the nerves prior to the surgery, or if there is a double crush, as I described above.
 

kerneldrop

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Funny thing about neurosurgeons and orthos specializing in the spine...they only get paid when they operate.
 

bykfixer

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I had a mild case of CTS and physical therapy solved it. It was two simple excersizes that seemed to work best.

One was to hold the hands at shoulder height and flatten the palm then bend the wrist to where the fingers are vertical like you were doing a heil hitler move. Gentlely the arm to stretch the tendons of the wrist. I did about 5 at a time at first, switching hands after 5. Twice a day for about a week.

Next was have a palm of one hand and lower arm at a right angle across the stomach facing up, the other face down on top of each other. Fingers bent to interlock. Use the hand palm down to gentley push down on the hand palm up causing the wrist of the palm up hand to bend toward the floor. You'll feel tendons stretching. Swap hands to switch excersize to the other hand. About 5 times then switch hands. Twice a day for about a week.
After a few days my situation was back to normal.

I still do the excersizes for a time before driving a long trip and wear fingerless gloves. My doctor said carrying weighty objects without using my thumb contributed. Things like a cooler I'd carry with just my finger tips and not wrap my thumb across the handle too.

On another matter, my (now retired) former boss got hit from behind by a truck backing up one year. Nothing bad really, but hard enough to "jerk" his ball cap off his head. Not knowing he was injured he never went to a doctor until the day he suddenly pooped his pants for the second time. Test after test for his digestive area yielded nothing. On a visit to an orthopedic doctor for another unrelated issue led to the discovery of pinched nerves in his neck from the injury he had just brushed off. He had a "cage" installed in his neck to relieve pressure on some nerves.

Over the next decade the pinched nerves had done weird stuff that led to a sore knee, that turned out to be pain radiating from his hip that had also been injured. After he had the knee replaced with a bionic parts but the pain remained the doctor found his hip was actually the culprit. Over time he has had both knees and both hips replaced because of a what seemed like a minor neck injury. So it does not seem to me that a neck injury from sitting behind a desk, or a whole host of reasons could lead to whacky symptoms elsewhere including CTS.
 

orbital

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+

Nerves end in unusual spots.
I had an abdominal injury and the swelling created unbelievable pain in the tip of my shoulder.

Not all is what it seems with pain.

Surgeons will do surgery if needed or not.
 

kerneldrop

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Surgeons will do surgery if needed or not.

Sad but true.
The biggest problem is those outside of the medical community don't know who the good vs bad surgeons are. Or even the great ones.
The doctor that refers generally just refers you to a practice and whoever can see you sees you, or just don't care, or really doesn't know.
There are great and conservative ones out there....it's just a matter of knowing who they are. And google reviews are misleading.
Primary care doctors really don't know because they aren't in the operating room to see how a surgeon responds to adversity, or see the follow-up care. And they've been beat down so much by systems that they just no longer care.

Medicine isn't the feel good job it once was. It's become a money race with over-worked, undertrained, and overwhelmed doctors at all levels of specialties.
 

kerneldrop

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Really? Funny that I have a stack of bills/EOBs/etc for office visits...

Figuratively, not literally. But the doctors themselves may not get paid for a lot of those visits. They are part of a global fee.
 

Poppy

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So it does not seem to me that a neck injury from sitting behind a desk, or a whole host of reasons could lead to whacky symptoms elsewhere including CTS.
You are right. A neck injury will not cause Carpal Tunnel Syndrome. CTS is a wrist problem impacting on the median nerve.

A cervical radiculopathy may cause the same symptoms of CTS, but to call it CTS would be a misdiagnosis. That is not to say that a cervical radiculopathy can not coexist with a true CTS (double crush). Either can be relatively mild, and each may be subclinical, but when added together, the signs and symptoms may become noticable.

Twenty year old studies have shown that low speed rear impact car crashes, as slow as 3 mph, can cause neck injury, and in older people, or those with previous injuries, the injuries may include disc herniation.
 

KITROBASKIN

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Yeah Poppy, both releases did solve the pain from Carpal Tunnel Syndrome.

I always wondered if I had been more vigorous using my hand and arm muscles when I was a kid, that maybe they would have been built up and somehow 'tougher' than just starting that kind of hard physical labor in one's 20's and 30's.
 

KITROBASKIN

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This hand got used even more sooner than it should; note the more evident suture holes and wider scar from incision. Calluses have diminished some with less use but still keep me from getting blisters unless totally overdoing it.Using a digging bar for cutting roots of trees for whole-tree removal is tough work but satisfying.
1D9EE874-344F-4DB9-8E31-A0A81A6A6E09.jpeg
 

Poppy

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Looks like you are getting a little contracture in your left hand. That could be from digging with a pole.
 

ampdude

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I think I've managed to avoid carpal tunnel all these years by using my left hand for the mouse instead of the right. I did way too much gaming when I was younger and it didn't help my wrist. I'm a tiny bit ambidextrous, so that helps. Only time I use my right hand for the mouse is if I'm playing an online game or at some random work station at work. I don't have any carpal tunnel problems to this day and can still type 80wpm.
 

kerneldrop

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I just recently started having CTS symptoms. I thought it was tied to my back and irritated from lifting weights.
My wife told me the surgery is easy but I'll avoid any surgery that I can, even if it means I accept a little impairment.
Eventually I'll have to have it because I have an office-clerical like job that'll keep it inflamed. Lifting weights and shooting pistols aren't doing it any favors either.
I just ordered a raised mouse pad and keyboard thingy.
I feel like my grip strength and forearm strength are weakening...but they stay fatigued from lifting so it's hard to pinpoint.
 

Poppy

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CTS symptoms would not come from your back, your neck, maybe.
Your forearm strength would not be affected by CTS.
If you are doing a lot of wrist curls, you can trap the median nerve in the forearm, which can give CTS symptoms. Biceps curls can too!

There are muscle stripping techniques, that physical therapists, chiropractors, and some better trained massage therapists can do that may help.

pachmayr pistol grips may help reduce the vibration, and impact to the wrist when firing pistols.
 
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