Carpal tunnel and a Quad

[cara_m]

It was bound to happen and unfortunatelly it did. After almost four decades of being an incomplewte quad I am pretty sure I now have carpal tunnel in my right hand. Normally, I have some finger movement and great index and thumb strenght and sensation. The other fingers just enough movement to open to grab. When palm is facing ceiling I can bring wrist up with some effort. Now what has happened is that my hand has gotten tingly, numb and much weaker. Thankfully I don't have pain yet and would know it if I did. I have an appointment with the dr. tomorrow, Thursday, to have it checked out. Does anyone know how he is going to test it on me and if a nerve conduction will be accurate on a quad. Is there anything I can do to get this better other than surgery? I am concerned that my PC dr. is not going to know how to diagnose and treat me because of my sci. Any suggestions? I am so devastated that this has happened as you can understand I desperately need my hand and wrist to transfere on my board to and from my bed. PLEASE HELP!!!

[rollin64]

i had the same thing happen a few yrs ago. i was scared to death. i didn't realize how much i needed that wrist function until i lost it. i went to my neurologist. she did some type of needle prick test with a computer. luckily after about 2 wks it came back. we finally figured i must've slept on my arm wrong. :thinking:

[SCI-Nurse]

CTS is fairly common in SCI at all levels of injury except for those with very high injuries and no hand or wrist function. Of course it is important to have a good exam to make sure that this is actually CTS and not some other type of nerve compression problem. We often see nerve compression problems with the radial or ulnar nerve from leaning on elbows too much, for example. This can cause tingling and numbness in the hands in the distribution of the ulnar (pinkie and ring fingers) or radial nerves (thumb, index and middle finger).

Generally rest and NSAIDs are the first line treatment for CTS. At our center, we do not anticipate surgery unless this does not help and if there is also an abnormal EMG. EMG tests are valid in SCI just as they are in ABs as there is nothing wrong with your peripheral nerves (other than perhaps the CTS).

Night splints are strongly recommended to keep the wrist in a neutral position. Day splinting is generally not encouraged. It is helpful to see an OT who specializes in hand therapy to learn both protective techniques for your daily care and activities, as well as some excercises you can do you help prevent the CTS from getting worse.

If you are advised to have surgery, I would recommend that you only consider a hand surgeon who does a lot of these procedures, and who will work with you on a plan for your post-op recovery. Be sure to get at least 2 opinions before going under the knife. At our center, no weight bearing on the hand having the surgery is allowed for 6 weeks. This may mean you need to have a caregiver take on transfers and assistance with ADLs such as dressing (or anything else you do where you have to support your weight on the involved hand). A power chair is also recommended (with the control on the opposite side). Some people can do this at home, others may need to consider a brief nursing home stay. It is also important to continue to work with the hand OT during this time and after weight bearing is again allowed, so that it doesn't reoccur.

(KLD)