Motor Coordination and Manual Dexterity

Dear Dr.      
I have had surgery on both hands for carpel tunnel. I recently completed vocational rehabilitation testing.  My motor coordination,manual dexterity, and finger dexterity all rate extremely low.  I still have tingling and occassional numbing. It is not as bad as before surgery. My problem is that I swell whenever I do anything substantial for an extended amount of time.  The voc rehab people had me doing tasks in a controlled enviornment.  They sent me home early everyday. They seem to think that even using a pencil to take the tests was causing pain and swelling. My surgeries were : January-left wrist and April-right wrist.  I am beginning to wonder if I will be able to do much of anything for an extended amount of time.  Is this normal for carpel tunnel or could something else be starting to happen?  I am 37 years old. I have been told that my factory days are over. I was given a 12% disability rating by IME doctor.  Any insight you can give me will be greatly appreciated.

[CCF Neuro[P] MD, RPS]

Dear Lisa:

I am not sure I can add anything that your neurologist and rehab team have not already told you.  I will assume that you do not have any of the systemic diseases that can predispose one to carpal tunnel, such as endocrine disorders, rheumatologic disorders, diabetis, polyneuropathies, dialysis, or pregnancy.  Some people have small wrists and are employed in jobs that can cause irritation of the median nerve.  If you fell into this latter category, you were one of the unfortunate ones to have carpal tunnel as an after-effect of your job.  It was unfortunate that your symptoms were not brought to medical attention earlier, but this is past history and there is not much we can do now.  Much of the degree of improvement will depend at what stage surgery was performed or in other words how bad was the carpal tunnel.  There is a point at which surgery will help but only minimally.  Since I do not know at what stage your carpal tunnel surgery occurred, I can't tell you much about the expected recovery, but your surgeon and rehab team should be able to fill in the possibilities.  I wish there was something I could tell you.  The pain should be somewhat better as you adapt to using your hands again.  Mediciation can often help patients over the initial period.  The key is to keep using the hands and the doing the exercises the rehab team has given you.  Stick at it as best you can, and you will maintain much more function of the hands.

Sincerely,

CCF Neuro MD

[kysassy]

In addition, I received my disability determination today.  It says that my condition is not severe enough to qualify.  I don't really want disability; however, when even the voc rehab people were concerned enough to send me home everyday.....one has to wonder.

[carolynr]

Lisa, not because of carpal tunnel problems, but related;  the wrist has multiple nerves traveling through it and it takes forever to recover from injury.  Two years is the minimum, if an
injury occurs on the job (in California) they have to keep paying
disability for an indeterminate time, based on your M.D.s statement(s).  Good luck.