Had/have carpal tunnel syndrome? Had surgery, it's working out.

[William Gaatjes]

Thanks. I'll try that. I've heard that CT comes back for some people and I don't want that. Mine was from the pressure on the palms, year after year, causing inflammation. Paid the shop to set up my new bike to a better position, got better padded gloves...we shall see.

To be honest, i have an old mountainbike, with small 26" wheels. And the handles have this rubber grip, it is sort of like the profile from a tractor tire. I do not use gloves. So i got the inverted image of the profile in my hand but that is soon gone after a minute. But the grip when you squeeze is firm. My hand cannot rotate while gripped.
I know from when my mother was alive, the way the doctor tests if a person has enough fluid in the body by pulling the skin on various places, which is to see how elastic the skin is and how fast the skin returns to neutral. Meaning before it was pulled. When you drink enough, the skin turns back to its original shape and marks like the grip dissapear fast. Not enough fluid in the body, means less elasticity. Dehydration does a lot of bad things, over prolonged time , uric acid or urate levels build up as well.



This is kind of the grip handle i have but the rubber grip extensions are slightly longer. And the grip handle itself is longer to accomodate the entire hand.



What kind of profile grip does your bike have ?

 

[highland145]

On the new bike, went with this paddle shape to spread out the pressure. The angle keeps my wrists straight. The damage was already done though. The goal is to keep future problems at bay.

Hydration isn't a problem. Even my 60yo skin pops back immediately.

 

[William Gaatjes]

This is very interesting , i was just reading an article about what compression does to a nerve. And it seems that when people suffer from diabetes mellitus , the nerves can be more sensitive to compression.
Diabetes mellitus is a disease where the body has a problem keeping the bloodsugar levels at safe levels.

Biological Response of Peripheral Nerves to Loading: Pathophysiology of Nerve Compression Syndromes and Vibration Induced Neuropathy - Work-Related Musculoskeletal Disorders - NCBI Bookshelf

As a reminder :
Type 1 diabetes is thought to be caused by an autoimmune reaction : Type 1 diabetes is also called : "Pechvogel diabetes". That is dutch slang for an unlucky person.
With type 2 diabetes, your body doesn’t use insulin well and can’t keep blood sugar at normal levels. :"Vreetzak diabetes". That is dutch slang for a person who has the munchies forever , every day in and out.


Anyway, this is also interesting :
I never knew this, but it seems that nerves can move around as well and stretch as well. But only when we move physically.
Perhaps that stretching before physical activity is not only muscle stretching and tendon stretching and fascia releasement and fascia stretching, but also nerve stretching. Stuff like yoga.
And at sites of inflammation, nerves may get sort of stuck as a result of local inflammation. Perhaps by fascia. I do not know.
Anyway, there will probably be a lot physical therapy for you called nerve gliding :

This you will need to do :
Nerve Glides in Physical Therapy
Flossing Exercises That Mobilize the Nerves

Nerve Flossing in PT: What Is It and Why Is It Done?

Nerve flossing exercises in physical therapy mobilize the nerves. See how a physical therapist might use nerve gliding for your condition.

www.verywellhealth.com

I also added some information to post 23 :

Had/have carpal tunnel syndrome? Had surgery, it's working out.

I have it, severe, in both hands. First knew I likely had an issue with it over 20 years ago when I had a difficult to diagnose and treat left shoulder problem. That came crucial one day almost 30 years ago while doing my daily 2 mile lap swim. Had to stop and I have never tried lap swimming...

forums.anandtech.com

 

[highland145]

Ha, 30 years of mashing then into the grips. A1C is a 5.2, fasting glucose 94. Tris 47ish, hdl 85ish. Total chol 215 but that's on a statin I take every other day. My brain needs some cholesterol.

My new shit is trigger finger on both pinky's. CT surgery can (does) cause that, apparently. It was a novelty until the knuckles started hurting. Tried youtube stretching but nada. Been using a short piece of pvc at night so the knuckle doesn't lock up but this is not a long term solution.

edit: spent a few trips with my massage person on just my hands...also, nada.

 

[skyking]

I had both carps tunneled last year. Would recommend.
Getting some numbness creeping back into mouse pinky.
I will try the dueling mouse trick.

 

[Leymenaide]

Both hands 12 years ago. Dr. said I was one of the few that needed it. It toook years but got use back in both hands. Close to 100%. I am glad I had it done. Now I am just plane old.

 

[Muse]

I had both carps tunneled last year. Would recommend.
Getting some numbness creeping back into mouse pinky.
I will try the dueling mouse trick.

Your pinky shouldn't be affected by carpal tunnel syndrome. That's not the median nerve, which goes through the carpal tunnel. It's cubital tunnel syndrome:

The most common symptom of cubital tunnel syndrome is numbness, tingling, and pain in the hand and/or ring and little finger, especially when the elbow is bent. Cubital tunnel syndrome can be treated with rest and medicines to help with pain and inflammation. Exercises may help too. In some cases, surgery may be done.

 

[Muse]

I did this today. I was reading a study...

Luca Padua et al CTS study at Lancet Neural 2023; 22:255-67. https://doi.org/10.1016/S1474-4422(22)00432-X

I sent this message to my hand doctors, the one who's been treating me for the severe pinky sprain I suffered about 1.5 years ago and the one who's going to operate on me for CTS this coming Monday:
- - - -
On pg. 256 (of the study mentioned above) mention is made of indications for tenosynovial biopsy during CTS surgery if amyloidosis is suspected, e.g. for males w/ bilateral CTS. It indicates bicep tendon rupture a warning sign, also spinal stenosis. I don't know if I have the latter, however I underwent left shoulder arthroscopic surgical Type 4 SLAP lesion repair on 10/15/2002, being bicep tendon reattachment of "bucket handle." I had been an aggressive swimmer & weight lifter, daily, for 10 years leading up to the injury. Part of attempts to diagnose my shoulder pain prior to the surgery was a neurological test. The doctor said as an aside that he saw indications of some CTS. I have this week talked to family members of both my parents & there appears to be no known incidence of amyloidosis. Should we biopsy for it during our procedure?
- - - -
I talked to my P.T. sister this morning and she assures me that if I had amyloidosis it would be obvious at this point and that I shouldn't be concerned. The operating doctor messaged me that there is no indication for a biopsy. I figure this is correct.

I figure ultrasound would be a good diagnostic tool at this point but figure ETCR on my right hand Monday is likely a good idea anyway. Otherwise I'd have to reschedule and lose time. I figure waiting could be costly in terms of my outcome given the results of the testing. I don't know what my clinical workup indicated.

Several documents are readily accessible online, 2 pagers, on what to expect after ETCR.

I talked to my P.T. sister this morning and she assures me that if I had amyloidosis it would be obvious at this point and that I shouldn't be concerned. The operating doctor messaged me that there is no indication for a biopsy. I figure this is correct.

@Brainonska511, etc.

I now think that was bum information. My P.T. sister, I believe, didn't know what she was talking about with respect to the possibility of my having amyloidosis. Sudden onset of severe idiopathic bilateral CTS, particularly in a man over 50 is a red flag, period. There would not necessarily be any other physical indication at the stage of the disease I might have. The doctor who refused to do a biopsy, I believe, was also remiss. He's an orthopedic surgeon, not specifically trained in hand surgery except AFAIK that he was trained to do ECTR. I'm surprised my hand surgeon referred me to him, actually, because I had severe CTS, what is more, some indication I might have amyloidosis, in particular ATTR. I should probably have had OCTR and a concomitant biopsy taken. This is my thinking now. I am going to see if I can be evaluated for possible amyloidosis. If it's caught early enough it can be controlled. I figure to contact my HMO about these things and see what they say for starters.

My MD cousin, when asked, said he was unaware of amyloidosis running in our family. However I'm now told that not all types of amyloidosis are hereditary in origin.

 

[Brainonska511]

@Brainonska511, etc.

I now think that was bum information. My P.T. sister, I believe, didn't know what she was talking about with respect to the possibility of my having amyloidosis. Sudden onset of severe idiopathic bilateral CTS, particularly in a man over 50 is a red flag, period. There would not necessarily be any other physical indication at the stage of the disease I might have. The doctor who refused to do a biopsy, I believe, was also remiss. He's an orthopedic surgeon, not specifically trained in hand surgery except AFAIK that he was trained to do ECTR. I'm surprised my hand surgeon referred me to him, actually, because I had severe CTS, what is more, some indication I might have amyloidosis, in particular ATTR. I should probably have had OCTR and a concomitant biopsy taken. This is my thinking now. I am going to see if I can be evaluated for possible amyloidosis. If it's caught early enough it can be controlled. I figure to contact my HMO about these things and see what they say for starters.

My MD cousin, when asked, said he was unaware of amyloidosis running in our family. However I'm now told that not all types of amyloidosis are hereditary in origin.

I only brought it up because many experts in ATTR amyloidosis believe there is substantial under diagnosis, particularly when related to heart failure. And bilateral carpal tunnel has also been identified as a warning sign.

But of course, there are two types to complicate things: hereditary ATTR amyloidosis (ATTRv) and wild-type ATTR amyloidosis (eg, nothing wrong with the underlying gene). Many with the hereditary variant have polyneuropathy symptoms, whereas the wild-type variant predominantly presents as cardiomyopathy. Why the wild-type disease starts remains a mystery.

As for diagnosis, generally a bone scintigraphy scan can show amyloid deposits, and biopsy can confirm the types of deposits if present.

Though, I guess the issue of screening really comes down to if you have any other symptoms. The carpal tunnel you had could have been a completely different and unrelated cause.

 

[highland145]

Trigger fixed today.

 

[Muse]

I only brought it up because many experts in ATTR amyloidosis believe there is substantial under diagnosis, particularly when related to heart failure. And bilateral carpal tunnel has also been identified as a warning sign.

But of course, there are two types to complicate things: hereditary ATTR amyloidosis (ATTRv) and wild-type ATTR amyloidosis (eg, nothing wrong with the underlying gene). Many with the hereditary variant have polyneuropathy symptoms, whereas the wild-type variant predominantly presents as cardiomyopathy. Why the wild-type disease starts remains a mystery.

As for diagnosis, generally a bone scintigraphy scan can show amyloid deposits, and biopsy can confirm the types of deposits if present.

Though, I guess the issue of screening really comes down to if you have any other symptoms. The carpal tunnel you had could have been a completely different and unrelated cause.

I have been visiting off and on r/carpaltunnel since before my procedures. A 71f posted there a few days ago with an FYI concerning bilateral CTS, saying her surgeon obtained a biopsy when he did OCTR on her hand in late February and the lab result confirmed ATTR. She credits the doctor for saving her life. She's a retired librarian on the east coast and comes off as intelligent, and she has obvious skills in researching information online. We struck up a PM thread. She said she's been researching ATTR in the 5 weeks since her diagnosis. She told me she figures I'm more likely than not also ATTR. Now, I figure that may well not be justified. I do have the impression in reading from the following page that bilateral idiopathic severe CTS may precede other ATTR symptoms and that a great opportunity to check me was missed when I was denied getting biopsied during either of my CTR procedures:

Amyloidosis and Carpal Tunnel Syndrome: Surgical Technique for Extended Carpal Tunnel Release with Tenosynovium and Transverse Carpal Ligament Biopsies - PMC

Carpal tunnel syndrome (CTS) is common in patients with transthyretin amyloidosis (ATTR), and many experience residual symptoms and/or develop recurrent disease following routine carpal tunnel release (CTR). An extended CTR with median nerve ...

www.ncbi.nlm.nih.gov

 

[Brainonska511]

I have been visiting off and on r/carpaltunnel since before my procedures. A 71f posted there a few days ago with an FYI concerning bilateral CTS, saying her surgeon obtained a biopsy when he did OCTR on her hand in late February and the lab result confirmed ATTR. She credits the doctor for saving her life. She's a retired librarian on the east coast and comes off as intelligent, and she has obvious skills in researching information online. We struck up a PM thread. She said she's been researching ATTR in the 5 weeks since her diagnosis. She told me she figures I'm more likely than not also ATTR. Now, I figure that may well not be justified. I do have the impression in reading from the following page that bilateral idiopathic severe CTS may precede other ATTR symptoms and that a great opportunity to check me was missed when I was denied getting biopsied during either of my CTR procedures:

Amyloidosis and Carpal Tunnel Syndrome: Surgical Technique for Extended Carpal Tunnel Release with Tenosynovium and Transverse Carpal Ligament Biopsies - PMC

Carpal tunnel syndrome (CTS) is common in patients with transthyretin amyloidosis (ATTR), and many experience residual symptoms and/or develop recurrent disease following routine carpal tunnel release (CTR). An extended CTR with median nerve ...

www.ncbi.nlm.nih.gov

There is definitely a lot that has been changing in the space over the last year or two. Expert guidance hadn't fully solidified or filtered down yet. I see some talks at upcoming heart meetings for physicians on things like screening carpal tunnel patients for ATTR.

Can't hurt to be screened. And if it is ATTR, there are several approved therapies and a few promising ones in clinical trials.

 

[Muse]

One thing I probably have not mentioned here: Hypothyroidism is a risk factor for ATTR. My blood tests have been pretty stellar, however a couple years ago I had borderline hypothyroidism and was retested for PTH a little later as follow up. At that point I was a bit better but still pretty much right at the borderline.

 

[Muse]

Another risk factor for ATTR is bicep tendon rupture. I had arthroscopic shoulder surgery about 20 years ago and they discovered a type 4 SLAP lesion, which, I believe, qualifies as a bicep tendon rupture. They fixed it on the spot. Being 20 years ago I don't know if it's a factor.

 

[Muse]

As for diagnosis, generally a bone scintigraphy scan can show amyloid deposits, and biopsy can confirm the types of deposits if present.

Though, I guess the issue of screening really comes down to if you have any other symptoms. The carpal tunnel you had could have been a completely different and unrelated cause.

I have been doing aerobic exercise pretty regularly recently and it seems to me that shortness of breath is my weak suit. Could be my age, but have to wonder if my heart is weakening. I had a stress EKG (I think I mentioned it earlier in this thread) summer of 2019 and it was pretty stellar, but that's over 4 years ago. I might not be able to approach that now. I didn't get any data, I was just told by the woman who administered it that it was pretty impressive.

 

[igor_kavinski]

I have been doing aerobic exercise pretty regularly recently and it seems to me that shortness of breath is my weak suit.

How about deep breathing? Are you fully able to inhale and exhale without feeling like air is "leaking" out of your lungs?

 

[Muse]

How about deep breathing? Are you fully able to inhale and exhale without feeling like air is "leaking" out of your lungs?

Yes

My vascular surgeon brother told me to look up "collateral circulation:"

Collateral circulation is alternate or “backup” blood vessels in your body that can take over when another artery or vein becomes blocked or damaged. Your collateral circulation provides alternative routes for blood flow.Jul 27, 2022

 

[igor_kavinski]

You could try increasing your heart's pumping capacity by walking up a flight of stairs and seeing if the number of steps you take improves with time.

 

[skyking]

Your pinky shouldn't be affected by carpal tunnel syndrome. That's not the median nerve, which goes through the carpal tunnel. It's cubital tunnel syndrome:

The most common symptom of cubital tunnel syndrome is numbness, tingling, and pain in the hand and/or ring and little finger, especially when the elbow is bent. Cubital tunnel syndrome can be treated with rest and medicines to help with pain and inflammation. Exercises may help too. In some cases, surgery may be done.

Look "Doctor", I know my symptoms and activity. If you inist on practicing medicine then the first step is to listen to your patient.
You can easily avoid this by not quoting a post and then offering diagnosis.

 

[Muse]

You could try increasing your heart's pumping capacity by walking up a flight of stairs and seeing if the number of steps you take improves with time.

Doh. 3x/week I've been biking 300 feet elevation to trail head, then hiking dirt trail additional 700 feet elevation. Also, 3x/week biking 5 miles each way to gym, spend 1 1/2 hours in gym. My heart's not exactly weak, but some people do much better than I. My goal is to make considerable progress over a year's time, just a brush stoke on the canvas. I'm doing OK, maybe. If I am ATTR, that's a serious issue and I want to know sooner than later.

 

[Muse]

Look "Doctor", I know my symptoms and activity. If you inist on practicing medicine then the first step is to listen to your patient.
You can easily avoid this by not quoting a post and then offering diagnosis.

Oh, sorry, it's a habit I'm in since being diagnosed with CTS. I visit r/carpaltunnel sometimes where lots of people do the same dang thing, giving advice, blah blah. Not used to getting blowback. Anyhoo, tingling pinky is pretty well known to be not median nerve related, it's the cubital tunnel. You didn't know that?

 

[Muse]

@Brainonska511
This page was pointed out to me. It suggests a procedure on the palm to screen for amyloidosis. I don't know if it would be as reliable as bone scintigraphy scan:

Carpal tunnel biopsy: MedlinePlus Medical Encyclopedia

Carpal tunnel biopsy is a test in which a small piece of tissue is removed from the carpal tunnel (part of the wrist).

medlineplus.gov

 

[Brainonska511]

@Brainonska511
This page was pointed out to me. It suggests a procedure on the palm to screen for amyloidosis. I don't know if it would be as reliable as bone scintigraphy scan:

Carpal tunnel biopsy: MedlinePlus Medical Encyclopedia

Carpal tunnel biopsy is a test in which a small piece of tissue is removed from the carpal tunnel (part of the wrist).

medlineplus.gov

Let me preface by noting that I'm definitely not an expert. From what I've seen, as I have become somewhat familiar with the literature and have sat in at least one conference on ATTR through my work, they generally use scintigraphy to see if there is amyloid in the heart. But they also generally want to follow-up with tissue biopsy to confirm the type, since there are a few types of amyloidosis. I'm not so aware of how they test for amyloidosis when it's predominantly causing peripheral neuropathy (or carpal tunnel).

 

[igor_kavinski]

Since amyloidosis is the build-up of a protein, going on a low protein diet may be the only cure. The lower protein intake would trigger autophagy in the body and the body's phages will seek out any undesirable, unwanted tissue to digest and then re-purpose the resulting amino acids for building structures actually needed by the body. It's not easy but this is why properly supplemented vegetarians generally have healthier and longer lifespans because plant food is low in protein.

 

[skyking]

Oh, sorry, it's a habit I'm in since being diagnosed with CTS. I visit r/carpaltunnel sometimes where lots of people do the same dang thing, giving advice, blah blah. Not used to getting blowback. Anyhoo, tingling pinky is pretty well known to be not median nerve related, it's the cubital tunnel. You didn't know that?

So go back and read my post that you quoted. I know you are capable of observation.
Here, I'll bring it forward for you.
"
I had both carps tunneled last year. Would recommend.
Getting some numbness creeping back into mouse pinky.
I will try the dueling mouse trick."

So let's break it down. I am observing some numbness and someone else suggested switching mouse hands to "give it a rest".
I thought that was a good idea and will try it.
You chose to assume I was blaming it on the surgery not working. See what happened there? You offered no solution beyond that giving it a rest, and bloviated all about some other shit. That you read up on all that anatomy and physiology is not an excuse to practice internet medicine.

back in that post, I can leave it at this. I have heard all sorts of stories from older patients, patients with much worse symptoms, surgeries with older more invasive methods complain about outcomes.
My post and intent were purely anecdotal. Here is the gist of it.
"I had both carps tunneled last year. Would recommend."

That's it.
I'd continue to offer that most of these surgeries are no longer the crapshoot they once were, with the exception of back surgeries. I've had one of the earlier arthroscoipic menisectomies in 1980, that went well.
The two shoulder surgeries in 2019 went well too.