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Thread: What are the current views on Carpal Tunnel Surgery?

  1. #1
    Senior Member
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    North Billerica, MA
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    Question What are the current views on Carpal Tunnel Surgery?

    I am a T-5, ASIA-B para, quite active in the maker community, an adaptive rock climber (one of two paras I know of to lead climb) and a heavy user of power tools and computers.

    I am primarily left handed, do some stuff with my right but mouse, drive my power chair, steer the car, and write etc. with my left... I am highly (stubbornly and determinedly so) independent, except where the environment prevents it (I don't do laundry because the laundry room isn't WC accessible for instance) I do all my own ADL's without assistance, etc. I don't get any sort of PCA services, and my GF would be very limited in what she could do if I wasn't able to do for myself.

    I am diagnosed with carpal tunnel in my left wrist, confirmed by EMG study. The ortho Dr. is pushing me very hard to get surgery. I'm hesitant, primarily because of concerns about 'down time' as I don't have the ability to live without transferring and so on if I can't load bear on my hands... A couple years back I had a car accident where I broke the 5th metacarpal in my left hand, which would be a relatively trivial injury for an AB, but left me stuck in a nursing home for a month...

    I'm also a bit wary when a surgeon pushes an operation, as I wonder if it isn't a case of 'If your only tool is a hammer, everything you see is a nail...."

    He did give me two cortisone shots, each seemed to work for about 3-4 months, but he says he won't give me any more as there is to much risk of the tendons or nerves breaking. I do sleep in wrist splints, but they seem to not do a lot of good, my hands are most likely to be 'asleep' when I wake up.

    He expressed very low opinion about any of the other sorts of exercises or 'lotions and potions' doing much good.

    The surgeon claims that the surgery is no big deal, and that while they would WANT me to stay off it as much as possible, that I could 'Do what you have to' although it would hurt, almost the same day...

    I've done a search on the forums here, and found SCI Nurse advice from circa 2007-8 saying that they didn't allow their patients to load bear for 6 weeks... I didn't see any useful comment from SCI-Nurse about what the current protocol is - I would hope that medical progress has been made

    I have seen some more recent mixed stories from users about the newer less invasive procedures having faster recoveries, but still some amount of down time - accounts vary....

    Is there any current info about what sort of down-time and recovery is expected for an SCI patient?

    What are the current protocols?

    What are the sort of things I should plan on?

    What sort of extra rehab / support should I be talking to the insurance company (Mass Health / aka RomneyCare / Medicaid) about that an AB patient wouldn't need?

    Are there any alternatives that have reasonably good evidence of effectiveness that I should try before giving the surgeon the go-ahead?

    Thanks,

    ex-Gooserider
    T-5 ASIA-B para, currently working on building own power chair, as being in a manual is an EXTRA handicap.

  2. #2
    You should definitely get a second opinion, and also have an evaluation by an hand therapist (usually an OT) to see if yours can be managed by exercise and learning some new hand skills that don't put as much strain on your CT. I would only have it done by an orthopedist or neurosurgeon who specializes in hand surgery as well.

    Up until I retired this last winter, we were still requiring no weight bearing through the hand/wrist involved with surgery for 6 weeks post-op; I assume it is still the same. It sounds to me like this orthopedist does not really understand how much someone with paralysis needs to weight bear on their hands.

    If you have sufficient help at home, and access to equipment such as a patient lift, power chair, etc. you can recover at home. For ABs, this is a day-surgery procedure, but they can walk out of the surgery center and only have to make a few adjustments in their ADLs afterwards, unlike someone with paralysis.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  3. #3
    Senior Member
    Join Date
    Nov 2011
    Location
    North Billerica, MA
    Posts
    173
    Thank you for the response, I'm definitely planning on seeking second opinions and the hand OT -

    I normally use a power chair when not at home (most of the time) as I find manual chairs to be a major handicap (why should I be forced to give up using my arms just because my legs don't work any more...?) but I drive with my left hand, and I don't have any of the other gear, nor room to use it, and my GF has her own limitations that make her unable to help me much.... So even though a nursing home verges on 'fate worse than death' for short term, it sounds like I'd need at least a short stay....

    The surgeon is supposed to be a good one, I'm told he is 'the hand guy' at Lahey Medical Center in Burlington which is where I get almost all of my medical care....

    ex-Gooserider
    T-5 ASIA-B para, currently working on building own power chair, as being in a manual is an EXTRA handicap.

  4. #4
    Can you move your wheelchair controls over to the other side? How do you do weight shifts? I have seen people get into trouble with their skin if unable to do a push-up type weight shift, so if you can do side-to-side or forward leans instead that should be considered. If you cannot do these types of weight shifts alone, you will need someone to help you with those techniques. Turning independently in bed can also be problematic. Driving is usually also not allowed.

    You will need to have someone (at home or in a nursing home) do a good amount of your ADLs...dressings, transfers, perhaps even bowel and bladder care if you are unable to do this one-handed without putting pressure on the operated hand at all.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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