Let’s try and avoid the slice and dice, shall we?

by Suw on February 24, 2009

In early November last year, I had steroid injections in both wrists to try and treat my carpal tunnel syndrome. After some initial side effects, the injections seemed to have done the trick. Instances of pins and needles in my hands over night decreased to nothing and I pretty much forgot that I’d had RSI. Until mid-January, when it all came back with a vengeance.

I had nine nights during January where I was getting pins and needles almost every night, and not just once, but two or three times, and it’s been like that, off and on, ever since. Now, don’t underestimate these pins and needles – it’s like a non-painful type of pain. It wakes you right up, and it keeps you awake until they’re gone. I discovered that if I stretch my neck in a certain way (away from the affected hand) the pins and needles would vanish almost immediately, almost all the time. Good trick – it helps me not wake up too much when an attack comes on.

So yesterday I went back to the physio to see what he had to say about it. Apparently, the steroids wear off in about five or so weeks, so I mine worked for about nine, which isn’t bad but not all that great either. The physio is reluctant to give me more steroids, as you can only have three injections a year and if they only work for nine or so weeks, it won’t help long term. Instead he’s referring me to the surgeon for an assessment for, well, surgery.

I’ve already had a number of tests, which have taken the form of flexing my wrists in certain ways, and pushing hard on certain points in my neck and shoulders, and I come up negative for all of them. My physio did them all again yesterday, and despite the fact that I had concluded that it’s all in my neck, he said that the tests he did proved it wasn’t.

So the first thing the surgeon will do is a “conduction” test:

In a nerve conduction study, electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed with which nerves transmit impulses is measured. In electromyography, a fine needle is inserted into a muscle; electrical activity viewed on a screen can determine the severity of damage to the median nerve.

Then they’ll decide whether surgery is a good idea or not.

Now, I used to be a big gung-ho about surgery, until I actually had some. Having a naughty mole removed (twice! (with pics)) made me think a bit harder about what surgery actually means, and now I’d really rather avoid it if at all possible.

I’m not actually suffering any pain or discomfort during the day. Occasionally I get a strange sensation in my hands, but it’s not pain, it’s more a physical feeling of something wrong. It’s hard to describe accurately, but you’d know it if you felt it.

I am, however, having a lot of back pain, and I have a long, long history of some quite serious back problems. I’ve had chiropractic treatment for years, and without it I would be in a right mess now, so my first instinct is to go back to that. I had been seeing someone in Islington, but like all these things, quality varies. I lost faith in her after she suggested that the pins and needles in my fingers could be diabetes, but failed to spot that it was more likely (given my general health) to be carpal tunnel.

So that means I need to find another. I’ve had a chiro and a physio recommended to me, but they are both out of London and it would be a bit of a trek for regular consultations. A London clinic recommended by someone I don’t know looks rather expensive, and I’m not exactly what you could call rolling in it right now. I’ve had acupuncture before and that worked well for certain types of problem. I’ve been told that for some people with RSI it can work, but to be honest, I’m willing to try it regardless, because having tiny needles stuck in you is better than having your wrists slit open.

My chiro down in Dorset, who’s very good but too far away for regular visits, has told me that carpal tunnel syndrome isn’t something that she can fix. That may be the case, but I’d like to rule chiro out through experimentation. My spine needs attention anyway so I’ll benefit from getting it all sorted out and put back in the right place. And if I still suffer the pins and needles, I’ll move on to acupuncture. Surgery has to be a last resort.

But it’s important to say that this is not like the mole, where there was a danger it would turn cancerous and where it was important to move swiftly and excise every last bad cell. If I had another mole go bad, I would not hesitate to get it removed. There are some things that alternative therapies such as chiropractic can do, and there are things that they can’t. Right now, I don’t know which category my RSI falls into, so I’m just going to have to find out.

Ian Betteridge February 24, 2009 at 11:38 am

Give Kim a shout – she’s been through the whole process (including being recommended surgery, I think) – so might be able to add some perspective on treatment.

Matt February 24, 2009 at 3:29 pm

I’ve had Japanese electric acupuncture for my RSI symptoms in the past and I certainly found it gave me some relief. Not usually immediately. In fact the following day was often worse but, after that, it would get better and stay better for a while. IIRC my acupuncturist claimed he could cure the problem if I could have enough sessions back to back. Never got to find out.

I’ve also been treated by Osteopaths and Chiropractors although never by one specializing in RSI conditions. Again both offered relief but no cure. Seeing the chiro regularly we got it up to 6 weeks between treatments before she moved. That was, I think, the most effective treatment I have tried: possibly because it also did a lot of good for my back.

I think you are right to be wary of surgery. It’s possible there has been a breakthrough in the last few years but, when I looked into it, surgery was only recommended for cases where you were, effectively, crippled because you had to be in that bad of a condition for the risks involved and the minimal gains possible to be worth it.

Where is the chiro you were recommended located? Are they a specialist in this condition?

Also are you using an application like Anti-RSI to manage your keyboard/mouse time? When I have flare-up’s I turn it up a few notches but I always keep it running at the low-setting regardless.

Good luck finding a solution!


Simon Coles February 24, 2009 at 3:41 pm

With my RSI, I always treated surgery as a last resort on the principle that it has risks which are significant, is clearly a disruption, and may not actually help. Especially with hard-to-diagnose conditions like RSI to some extent you’re trying various treatments to see which one works – so I started with the conventional and then the alternative, and eventually found a Chiropractor who really helped.

I’m glad I didn’t do surgery or the like because it turns out, it wouldn’t have helped – and it wouldn’t have taught me how to avoid re-injuring myself (let’s face it we got these problems with our hands for a reason).

Disclaimer – my RSI is my RSI, and it will be different from anyone else’s…. the point is we all need to make our own mind up about how to treat our own specific problems…. 😉

Pascale Soleil February 24, 2009 at 5:07 pm

I had bad carpal tunnel syndrome that I successfully treated without surgery through physical therapy and ~ bear with me ~ appropriate regular doses of B-vitamin complex.

Disclaimer: I am not a vitamin kook! 🙂 But do check that your diet contains adequate supplies of B vitamins, as they are essential to nervous system health and function.

Nicola Robinsonova February 27, 2009 at 12:21 pm

One thing I found helped was minimizing the amount of mouse movement necessary when using the computer. My settings are now such that a very small movement will get the pointer to the other side of the screen.

Suw February 28, 2009 at 3:07 pm

Thanks for all the comments!!

Matt, I’ve found acupuncture to be really helpful, so if I can find a good one I’ll certainly try it, but as you implied, cost is an issue. I’m not exactly feeling rich right now so it’s going to be difficult to necessarily do as many sessions as I might need in the time frame I might need them, whether chiro or acupuncture.

I have yet to actually be able to correlate typing with attacks, and as I feel no discomfort or pain during the day it’s difficult to say that it’s specifically typing that’s doing it. I have days when I type lots and have no problems at nights, and days when I hardly type at all and have several attacks overnight.

I do know that the initial problem was caused not by typing but by making jewellery, and I suspect that now that activity has ceased, my posture is probably a bigger issue than the amount of typing I do. I’m working on that. (I’ve always had posture problems, so I’m familiar with how much damage it can do.)

Simon, I couldn’t agree with you more. I’ll go and have my problem assessed but I’m going to hold off making a decision on the surgery until I’ve tried other things.

Pascale Soleil, funnily you’re not the first person to mention vitamin B to me. I might have to get some and get Kev to remind me to take it, and see if it helps!

Nicola, I don’t use a mouse, but a trackpad, and even then I use a lot of hotkeys. I think you’re right, mice can cause problems, but I’m not sure that’s mine.

Other things to take into account are my pillow and my working arrangements. I need to get a new pillow, although the really expensive one I bought to try and combat the problem didn’t help at all and now Kev is using it. Stopped his snoring a treat! 😉 I also need to buy a proper chair and desk but that won’t happen until a) we’ve moved house in April and b) I’ve got the money.

For now, I’m focusing on:

* exercising my abdominals and back muscles to help me with better posture
* stopping myself from leaning on my elbows, and leaning on my wrists when typing
* sitting up straight
* stretching more

Even that is surprisingly hard after slipping into such bad habits over the last couple of years. Shame on me – I really should know better.

Vinay Gupta March 3, 2009 at 12:09 pm

Music physiotherpist. I had RSI about 15 years ago, really bad, and they prescribed me some exercises and very simple-seeming treatments, and I haven’t been troubled since. They have a very different approach to RSI based on, well, treating musicians for whom it is a career-ending condition.

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