Carpal Tunnel Syndrome

June 1, 2007 at 09:09 PM · You've already given conservative therapy a try--no luck. I would talk to a hand surgeon--I've had both my wrists done and I was back to normal within 2 weeks(I didn't have them both done at once.) The surgery is a simple procedure that lasts maybe 12 minutes.

June 1, 2007 at 10:03 PM · Agree with Jay. It's a simple surgery that releases the pressure. You'll be playing and as good as new quickly.

June 1, 2007 at 10:39 PM · Before you jump to surgery, make sure you're doing some really important things:

1. Play NO MORE than 30 minutes without at LEAST a 10 minute break.

2. Isometric exercises---lots of good internet sites on these (sorry I don't know any off-hand)

3. STOP playing the MOMENT you feel pain. CTS gets worse when you continue the actions that caused it---you can't play through the pain; it won't go away unless you rest.

4. Ice your wrists after every playing session to calm inflammation.

5. See if there is anything else you're doing with your hands that is aggravating the condition---gardening, typing, etc.---and stop these if you can, or at least moderate the activity.

6. Sleep with your wrist braces---it's very easy to sleep with your wrist in a funny position and make things worse overnight.

7. Consult a teacher and see if there is anything you can correct about your left and right-hand playing positions to alleviate tension---not keeping fingers curved, wrists bent too much, etc.

I've had CTS for ten years and never needed surgery, but I did have to change the way I used my hands. It's still painful sometimes, but usually when I've been overdoing it. I take the pain as a sign to slow down and do something else for a while. Good luck!

June 1, 2007 at 11:15 PM · Shailee--

I doubt that a professional violinist with all of the obligations that entails could follow your regimen. Being a pro means having to play on a schedule that is not always of your own making.

June 2, 2007 at 01:48 AM · Jay, it's true that she won't be able to let up on her playing as much as would be ideal, but there is still a lot that she can do to lessen the pain and not aggravate the condition, some of which I mentioned above. She said that it's only a recent problem, when she was playing 8 shows a week---she doesn't say whether it's permanent or temporary, but it's reasonable to think that if she goes back to her previous routine and is careful, that she can avoid making the problem worse and needing surgery.

Surgery is not the answer for her current problem, either---she needs to be playing this summer and that won't happen if they cut into her wrists. It's not one of those afternoon-at-the-doctor's-office procedures, it has a recuperation period from which she would need to work back to her current level of activity.

Also, the thing about CTS is *it comes back* if you don't modify the way you use your hands. I personally know people who have had *multiple* surgeries because they went right back to what they were doing before and induced the condition all over again. It's far, far better to avoid surgery if at all possible.

June 2, 2007 at 02:14 AM · Jay, just read your bio and realized I'm debating with a physician. So I guess you have some authority on this subject! I'd be interested to hear what you know about how likely CTS is to return after surgery if the patient doesn't modify her activity level. And also what happens if more surgery is necessary---I knew someone once who was denied a third surgery because there was so much scar tissue from the first two procedures that they couldn't clear out the nerve tunnel any more.

And I must admit, I'm a bit disappointed (and even suspicious) that you would rush to recommend surgery without even asking about activity levels and patterns---the cause of the condition. She might have eight shows a week to perform, but she can still rest a lot during her practice sessions, keep lots of ice on hand, stretch between pieces, etc. I'd better stop---my wrists hurt just thinking about this!

June 2, 2007 at 03:12 AM · As a medical layman I still agree with Jay. Why keep using ice and braces when the problem can be fixed permanently in 15 minutes? My wife was a professional athlete with CTS, had the surgery and a few weeks later was back in full swing.

June 2, 2007 at 03:18 AM · i think one key thing to consider is who is a good surgical candidate and who is not. to make that decision wisely depends on many factors, one of which is that the clinician needs to be very astute. when in doubt, the poster should consult with a specialist who does cts everyday.

there are many nurses or even patients who have more common sense or experience than inexperienced doctors. everyone knows of cts. everyone can come up with some suggestion. but when an individual is confronted with the tough decision to go under the knife, all the stories, all the stats seem distant.

and they are.

it takes more than dumb luck to have a good surgical outcome. but, it is not very straight forward to relate the experience of one person to that of another. a postal clerk, a typist, a violin player all can be dx with cts but with very different diagnosis and prognosis.

one of the most important things to consider, other than coming to v.com for support:), before going forward, is the extent of the injury.

how? electromyography/nerve conduction studies (not the most pleasant thing to undergo, with shocks and pins, but tolerable in the whole scheme of things). in ca, the studies are done by neurologists or rehab doctors. if the center is academically affiliated, all the better.

why bother with the studies?

they provide data to rule in or rule out cts. if ruled in, they demonstrate severity. and here is the key part: the data from the studies may help guide an astute clinician in deciding whether the patient is a good surgical candidate.

for instance, if the studies reveal signs of acute injuries with early signs of reinnervation, clinically speaking, it is a potentially good surgical candidate, IF there is a strong consideration that conservative management for the long haul is not ideal.

another person with similar presentation can have a totally different set of data on the studies. it may show signs of significant denervation, axonal loss of chronic nature. in other words, if the nerve is a bundle of 100 electric wires, 50 of them may be broken (copper and plastic all separated) and they won't grow back, then, despite the severity, this may not be a great case for surgery because you have to weigh how much is left to salvage against how much risk there is to go in. as another poster has pointed out, post surgical scarring can be very significant in some people; things can get worse with surgery for unpredictable reasons like that.

here is the confusing part: whereas chronic cases are rarely good surgical candidates, some acute cases respond very well to surgery but some to conservative management. it is as reassuring as flipping a coin.

to tilt the odds to your favor, you need to get in the office of someone who is very good at this, someone who has enough experience and authority to say: trust me, do it this way or that. what you do not want to do is to drag this on on your own, trying all "remedies" under the sun and turning an acute, potentially reversible case into chronic.

at this stage, you definitely do not want a chiro to be your primary care provider. they will probably tell you your neck is subluxed or something. no, no.

spend some money and do the right thing.

June 3, 2007 at 01:28 AM · Shailee and the others,

I appreciate all the advice. I'm glad I found this site.

As soon as I start to play I aggravate my whole right arm. (I am typing only with my left hand right now.) So I am keeping my right arm from all activity. My whole family is doing everything for me. When I play for even ten minutes my whole right arm gets numb up to the shoulder. I am on vitamin B6 and other joint supplements. I have an appointment with my doctor Monday. I might be referred to a surgeon. I at least want to talk to a surgeon. I'm not as afraid of facing surgery after reading all your posts. I wish I could follow the regimen you suggested, Shailee, but since I can't play at all right now I need to fix it first and then do some of those things in the future. I will, however, ice my right wrist tonight to see if it helps. My left hand was sore for awhile, but is doing better, so I'm relying on it.

June 3, 2007 at 01:59 AM · Good luck, Cathy, it can't be any fun to go through what you are right now and not be able to play, and I sympathize. It certainly can't hurt to have tests done to see exactly what's wrong and what your options are. I would try to get more than one opinion if you can. And let us know what they say!

June 9, 2007 at 09:30 PM · I went to the doctor. Instead of carpal tunnel I have been diagnosed with Repetitive Stress Injury. The pain and injury are in the upper right arm and it's affecting the entire arm and wrist and hand. Numbness comes and goes. I'm getting a massage today and I start physical therapy Thursday. I am not to use my right arm to do anything. I've been resting it a lot. Wish me a speedy recovery!

June 10, 2007 at 02:23 AM · One option is to change the way you use your mouse and keyboard. Maybe the pain will subside simply by changing your current behavior.

I'm not sure about the proper way to avoid the carpal tunnel syndrome, but currently I type such that my arms and wrists don't touch anything at all, and when I use the mouse, I lay my entire forearm flat on the desk (my mouse is pretty far back) and the only part of my hand that touches the mouse is the tips of my fingers and thumb.

This may be the perfect setup for cts, but I don't know anyone else who types/uses the mouse this way, so maybe it will be fine. I'm probably too young to get the disorder though.

June 10, 2007 at 11:51 AM · rob, the idea of having the forearm flat on the desk is a good one.

a better setup will be forearm flat, but resting on a raised platform, say a book, so that wrist joint remains flat during mouse use.

the slight wrist extension during "regular" mouse use creats tension inside the wrist, made particularly worse if the entire person is tense to start with.

June 10, 2007 at 09:24 PM · "a better setup will be forearm flat, but resting on a raised platform, say a book, so that wrist joint remains flat during mouse use."

I actually did that last week when I was posting my books to eCampus...I left my Java book in front of my mouse. The book is about two inches thick, and it actually felt pretty comfortable. Then I got yelled at for having a messy desk, so I moved it.

June 20, 2007 at 02:50 AM · I did change the way I held the mouse immediately. I knew that was aggravating things.

I have some very interesting news!!

Last week I went to a physical therapist. She assessed the injury was in my NECK! She gave me an electrode treatment. That afternoon my hand swelled up. My arm and hand continued to be numb and tingly. I iced my hand and the swelling went down.

The next day I went to the county fair. I happened upon a Thai group giving accupressure massages. I told one of them about my injury. After the massage my arm was no longer numb or tired. It felt normal.

THEN I came to this site again and read about shoulder rests and chin rests and it dawned on me that I had changed my chin rest at the advice of another violinist several months ago!!! We were experimenting with sound and how it was different depending on whether the chin rest clamped over the tail piece or to the side. The chin rest was uncomfortable at first. I accommodated by slightly adjusting my hold/posture.

I ran to my violin and changed the chin rest back to my old one and VOILA!! That was it!! I am playing without discomfort. NO MORE INJURY!!!