I had gone to the hand doctor last month complaining of a lot of things and one of the specific things was carpal tunnel syndrome. I have not had a previous diagnosis of it, but there was little doubt that is what I’ve been dealing with. So today I went and had the nerve conduction study and EMG on both hands. My results are just so much fun. I do have mild to moderate carpal tunnel on my right side, moderate carpal tunnel on my left side (I’m left handed) and mild cubital tunnel syndrome on both sides. When we talked about that, I realized that I do indeed have symptoms of that as well.
I will be going back to discuss the results on Friday with my hand doctor because I already seem to have some deficits in my left hand. I will probably arrange to schedule the release for that.
Indeed. However not every carpal tunnel needs a release surgery, more so when caused by PsA inflammation. Which yours is so very likely. What you need instead are PsA meds that are working optimally for you. This is because the recovery from it given the ongoing as yet uncontrolled or indeed under controlled PsA inflammation causes a very difficult recovery from the operation. First you’re cut and second all those inflamed bits are fiddled with. All that is a likely reason for even further PsA inflammation to really take hold inhibiting cogent recovery or even making it worse.
I spent over 10 years litigating upper limb work related claims. So lots of carpal syndrome and trigger finger issues along with tennis/golfer elbow and general forearm tenosynovitis experience here. I would first try and ensure you are treated optimally for PsA @Stoney. You’re not presently as your Humira hasn’t been working well enough for some time given your knee and indeed feet issues. And the issues you’ve raised with your rheumy on here. Believe it or not if you can quell the inflammation process in a carpal tunnel your symptoms can abate. Same as they can in tennis elbow issues, knee issues hip issues and other feet and hand issues.
I remain fascinated in the USA that they all reach to operate instead of treating your actual disease cogently and effectively. Completely forgetting that any operation can totally reignite you PsA disease activity horribly.
Not in a rush, but because I already have some loss of function in my dominant hand, I likely will have the release surgery on that hand. I’ve done pretty well with minor surgeries not causing any flares. I was slightly surprised about the elbows but not super surprised.
In terms of not being treated properly. . . My initial response is that you’re correct, but when I think about it more, I have no swollen joints, no significant tendon pain, etc. My knees are the worst of it, but there is significant arthritis in them so that’s not really surprising. I have been working on my weight, which will benefit my knees and overall inflammation. I’m already down 30 pounds, with about the same amount to go.
But since no rheumy in the USA (it seems) adheres to cogent PsA monitoring measures which are used globally for PsA elsewhere such as the PsARC exam it’s really hard to be sure what a patient’s PsA disease activity is doing surely.
I’ve gone to a rheumy appt thinking I’m doing pretty well only to find my PsARC score has inceased which in turn means my PsA disease activity is too active. We can have inflammation without pain and we can have damage occuring without visible swelling too sadly. All too often too. The joints have to be felt and squeezed to find the PsA inflammation, it’s not always apparent even on scans and MRI’s either. It’s the sole reason why GRAPPA decreed the PsARC exam should be used as a disease measuring tool worldwide. Having damage in your knees means your disease activity wasn’t effectively reduced by whatever treatment you were on, so why weren’t your meds reviewed?
Losing weight sadly doesn’t stop PsA disease activity but it can make dealing with the effects of consequent PsA damage a little easier. But it truly does little else PsA disease acitivity wise. However so well done you for losing 30lbs, and wanting to continue on with more weightloss, as it certainly helps loads of other potential and possible medical conditions, many of them comorbidities with PsA just anyway.
I’d like to say something like, “Look on the bright side…at least PsA has lots of variety!” I never know if an actual diagnosis is a good thing or not but sorry to hear of your one more thing to be concerned with. Our hands are so very important. I hope you get more resolve and that the way forward is clear and hope filled.
I had a bilateral carpal tunnel release probably more than 45 years ago. It was really bad by the time a dr finally figured out what it was as it was not commonly seen back before the age of computers and cell phones. Especially in women. It’s not a terrible surgery and I’m sure surgical techniques have improved massively since then.
I have it again as my wrists are now so degraded and collapsing that the median nerve is being crushed. I’ve lost a fair bit of hand strength, dexterity and actual muscle mass. Not to mention near constant pain of some degree. I’ve finally been approved for Humeria so my orthopedist does not want to do any surgery until I’ve been on it for at least 4 months and we can reevaluate things. We’re in a bit of a rock and hard place situation because operating again is going to be harder than it was the first time, not just because it’s a redo but also because of the collapsing wrist joints. However, I will reach a point of no return if I do not do something in the not too distant future. Once muscle is gone it does not return. And functional hands are very very important to have.
All of that is my left hand. Which I think is odd since I’m right handed. The right hand/wrist is also affected but not to that degree, so I have a bit of time for that one. I’m also looking at another surgery to fix my thumb. It has collapsed so far into my palm that picking something up causes thumb hyperextension, not to mention is incredibly painful. So at some point I will have to address that too. Fortunately if both issues need surgical repair he can do both in the same surgery. But even if the Humeria can help w/carpal tunnel it can not address in any way the thumb issue.
I guess I said all that to encourage you not to let it go too far, whatever you and your dr decide is the best treatment. Good luck and all the best!
Hopefully you can get some relief from the humira. It’s been a good med for me overall. But yes, once the damage is done you either have to live with it or repair it surgically. That’s the goal of the meds, to slow down damage.