Cortisone Vs Operation

Question: Today I had my number 4 specialist visit & am looking for input after 12 month – I joined this list 2 weeks ago – I travel & am trying to minimize keyboards to response may be slow.

Background – work in stressful operational management role!  Many flights to USA, Japan, Europe Drive Edinburgh Glasgow & back daily – 1 HR either way Age 37 – young! Keyboard activity pretty high.

First pain last Feb  Tingles fingers Swelling on flesh at bottom of thumb Sometimes swelling on hand below small finger

Treatment  GP Ibuprofen – no result  Self – Change car to automatic Get briefcase with shoulder strap Get wheely type travel bag Ibuprofen gel good Vs pills Solpadine minimizes pain No improvement .

Doctors – X-ray , structure in hand ok – no permanent damage 30 day diary – no link clear – Rheumatologist Neurologist – Nerves ok refer for Nerve conduction studies Nerve studies – Diagnosed mild carpal tunnel/tendonitis , slightly worse left hand ( left handed) – recommends cortisone.

 Today Rheumatologists feels after 12 months Cortisone risk is high not to work & often does more damage than good – suggestion is surgery to release the pressure &fix the issue – state’s minimum risk. He clearly is unhappy with risk of hitting a nerve with Cortisone & says let’s fix once & for all Hands – swollen, tingling XXy sore.

Can anyone comment on good / bad experience of Cortisone?  Can anyone comment on good / bad wrist operations – I have 2 good data pints here?

Answer 1: The question might be, what is causing the pressure in your wrist? If tight muscles are the problem, stretching exercises are the answer (and if not, then not).  If you want to try this approach, you will have to find someone who can accurately identify the tight muscles and then show you precisely how to stretch them. The exercise needs to be done exactly right (otherwise you don’t stretch the right muscles), and needs to be done often e.g. many times each hour.

At our occupational health practice we (mainly Robin the doctor, I am the psychologist) “prescribe” stretching exercises for most people with occupational pain. We find it really useful. Although we have not done formal research, in the one case in which we sent the person back for a nerve conduction study, there was as much improvement in nerve conduction after a few months of stretching as typically occur after surgery.

We don’t really know why it works for some people and not for others, but it seems that people who perform the stretches very often and very well tend to do better. That leaves open the possibility that some people find early on that it doesn’t work for them, and simply stop doing it.

Answer 2: From what I have read/heard I would avoid operations until you know what is your trigger for causing the carpel tunnel. Unless you know how you can avoid the factor after you have had your operation, and have the additional problem of healing scars? Have you tried a specialist in adverse neural dynamics (also called adverse neural tension or adverse muscular tension) you get very similar symptoms to carpel tunnel… I know,I went through this diagnosis route.

For allowing your tendons to heal, there is nothing better than rest. Have you tried splints? Although you won’t be able to drive in them, if you wear them for a typical day at work, you may be able to diagnose which actions are causing the problem… they’ll be the ones you can’t carry out when wearing the splints! Get a voice interface for your computer to stop having to type. If you pick a suitable machine, you can get a suitable set up for a portable PC… it sounds like you might need one for your jet set lifestyle.

I guess you looked at the RSI UK pages which have lots of helpful hints for prevention and cure? You have my sympathy, RSI injuries affect the whole of life, but if you catch the actions which are causing your injuries soon enough you don’t have to suffer permanent damage.


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