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  • I think I have carpal tunnel - what can I do for relief?

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    Old 06-04-2008, 05:43 PM   #1
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    I think I have carpal tunnel - what can I do for relief?

    I think I have carpal tunnel syndrome. I have a numbness in fingers/hands (pointer, middle finger, and ring finger are the worst - thumb a little nothing in pinky). I used to be able to put a wrist brace on at night and I wouldn't wake up with a hand/wrist/arm pain, but now that doesn't work and I cannot get a decent nights rest. As long as I keep my arm below the heart or lay with my arm pointing towards the floor hanging outside the bed it's not so bad and will go away. Lately though I wake up in the morning and get ready for work and the only time the tingling/numbness goes away is on the car ride in... but then I feel like I have no gripping capabilities and my hand feels swollen all day. I also have developed pain in my shoulder blade on my right side (the hand that is 'bad'), I'm assuming that's from sleeping with my arm hanging loose outside the bed though. I'm a hobby cyclist and holding the handle bar on my bike always causes the tingling to start and it's getting harder to make myself ride because it tingles and aches. I'm 29 years old and I work on computers all day. I've been typing ever since I learned how to form sentences and words.

    If this sounds like carpal tunnel - what can I do before going to surgery? I'm trying to lose weight and I know my thyroid was suspect low (but test results never have proven this). I've also thought maybe it has to do with hydration levels, so I've been drinking more water.

    It got better for a month or two, but now it's worse than ever - there is a constant slight tingle in my right hand... maybe it's not constant but it sure does seem that way!!

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    Old 06-15-2008, 10:48 PM   #2
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    Re: I think I have carpal tunnel - what can I do for relief?

    I'm sorry you're having so much trouble. I am fortunate that nighttime wrist braces have alleviated most of my symptoms (I have CTS in both wrists).

    One possibility for you might be physical therapy. A primary care doctor can usually diagnose CTS and refer you for PT.

    Good luck.

    Old 06-17-2008, 08:33 AM   #3
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    Re: I think I have carpal tunnel - what can I do for relief?

    The fact that you have numbness in your pointer finger, middle finger and ring finger means that you probably do not have JUST carpul tunnel syndrome--there's much more going on here. (If it was CTS, you would have symptoms on your thumb, pointer finger and the top half of your middle finger.) THIS IS SERIOUS! The fact that it went away then came back with a vengeance means that it is EVEN MORE SERIOUS!

    IMMEDIATELY limit the use of your hands. Limit your typing as much as you can. Limit your cooking, cleaning, anything involving your hands. Don't drive a car unless you absolutely have to. No more cycling until this clears up. Your career is in danger. I know--I have a total disability because of this sort of injury.

    You NEED to see your primary care provider ASAP. You need an Urgent Care appointment (not an emergency care appointment). THIS IS POTENTIALLY DISABLING! The sooner you get medical care, the greater the chance you will heal. You need a referral to either a neurologist who is interested in peripheral neuropathies or a physiatrist (physical medicine and rehabilitation doctor) who is expert in hand rehabilitation. Do not go to an orthopedic surgeon or hand surgeon yet. You really don't want to be cut unless you have no other option. If you have more than one neuropathy, (and that's what you're describing), surgery might not be appropriate.

    Get a diagnosis from a qualified expert who is NOT a surgeon. (Many surgeons are cut-happy... On the North Shore of Boston, we have a hand surgeon who is too cut-happy) There are many diseases that can cause one to have nerve pain, so expect that you will be having some serious lab work done. (In 1993, when I was initially diagnosed, my lab work cost my HMO 1,200 dollars. Unfortunately, I did not have a medical problem discoverable by lab work that accounted for my nerve pain.) You really don't want to see an Occupational Medicine expert--for the most part, their job is to lessen employers' liability and many of them are hacks. (This is not completely true--I have a friend who has a disabling peripheral neuropathy in her hands and arms who is being treated by an occupational medicine specialist and is getting good care. He helped her get Social Security Disability Insurance and Workers' Compensation. One good apple does not mean that the whole barrel is rotten.)

    The current first-line treatment for peripheral neuropathy is either low dose antidepressent medications or low dose anticonvulsant medications plus occupational therapy (since you have a hand injury, you'll be seeing an OT not a PT). Here in Boston, more forward thinking doctors are having Neurontin compounded into a gel and having patients apply that to your arms. Expect to spend 3-6 months exploring conservative treatments. If conservative treatment fails, then your doctor will refer you to a physiatrist for electrodiagnostic testing. (Electrodiagnostic testing is risky--it CAN cause permanent nerve damage if it is done improperly. This is not a comfortable test, but not necessarily all that painful if the operator is very, very skilled and you stay very relaxed. It's a good idea to have this test performed by a physician who is board certified in this technique.) In cases of suspect entrapment neuropathy, electrodiagnostic testing is NOT diagnostic--it's only predictive of whether surgery might be successful.

    If you have short-term disability insurance or long-term disability insurance (either a private plan or from your employer), it is time to review the policy. It's time to get the forms, to get information. There's a good chance you're going to need it. If you have credit card insurance, it's time to review the plan. This sort of insurance makes the minimum payment on your credit card while you are on medical leave from work or disabled. Unfortunately, if you use this, you won't be able to use that credit card. Also, review your financial situation--the odds are that you are going to need to take time-off from work--that is, if you're lucky. Get information on the Family and Medical Leave Act--it protects your job while you're on an unpaid leave for medical reasons.

    Since you work on computers, it's likely that your problem is work-related. Right now, you don't need a Workers' Compensation attorney--but there's a good chance that you're going to need one. It's time to begin researching Workers' Compensation attorneys. If your doctor says that you are disabled for your occupation, you'll need a lawyer. It's a very real possibility that will happen.Make sure you ask your treating expert (physiatrist, neurologist or hand surgeon) whether your problem is work-related. When choosing a treating doctor, ASK if the doctor is willing to help patients get Workers Compensation or Social Security Disability if he or she thinks it is appropriate. Physiatrists are generally the most knowledgeable when it comes to doing the paperwork, dealing with lawyers and getting people the benefits they need. Some doctors are really good about doing paperwork (my physiatrist and neurologist do it for free as long as I give them outlines of what is needed), others are pretty crappy. Many charge for this, because it can take about an hour for the doctor to generate the specialized report.

    Old 06-17-2008, 12:20 PM   #4
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    Re: I think I have carpal tunnel - what can I do for relief?

    What should you be doing now?
    1. Make an appointment with your PCP asap.
    2. Take extra B Complex. Some neuropathies resolve with that.
    3. Don't use your hands.
    4. Take a NSAID to control inflamation.

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