Re: Carpal tunnel-surgery?

Subject: Re: Carpal tunnel-surgery?

Forum: The Neurology and Neurosurgery Forum


My wife was diagnosed with carpal tunnel by nerve conduction.  It has bothered her for years but is getting worse.  The neurologist was sort of unconcerned and told her it depended on how much it bothered her.  She handles pain pretty well so she's not inclined toward surgery.  However, I've heard you can lose the use of your thumb if it goes on.  Her thumb "snaps" at times and gets stiff (she's a computer operator).  How do you know when you are at the point of surgery to save the thumb or should she do something else?  She has a special tray to lower the keyboard-too little too late!  She says she also gets a popping like tendons snapping in her hand and an electric shcok feeling at times in the hand.  Any suggestions?




Dear Paul:
Sorry to hear about your wife.  The move to a more friendly computer keyboard height.  Some things that you can try before surgery.  First try splinting, initially at night.  Then try an anti-immflammatory medication.  There is a new medication on the market that will calm down the inflammation without damaging the stomach called Celebrex.  Ask your neurologist about Rx'ing this medication.  Your wife should take frequent breaks during the day from the keyboard.  These breaks do not have to last for very long, just a few minutes.  Surgery is indicated if there is thenar muscle atrophy (when you turn your hand palm up, it is the thumb muscle at the base of the thumb that looks like a big cube, compare hands for atrophy estimation).  The second criteria would be a positive Phalen test or Tinel sign, your doctor can tell you this, and the last would be an extreme sensory deficit (loss of two point discrimination of 0.6 cm or more, your doctor could tell you this).  Finally, an EMG that tell you that this is
severe disease.  Any of the above could tell you that you may need surgery.  The popping of the tendons is not a sign of carpel tunnel.  The electrical shock feeling might be correlated with the carpel tunnel.  I would try the suggestions initially and see how they help her problem.  I hope that things go well.
Sincerely,
CCF Neuro[P] MD








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