Carpal tunnel syndrome, or is it?

[Loose rivets]

For at least ten years, I have suffered what seems to be carpal tunnel syndrome. I had assumed that one day I would have to have both wrists operated upon.

But I'm not totally sure because.....

I once read that the Americans deem this to be a ‘communicable disease', and I certainly started the symptoms shortly after my mother had the same thing. (30 years difference.) Having been diagnosed by a surgeon, she slowly got better.

I too seem to have long periods of remission.

Long periods of using power tools certainly makes it worse when I'm in a vulnerable phase. But does not affect me when I'm not is such a phase.

Almost always, the discomfort is perfectly symmetrical between the right and left hands.

There is just a hint of numbness in the 4th and possibly 5th fingers as well. But it is predominately 1st 2nd and 3rd.

Shaking my arms brings immediate relief.

There is often a hint of swelling under the armpits when this is at its worst. My GP could never find any evidence of this, but I can clearly feel nodules ‘internally'.

Today I have been swimming and doing pull ups on the pool rails and it is very noticeably worse, but I'm still not sure that this is not just exacerbating something that comes and goes that is quite unrelated.

Anyone know of a deceptively similar disorder.

[BelfastChild]

Could be carpal tunnel syndrome but a few comments to make:

1. Never heard of it being a communicable disease. I think the fact that your mother had it too is a furphy. It is usually a primary problem, ie no cause, but can be secondary to other conditions such as thyroid disease, pregnancy, hormone abnormalities etc
2. Can't think of a connection between CTS and swelling under the armpits.

Basically, carpal tunnel syndrome is caused by compression of the median nerve as it enters the hand. This nerve supplies the skin of the thumb, index, middle and half of the ring finger, so the tingling in these fingers could be related. With chronic CTS, you also get wasting of the thenar eminance (this is the ball of muscles at the base of the thumb). Compare sides and see if one is more wasted than the other.

One question - do you wake at night with tingling in the fingers? If you do, wearing wrist splints might help

To be certain, nerve conduction studies can be done if there is any doubt about the diagnosis.

Don't think swimming will be a problem for you. If you have ongoing concerns you should go back to your local doctor.

[Loose rivets]

Thanks BC for your reply. Furphy now that's a word! I had to look it up.

http://en.wikipedia.org/wiki/Furphy.

I too found the concept of CTS being communicable, very doubtful and wondered why such an idea would be only be mentioned in America. However, it's more than the timing with my mother's symptoms, that gives a hint of truth to the idea.

Although I have found out a little about the subject, I didn't know that part of the ring finger was 'wired by the same harness'. So, next flare-up I will be more critical in my observations of the symptoms reaching past the first three fingers. (in pianist's terms )

The very term ‘flare-up' seems to point to more than just reaction to hard work. I did heavy building work when I wasn't flying, and dug foundations out by hand...all without a trace of a problem. Then, one day, just the use of a drill or some such tool would leave me shaking my hands every few minutes to relieve the tingling. Night times are often bad, and I suspect that it wakes me up sometimes. It lasts a month or so, then can vanish for a year.

I accept that at my age things are going to go wrong, and am not unduly worried...more curious. But it is the main reason that I gave up playing the piano, which I loved. It all pales into insignificance compared to a lower back problem that I have, and there is a link here. The way the back flares often seems unrelated to work done, so agin I'm trying to think laterally to see if there is a ‘global' cause.

The main reason that I suspect there may be another factor is that I would have thought that a nerve routing, that was partially closed up, would cause a chronic condition. Furthermore, I have another odd disorder. What I thought was a simple reaction to washing up liquid, became so bad that my hands become slightly swollen and very itchy if I use the wrong stuff. One day this became so severe I was unable to drive. Withing a few minutes, I was on a 999 call shouting for help. I later gathered that I had gone into full anaphylactic shock. This was never truly diagnosed, and as I was not flying anymore, let the whole thing fade into the past. I was however given an epipen to carry on my travels.

Some years ago I went to an Essex Hospital and saw a surgeon...who then preceded to brutalize my right arm with electric shocks for what seemed an eternity. I got the feeling that he was doing a private study into how much pain certain types of people can take. ("Electricians are the worst." he said, enthusiastically.) He injected cortisone into the nerve area, which did not help. The reading, ( which was done on an old oscilloscope that looked as though it had been left over from the war.) showed a slight reduction in electrical transmission. It was not conclusive.

Going to the doctor has become something of a problem, my doctor being 5,000 miles away, but so often, just communicating with someone that has happened across a similar thing will point towards the answer.

nota bene The doctor that gave me the epipen was somewhat sympathetic. His dad exploded from both ends outside a Chinese restaurant, and looked as though he was going to die. It was diagnosed as anaphylactic shock, which like me he had never had a hint of before. His dad was also a GP.

[BelfastChild]

Sounds like it probably is CTS then. A few recommendations:
1. if you are overweight, try to lose some
2. if you smoke, stop
3. try to get some wrist splints to wear at night during a flare up. You will probably have to get these through a doctor (a problem I know if your GP is 5000 miles away)
4. surgery is a last resort but can be effective - if it were me and it was significantly interfering with my life, I might get one hand operated to see what happens and then get the other one done if it helps. Only you know how much this is affecting you

Only other thing I can think of is a condition called vibration white finger. It affects people who regularly use vibrating power tools such as jack hammers. It is a variant of Raynaud's phenomenon where your fingers turn ghostly white in the cold. I doubt this is your problem though.

[currawong]

First off, sympathies. Sounds pretty unpleasant.

Have you explored psoriatic arthritis or perhaps gout?

Both conditions have a hereditory side, and fit some of your symptoms; the former even the swelling in the armpits, reaction to detergent related also. Both the inexplicable flare ups.

Try a search on both, see what symtoms match yours.

Good luck with it.

[Loose rivets]

Thanks for the info(s). I'm a non smoker and was very fit until 60 years of age. I'm convinced that something specific is wrong that would answer more than the CTS

I'm intrigued by the psoriatic arthritis concept. I shall give it more thought when the problems caused by my wife's handbag snatch have been sorted. (Posted on JB).

I was beginning to drift towards that kind of logic, but while I can learn about mechanical joints, the underlying microbiology is orders of magnitude more complex.

About the time that the reaction started, I was very keen on so-called super bikes. They are like aircraft, one seems to need to work on them as much as use them, and my hands were always being cleaned by a mixture of washing up liquid and white spirit.

For a time I also suffered patches on my knees as well as in the centre of my hands. I remember one day in Geneva trying to wipe the blood off the power levers, before my (Swiss) fo could see it! Very embarrassing, but it would vanish in a day or two, leaving my hands utterly unmarked. I can see, and I make this comment seriously, how some people living in a religious community, might have assumed that such symptoms are stigmata. Anyway, this all vanished as my lifestyle became more settled.

The back pain that I have now live with is beginning to make me suspicious of there being another contributory factor. My MRIs show some bulging, but nothing that would account for the life altering pain. The point is, that when it really flares, it is horrendous. The next day, I can be perfectly normal. It's almost as though the battle in the hot spot had been won, and the offending inflamation quelled...for a while. Mind you, with this I'm clutching at straws. It has been very difficult to maintain a modest fitness for the last six years, but I have resolved not to give in and let my back weaken. As mentioned on an earlier thread, I'm looking at the DRX9000 system, but I feel that this might just be palliative, and that I should be looking at T-cells not traction tables. R

[TheFlyingPhysio]

Interesting collection of symptoms and signs !

A few comments on CTS.

The symptoms will be aggravated if the wrist is not in neutral i.e. the wrist is flexed or extended. The latter is often seen when people use computer keyboards and mice not to mention tools.
Gripping compromises the nerve as it is the least able of the structures in the carpal tunnel to withstand pressure. (Consider what you did in the gym ?)
Vibration also affects the nerves and could explain the response you mentioned.
In the USA CTS is frequently diagnosed in office and assembly workers based on the symptoms and it fits under the umbrella term of Cumulative Trauma Disorders (CTD's) but in other countries different terms are used e.g Upper Limb Disorder ULD (UK) or Occupational Overuse Syndrome OOS (Aust). Unfortunately, these terms are all a bit meaningless.
Night splints can be useful but only use at night.
A bilateral problem could also be caused by dysfunction further a field e.g. neck degeneration. This is more likely if you have what is described as a poking chin posture.
It is prudent not to rush into surgery until the real cause has been identified.
Some of the less common "rheumatic / arthritic" i.e. inflammatory conditions do have skin associations e.g. psoratic arthritis. Some of these conditions can come and go quickly but are often best managed with medication.

Low back pain. Have you read "Treat your own Back" by Robin McKenzie ? This Kiwi has produced an excellent laymans guide to self management and it is an inexpensive. It is published by Spinal Publications. The techniques advocated by McKenzie are used worldwide with great success.

Good luck on getting your problems sorted but in the meantime monitor what makes your symptoms better as well as worse.

[BelfastChild]

It is prudent not to rush into surgery until the real cause has been identified


I agree. My comment about having surgery was based on the assumption that you have CTS. I hope I did not imply it's a diagnostic test.....

[Loose rivets]

Thanks again for your replies.

It was not my intention to talk about backs, and this post is getting seriously close to being put in the Agony Aunt forum, but the pattern of flare-ups suddenly sounded familiar, and it was this that caused me to go into the thread-drift while asking about CTS.

In trying to correlate a possible common cause for two quite separate problems, I have of course created several red herrings. I'm banned from talking about backs in the Rivet household, it's all been going on so long. In my years of investigation into back pain, I hear of many famous, and often wealthy people, who's life has been ruined by this problem. Their wealth usually does not buy them an answer. For Jerry Lewis, it was a great deal longer than six years, and he says that it was only his (young) son that kept him from ending it all. ( He resorted to a catheter implant that manages pain control.)

As mentioned, I am trying to think laterally. I really am suspicious that if psychological factors are eliminated, there may be an inflamation factor that fluctuates in a way that may give a few clues. Today I have been working on the house and swimming with the g-children...not a hint of a problem. Yesterday was c&@p

I know that ‘reassuringly expensive' drugs can be injected into the discs and facet joints, but the underlying mystery of inflamation is something that can not be easily determined as the cause. It is not easy to do a biopsy–or indeed to determine the location for such an investigation. It is also very difficult to determine which came first, inflamation or irritation by abrasion. A classic chicken and egg problem.

As one who has tried almost all permutations of exercise and traction imaginable, (but not the DRX9000 mentioned a while back ) I have long thought that the variation in pain is somewhat mysterious. To relate it to CTS is just one possible line of logic.

I am typical of millions of people, and I would like to see more training and education given to the young, so that the worn and collapsing discs found in otherwise active people, can be obviated. Just saying ‘keep your back straight while lifting' is just so much tosh. Sure, it is important, but it's only a fraction of what is needed to keep backs healthy.

The fundamental need for building the structure of the body up--before the age of thirty, is something that catches out a lot of people. I for one, worked harder at sports after that age than ever before...because of a commitment to flying. Cars, pubs and airplanes filled my life before that time, and although years of tennis and judo did not give me a jot of back pain, it left me with a ‘push through red-line' mentality. At sixty years old, the bits inside just did not agree with this viewpoint, and I feel that I have aged 20 years in the last six.

For general interest, I will try to scan an MRI and post the pic or link. It shows some of the problems experienced by people as they age. (I haven't tried this before.)

[TheFlyingPhysio]

Backs !!

Is there a pattern e.g.
OK when active but not good when just sitting around ?
OK when activity in moderation but no good when overdone ?

With the former there could be a suggestion about dynamic stability being reduced when inactive hence a problem. The latter may suggest stirring up (inflaming) some degenerative parts.

Inflammatory problems tend to have a pattern. Overdoing things will stir it up but there is also a time pattern to it as well. See if there is a pattern.

MRI's will show the state of play but should not be considered in isolation.

Move well and you will stay well !

[Loose rivets]

Will just try this as I say for general interest. EDIT the pics come out too big, but long so i guess that will do.

This is how a spine should not look.

I don't know what has caused the thickening of the ligamentum flavum, but I'm sure that it is narrowing the spinal canal.


http://img.photobucket.com/albums/v703/walnaze/SpineIPS2000.jpg

[BelfastChild]

[quote=Loose rivets]

This is how a spine should not look.

/quote]

I'm afraid that is how a spine does look in a person on the wrong side of 50. Bit hard to tell from a single sagittal image though......

[Loose rivets]

At 03:00 this am, I was getting all too involved in trying to scan some more recent, and much clearer MRIs. However, the masking system on the Epson photo scanner is coded, so I can either chop up the film or make an improvised mask--with appropriate white patches--that I assume tells it what frame to look for.

It's strange that the profession still relies on film. After all, it's in the scanner in digital form first. It could be ported round the world and viewed with all the advantages of computer enhancement...I personally found it much easier to look at when ‘inverted'. I suppose this will happen.

I've mentioned before, that I have spent some time looking at a modern CAT scanner. The (flat) screens were breathtakingly clear. At least the equivalent of 1600 lines, with perfect pixel isolation. However, I can understand how the old school is so used to interpreting film, that there will be considerable inertia.

Will post if I have any success, but now I'm off to clambering in boiling attics, after having asked Mrs R to hang on my belt for as long as she can. The sum of my leg's weight and my wife must give around 200 lbs of traction. On a good day this will buy several hours of active work.

It's a strange world.

[Mac the Knife]

"Anyone know of a deceptively similar disorder."

Odd that its so symetrical.

Post-fixed plexus?
Cervical ribs?

[BelfastChild]

Still reckon it's CTS. In my experience it is often bilateral. I know Ockham's Razor tells us everything should be explained by one diagnosis, but I think the back problems are probably unrelated....