Carpaltunnel & Ulnar Nerve Symptoms
Normal EMG in CTS
Can you have a normal EMG test yet still have carpal tunnel syndrome? I have heard of something called Clinical & have heard about something else that has to do with being undetectable for some reason? Please advise. Thanks
Answer 1 :
Yes there are EMG negative Carpal Tunnel Syndrome in which the patient has the clinical signs and symptoms (check out https://www.teleemg.com/guides/cts.htm) of carpal tunnel yet have a negative EMG. But it may also not be Carpal Tunnel. A good way to find out would be to purchase carpal tunnel wrist splints and wear them mostly at night for a couple of weeks to see if symptoms improve. If they do then it is likely that it is carpal tunnel.
Answer 2 :
Sure, NCS may be normal in CTS. But such cases are uncommon or rare, also has to be mild. The problem there is no good correlation between symptoms and NCS abnormalities (if any). I can recall one patient few years ago came with symptoms of CTS. The study was "normal". However, the orthopedic surgeon did the median nerve surgery. The patient improved. The other point which should be kept in mind is presence of anomalies, that may cause confusion.
Electrodiagnostic assessment & management of CTS
I have been diagnosed with CTS and now am being sent for an EMG. I would like to know what this test is, the pain involved and whether or not a positive or negative result changes the diagnosis. I have done the splints for a long time with relief way back when but no relief now. I have had one cortisone treatment which has done nothing except relieve the nighttime pain but day to day is actually worse.
Answer 1 :
An EMG, which studies nerve conductions (by delivering electrical impulses to the nerves) and muscles (by inserting a needle probe into different muscles), is an uncomfortable procedure but a very useful and sensitive test for carpal tunnel syndrome. If your symptoms are as severe as you describe, then in all likelihood the test will be positive. If it is not, I would seriously question the diagnosis of carpal tunnel.
Answer 2 :
have had EMG testing which resulted in surgically releasing both my wrists due to CTS. The pain associated with these tests can be mild to moderate. I would suggest if possible to take a doctor prescribed pain medication one half hour before the testing is done. I am going again for further EMG tests tomorrow as I am still suffering effects of CTS even after surgery. The testing takes approximately 20 minutes to a half hour and is quite bearable. Good luck to you with your results.
Weakness and pain months after surgical release of carpal tunnel
I am experiencing medium to severe pain and weakness after having a surgical release for carpal tunnel in both wrists. My first one was done over a year ago the second was nine months ago, shouldn't the weakness and pain be gone by now? I am a secretary by trade and have to use my hands in a repetitive manner on a daily basis, I need to elevate this pain and weakness, can you help or suggest something?
When the surgery is successful (and if the problem prior to the surgery was indeed carpal tunnel and not something else), then all the symptoms, pain and weakness should disappear. Exceptions to that include such a severe carpal tunnel that surgery may not be able to restore full function to the nerve. To verify whether or not the surgery released the carpal tunnel entrapment, a repeat EMG study on both hands would be very useful.
CTS & Cervical radiculopathy
I had an EMG test last Friday because an MRI showed herniated discs in C5-6. I was still having considerable pain in my left shoulder. Since the test I have had significant pain in my left hand and arm. The test showed I have carpal tunnel syndrome and some nerve damage in the neck area. Would the test have aggravated the nerves that are associated with either of these problems?
The study does not cause any lasting damage to either nerves or muscles but you can be left with some soreness in the areas that were studied for about 24-48 hours due to local tissue irritation
A couple of questions:
1) I have at least a thousand fasciculations a day. How come during the 3 EMG's (2 partials, 1 full) no fasciculations were detected? Seems impossible.
2) Besides random fasciculations, I frequently have fasciculations right after moving a muscle. Is this more problematic than a "random" fasciculation?
3) Is it likely that twitching can occur for six months without loss of strength and still get diagnosed with ALS???
Actually it is not always surprising if the concept of EMG needle recording is understood. If the tip (or the recording pick up area) is far from fasciculating potential, then you do not see any fasciculations on the screen. For the second question, yes it is possible, and that is why a follow up EMG is usually needed. Regarding time period after onset of twitching without weakness or an abnormal EMG, it is difficult to be absolutely precise in time. But several months are usually acceptable by the time fasciculation is seen, but provided no other clinical/EMG findings.
Thoracic paraspinals EMG Specificity in ALS
I am writing you to ask if there is any other way to test for nerve damage? I have severe wrist and lower and upper arm pain in one arm. It started in my fingers then after 3 days protruded to my arm and my shoulder and now y breast is also numb. I just received a crotz shot in my wrist to supposeively help soon. To hold me until the testing next tuseday 4/4/00. I can tolerate pain but not anymore than I have now! Why must they put me through a test, which could lead to more pain to say yes you have carpal tunnel syndrome? This pain has been going straight 12 days and night without a break. Help please give me a solution. I probably won't /can't go for this test knowing it will induce further deeper pain. Please respond, you are my last straw for help. I forgot to state that this started with both hands getting numb two years ago. I would wear braces to bed at night and they would be better after 3 nights of doing this. I feel I got this when I was always using a hand grinder to grind off decks. (Carpenter work in summers) I also am a tax prep, self employed luckily my right hand which is my dominant hand can still type. I used my left hand mainly for holding the phone. So, this started over a long period of time.
From what you describe, your symptoms sound like carpal tunnel to me and the wrist splints and the cortisone injections usually help. The EMG (if you haven't had one before now) will be very helpful to diagnose your condition and therefore help your doctor develop option plans for treatment. The idea is to find out what is causing your symptoms first, and then treat appropriately.
You were right. The testing was very important. Can there be errors in the test. It showed my bad arm/wrist being negative and my good arm being positive? May be as he was looking at me. His right is my left and his left is my right. Do you know what I mean?? Well at least it showed nerve damage up in the neck area. He said the pain was probably muscle spasms. And that might be why my left side is numb and paining. Thanks again for replying to my postings.
Well errors are always possible but a neck lesion can cause bilateral symptoms. Doctors are usually very careful in noting the side they study so I would say the chances of them getting confused with sides (although not zero) are fairly small.
EMG for CTS & Spinal Stenosis vs. Hip Replacement
My mother broke her hip and her wrist in 1993. She has since been diagnosed with CTS and Spinal Stenosis. She is in quite a bit of pain and has just been referred for an EMG for the arm and the leg. Is there any reason that both could not be done on the same day? Also, will the EMG help to resolve the question of whether the stenosis or the hip is causing her pain?
Usually the EMG of the arm and leg are done in a single session. Also the EMG will be able to determine whether or not the spinal stenosis is causing nerve damage which in turn causes pain.
Curious about EMG in CTS
Hello, I'm going to take the EMG / Nerve conduction study in a couple of days for carpal tunnel. I was just curious in how big the needles are, and how far the needles are inserted. And how thick they are. I hate needles and I'm really afraid to take this test, so any information to help me prepare myself would be appreciated. Thank you so much.
In your case of carpal tunnel syndrome, the diagnosis is dependent on electrodiagnostic tests. Think that the test will help to reduce your suffering and does not hurt. One more point, needle electrode examination is not always performed in such case, depends on the symptoms and signs. The electrode (needle), in your case, is quite thin like a small pin (even thinner) and its length is about 2 cm for hand muscles and very little of the electrode is inserted. Good luck
Thanks for the reply. They are going to perform both studies, needle and just the normal nerve conduction study. But if the needle isn't that big I should be okay. But once the needle is in, does it move around inside the muscle, if so wouldn't that be a tremendous amount of pain? Thanks for any information that you give. Everything is greatly appreciated.
Thank you. Once the needle electrode is in, it does not, actually, hurt more than that, but we do move the electrode little bit inside.
I took the test today and it was pretty painful. But the doctor said that he didnt really see damage but was going to look over and calculate everything. I know I have the pain, and every symptom of carpal tunnel. So if it does come out negative, what do you think the next step will be? Is it possible for it to come out negative when it's really positive? It's just that this is a workman's comp claim and it has been on hold, and they I guess need some kind of solid proof that something is wrong. Only I know how much pain it is. But thanks again for the advise.
Normal nerve conduction results in tight carpal tunnel syndrome
What is the percentage of negative results on a positive finding? And the percentage of a positive result of a negative finding? I've gone through 5 nerve conduction tests previously, and finally was diagnosed with carpel tunnel. The neurologists said it was because of my small boned structure that gave a negative result when it was actually positive. When I received the tunnel releases, it was very tight and surgeon was surprised that it didn't show up earlier. I now have possible ulnar nerve problems, but again my conduction test shows negative. Please give me some information as why this happens.
The answer was offered in the Doctor/patient forum. Anyhow, it was "The pick up of carpal tunnel or ulnar neuropathies by nerve conductions is fairly easy so the false negatives there are very low. For pinched nerves however (root lesions) the number of false negatives is higher, sometimes up to 30 or 40%."
CTS and proximal radiation of pain
My 90-year-old father developed a problem in mid March. He woke up from a night's sleep with swollen middle fingers and pain in his upper arms that only occurred when he tried to lift them at the shoulder joint (no pain with arms at his side). He did have excruciating pain in his left hand, but that has passed (it is swollen however). He still has tremendous pain in his upper arms upon lifting movement. After two misdiagnoses at the VA Hospital, they now think he has CTS (an EMG was done) and plan on operating. Can CTS cause upper arm pain? He's slowly getting worse. Can this migrate to other parts of the body?
The presentation of your father's illness (waking up at night with the swelling you mention) is not CTS, it sounds more like a joint (arthritis) problem which I take it has now subsided. Can the swelling cause CTS, the answer is yes and CTS does give symptoms in the arm and occasionally the shoulder but does not present itself in this manner. If the CTS is severe, then surgery is needed but if it is mild to moderate, you can get away with conservative treatment for a while at least.
He still has swelling, mostly in his left hand and arm. And both hands have lost considerable flexibility (he can't make a fist nor extend the fingers). But his biggest problem is the tremendous pain that occurs in his upper arms when he lifts them (no pain at rest).
would like to say that CTS is common in patients with arthritis. You said that he is planned for surgery; this should help to relieve at least some of his symptoms. All the best.
Carpal tunnel surgery complications?
I was diagnosed with bilateral carpal tunnel and "trigger thumb" and had surgery on right hand for the CT and TThumb on 1/3/01. I thought I would wait a few weeks and then have the carpal tunnel surgery on the left hand with the hopes I would be as good as new. However, I am in worse shape now than I was before I had the surgery on my right hand, and I don't dare have the other surgery because I am afraid it will turn out like this one. I am in more pain now than I was before I had the surgery. The pain is mostly in the wrist are and radiates up the arm almost to the elbow. My thumb is practically useless as I have very limited movement and cannot open doors, jars, or write. I could do all these things before the surgery. I have less strength in my hand than before. I have to change the gear shift in my car with my left hand and it is painful holding onto the steering wheel. I can barely hold my coffee cup. The pain is so bad at night that it wakes me up and I could cry. Needless to say, I am very depressed over my condition. I am going back to my surgeon this week and would like some advice on any tests I might request to see what is wrong. I have also developed a lump at the base of my thumb at the wrist area and a larger area on my arm right above the wrist. I talked with other people who have had this surgery and no one has had the problems I am having. So you can see why I can't risk having the CT surgery on the left hand at this time. Has anybody ever heard of anything like this before?
I can really understand and share with you the pain. It is not however, clear to me the exact cause. But the surgeon who did the operation should be able to tell you more about it. Perhaps repeat EMG to assess the position of the median nerve post operative would help. I hope you get better soon.
Possible double crush to ulnar nerve
Two years ago this May 17th 2001. I was rear ended by a drunk driver to make a long story short I have had a long recovery and am still going threw treatment, My question: After the accident and to date I've had neck pain and numbness in my little and ring fingers. I had very severe pain in my neck so bad that just riding in a car was like having no shocks, feeling jolts to my neck even gravel seamed like boulders, and I would get pains in my collar bone as if it was broken. I went in and had Ulnar nerve surgery to help the numbness in my arm and fingers and in this area has helped, the perplexing thing is as I awoke in the recovery room I noticed a great improvement in my neck pain? and the pain in my collar bone has not returned, this is all on my left side. I have been told that the Ulnar nerve should not effect the neck in this way, but, I know the relief I have gotten to the neck area since! I still have damage at the C6,7, and T1 nerve areas. that I am going threw injections for at present but since the operation have been able to drive fairly well though turning of my neck becomes more painful the longer I do. A friend of mine who has some knowledge in this area has suggested a "double pinch" of the ulnar nerve that she had heard of? But I've been unable to find any information in this area of question. Are there any answers? There must be? Is there any information I can be directed to? I thank you sincerely for any help in this area.
The Double-Crush syndrome is well known and has been described by Upton and McComas in their landmark paper in 1973
TITLE: The double crush in nerve entrapment syndromes.
AUTHORS: Upton AR, McComas AJ
SOURCE: Lancet. 1973 Aug 18;2(7825):359-62
The basic premise is that when a nerve is injured proximally (or in this case close to the neck), it makes it more susceptible to injury distally (away from the neck).
What exactly happens to give pins and needles sensation?
When you experience the sensation of "pins and needles" what exactly is taking place? Is it a result of the healing process of the nerve or is it a result of damage to the nerve. I know when your foot is "asleep", the pins and needles come after the numbness but before normalcy, as your foot recovers......so I am wondering if the sensation might indicate a reactivation of proper nerve impulses? I'm experiencing pins and needles in association with lyme disease and am wondering if this could be the reawakening of my damaged nerves and thus a good thing.....or does it result as my nerves are damaged, and thus a bad thing? Thanks. Ruth.
This is quite interesting question. Any or all of the sensory symptoms (pins and needles) and signs are considered diagnostic for a dysfunctional sensory nervous system or point that some thing going on with sensory nervous system. It could either occur at start or later in the process of nerve affection. Although pins and needles may get less with recovery. But does not basically or necessarily be a bad sign.
Time lag before detection of positive sharp waves
In your quite lucid explanation you make mention that fibrillations cannot be picked up until about 2 months after injury. I was wondering how long a lag exists till the EMG can pick up positive sharp waves. Also, I've seen differing opinions as to whether patients can actually feel the fibrillations and the waves themselves. What is your opinion on this? Thanks very much.
Fibs and positive waves are seen at about the same time. In fact it's been argued that fibs are positive waves, which are seen from a different vantage point by the needle. People cannot feel either fibs or positive waves, what you are referring to is fasciculations, which are much larger contractions of muscle, and which patients can usually feel.
I have Left elbow pain. Is it necessary to have EMG?
Do I really need this test? I have been treating what the doc thought was tennis elbow. But the cortisone shot I had didn't help that much. So he wants an EMG. I don't want it if it is not necessary! I have always had left neck and upper arm pain (I have Fibromyalgia and injuries from years ago) The main pain is in the elbow area and runs down the arm...It is different form my usual pain. Hurts to use the arm and hand...gripping and pulling mainly! Any advice out there? Sometimes the hand gets cold and tingles and turns bluish too. I still think it is a joint problem.
You are right. It sounds like a joint problem. However, only tingling suggests nerve problem. Therefore, EMG may be of help.
Thanks for the quick response. I am concerned that with the Fibro pain I already have that the test will make my pain worse so if I don't need it I don't want it. The arm is also sensitive to touch. Like skin surface pain...all this seems to lesson when I don't use it. That tells me it is a joint problem but the doc said since the marcaine took the pain away for 3 hours it could be nerve pain??????????? Any input here? It is set up for next Tuesday in the doctor's office. (A neurologist) Wouldn't the marcaine take any pain away????????
Marcaine should work as local or regional anesthesia and analgesia for pain of any kind, as you said. However, The EMG study should not worsen your pain, although it does cause little pain by itself, which is quite tolerable. EMG is a diagnostic test only.
Rate of false negative and false positive results of electrodiagnosis in CTS
What is the percentage of negative results on a positive finding? Also, what is the percentage of a positive result of a negative finding? I've gone through 5 nerve conduction tests previously, and finally was diagnosed with carpel tunnel. The neurologists said it was because of my small boned structure that gave a negative result when it was actually positive. When I received the tunnel releases, it was very tight and surgeon was surprised that it didn't show up earlier. I now have possible ulnar nerve problems, but again my conduction test shows negative. Please give me some information as why this happens.
The pick up of carpal tunnel or ulnar neuropathies by nerve conductions is fairly easy so the false negatives there are very low. For pinched nerves however (root lesions) the number of false negatives is higher, sometimes up to 30 or 40%.
Ulnar nerve entrapment
One month ago I had an EMG on my left arm. The results indicated an ulnar nerve entrapment, and recommended elbow surgery. I had continual pain in my arm and hand before the EMG. The pain greatly increased immediately after the test, and has persisted continuously to date. I understand this is not normal. What could be the cause? Has anyone had a similar experience?
Thanks for your help
The nerve stimulation itself does not cause any lasting damage and usually the pain and discomfort resolve within 24 hours. In some instances however, nerve irritation during the test can cause an inflammation around it, especially if the nerve is already irritated because of the damage to it. In those instances, anti-inflammatory such as Aspirin or Motrin might help by reducing the inflammation. If they don't something else is going in and it is best to seek a consultation for that.
I would suggest caution on this one. I had numbness/tingling symptoms and a specialist (with good recommendations) diagnosed Ulnar Nerve problems. I had a release & transposition on one elbow and a year or so later on the second. It turns out that more than likely the source of the problem was c4-5-6 problems, not the nerve. I did have an EMG to rule out the neck but my guess is the results were inconclusive or false. This syndrome (from my research) is not that common. Feel free to mail me for more specifics
EMG in CTS and double crush syndrome
Hi, I have had an EMG results show carpal tunnel. I also have cervical radiculopathy from disc bulge and spurs impinging on nerve at C5-6 and C6-7.My neurologist does not believe in the "double crush" theory and states that even if he did, I did not have impingement of the C7 nerve. He obviously did not even look at my MRI report, which clearly states this. He also said that because he tested my median nerve at the wrist and it showed compression this proved only Ct. This is not my understanding of the process. My question is; if it were indeed double crush would the testing of the wrist median nerve still show entrapment? Thank you very much
Answer 1 :
I would say that neurologists are evenly split on the existence (or lack thereof) of the double-crush syndrome. Let me quickly explain it. The double-crush theory says that if your nerve is compromised proximally (up high near the neck) it is more likely than not to be also damaged distally (below near the hand), meaning that the existence of a proximal lesion makes the nerve more susceptible to damage distally. So in answer to your question, if you are a double-crush believer, the testing of the median nerve at the wrist will show entrapment.
Answer 2 :
The concept of double crush syndrome is known for many years. I think from seventies. It means, there are 2 lesions along one nerve course, i.e. patients with one peripheral nerve lesion did in fact have a second lesion elsewhere and they implied that both lesions were contributing to the symptoms or on another way, somewhat include symptoms which result from a combination of two separate, local lesions at different anatomical sites in the same nerve, whether or not one actually contributes to the causation of the other. Practically, a patient may have carpal tunnel syndrome (distal) and another lesion (proximal) of plexus/root in addition. So, yes, EMG could show a carpal tunnel syndrome (to answer your question), which is fairly easy to diagnose by such method.
CTS and EMG questions
I recently had and EMG done and was referred to an orthopedic surgeon for surgery on both wrists. While having both parts of the EMG done, the doctor tried to explain what he was seeing to me. I guess what I am not clear about is how bad this is. I mean, I know it's bad because he insists on surgery and the pain; numbness and burning are more than I can handle... He mentioned that when he did the shock down by my wrist that it was a " 2 " and a " 6 " up by my elbow on my right arm. And " 1 " and " 8 " on my left arm. What does this all mean? Can you refer me to any pages to help me understand this more? What are bad results?? Semi bad??? What can you get by on without having surgery?
Me too, I am not familiar with these numbers, perhaps further information would help. Generally, a "bad" CTS depends on the clinical picture and EMG findings. However, the presence of muscle wasting and/or abnormal EMG spontaneous discharges are bad signs. It is important to follow the advice of the surgeon, as without surgery the symptoms would persist. The wasting or atrophy will develop, if it is not yet happened. At advanced stage the surgery would not actually help to recover the nerve, but it would anyway save what is left.
Puncture to nerve in inner elbow area
I was in for a routine physical on March 29th. And upon a blood draw I experienced intense pain shooting to my left hand. I thought right away it was my nerve. The lady that took the blood said she had never experienced that either. I have been seeing an intern and he had his dad who semi-retired and is a neurologist do a nerve conduction test last Wednesday. The test came out negative. I have numbness in my hand and fingers I have had what my therapist call a lot of trigger points in all areas of my lower and upper arm all the way to my underarm. I have been going to therapy for three weeks being treated with heat and electro therapy. Should I be as concerned as I'm on Vioxx for the inflammation if I don't take it by the end of the day my arm is clinched so close to my side because my whole arm hurts. Is there another test I should have done? Should I continue the therapy and give it time? Would an MRI tell me what is going on in there, could she have got a tendon also? I thought I should give you all of my symptoms. It started with tingling in my hand and fingers shortly after it happened. The tingling started spreading up my arm and I started getting increased discomfort in my elbow area. Within 5 day's the muscles in my arm started hurting. Today my fingers are numb and are very sore and stiff. My muscles in my underarm hurt a great deal as well as my forearm and bicep. The discomfort in my arm changes spots. The pain in my fingers is consistent I'm sorry to post twice before a response but I just found this forum and I have been searching for answers to insure I am getting the right treatment. I have never had something like this. It's been a month. I have been told it takes a long time for nerves to heal. I guess I just want to know how long, and is it my nerve. Will an MRI show what it is or would you recommend an EMG? Thanks so much, I'm scared! Thank you for any advises you can give me.
According to your symptoms, it seems like a nerve lesion by injury or pressure, probably the median nerve was injured during needle puncture. I wonder did you have an EMG needle examination of the muscles or just nerve conduction studies. If it is so, then I think you need to see your neurologist again to do (or repeat) EMG needle examination of the muscles, which should be helpful to exclude nerve lesion and its degree. I think the EMG is more helpful in your case than MRI.
I went to a Neurologist yesterday and was diagnosed with a median nerve lesion. I have been treated for 6 weeks for ulnar neuropathy. Lots of therapy and taking Vioxx but I still had a lot of pain. You suggested I see a neurologist and get an EMG. I found a sharp Dr. and the Dr. agreed he will be doing the test on the 22 of May.
My question is He gave me a prescription for Neurontin, I was wondering if it will interfere with the test in any way.
I am very thankful for this forum and for all your help. I will keep you posted. I still have a great deal of pain in my whole arm and I hope the Neurontin will help.
Hello Dr., I have appreciated all of your advise in the past.
I went to the Neurologist Wednesday he does believe I have a Median Nerve lesion. He did a nerve conduction test and told me it did not show any concerns of permanent nerve damage or motor skill damage. He has me on Neurontin, I am up to 4x/300mg per day. I was told He does believe I have pain and that the nerve will take time to heal. I was very relieved to hear that and left his office feeling good, then when I got home I started thinking why did nothing show up when I have so much pain.
The pain is mostly in my finger index, middle, and ring finger. If I wait to long before I take the medicine I have a lot of discomfort in my elbow and lower arm.
The Doctor said, "be patient". Those nerves heal an inch a Month
I called the office back today and asked if he would send me for an MRI and he had the nurse tell me he would not OK it. I was hoping I would have someone tell me exactly what is happening in there.
Should I just give it time he wants me back in 2 Months.
Thank you in advance,
Thank you. I am pleased that you feel better. All the best
I have post several times in the past and you have been very helpful. I currently am healing I hope from a puncture during a blood draw. I am concerned and have asked my Doctor about a tingling in my cheek that started shortly after the injury. It is not always there and changes to different areas of my left cheek. The elbow that was injured is my left elbow. It has been 5 months.
Is this something that can happen when you have an injury of this kind?
I have the physical therapist tell me everything is connected and as long as I take the Neurontin I am on regularly it is not as noticeable.
I cannot see a relationship between the problem at the elbow and the tingling in your cheek. I am not sure why do you have cheek tingling. It seems coincidental.
I got my injury to my nerve back at the end of March (blood draw, elbow). I have had a lot of different stages of healing, and strange feelings at different times. I get jabs and pains in my fingers but I also get jabs and pains in my toes. Do you think this is all a normal part of healing? I had an EMG in May and I was told it did not show any sign of Permanente damage.
Should I have another test done? I am on Neurontin 600 mgs three times a day. I get these pains if I go to long between doses.
Should I get another EMG?
Is this normal?
Should I see another Doctor?
I can understand the pain in the fingers but not the pains in the toes. Therefore, it would be good idea to consult another doctor before you proceed to another EMG.
I have posted before and you have given me good advice. I the best advise you gave me was to see another Doctor. I did and was given diagnoses of Venipuncture RSD, are you at all familiar with this? I am hoping I have not waited to long to get the right Doctor. I have had two visits with Dr. who is in Florida and he has treated RSD in patients for 30 years. I feel I am getting the proper treatment although he has said that my type of RSD is the most vicious type to have. He has me on 4 medications and I am in Physical therapy and I am using a heat pad and feel somewhat better. I have stopped taking the Neurontin that was making me very tired all the time and that caused me to gain 20 lbs. in 8 months. I have a very scary health problem that might be with me for life.
had told you and you asked me to keep you posted so I am doing that. I hope that if there are other patients out there that don't feel the Doctor understands their pain that they get other help and with someone that knows about RSD.
Curious about electrodiagnostic study for CTS
Hello, I'm going to take the EMG / Nerve conduction study in a couple of days for carpal tunnel. I was just curious in how big the needles are, and how far the needles are inserted. And how thick they are. I hate needles and I'm really afraid to take this test, so any information to help me prepare myself would be appreciated. Thank you so much.
In your case of carpal tunnel syndrome, the diagnosis is dependent on electrodiagnostic tests. Think that the test will help to reduce your suffering and does not hurt. One more point, needle electrode examination is not always performed in such case, depends on the symptoms and signs. The electrode (needle), in your case, is quite thin like a small pin (even thinner) and its length is about 2 cm for hand muscles and very little of the electrode is inserted. Good luck.
Thanks for the reply. And they are going to do both studies, needle and just the normal nerve conduction study. But if the needle isn't that big I should be okay. But once the needle is in, does it move around inside the muscle, if so wouldn't that be a tremendous amount of pain? Thanks for any information that you give. Everything is greatly appreciated.
Thank you. Once the needle electrode is in, it does not, actually, hurt more than that, but we do move the electrode little bit inside.
I took the test today and it was pretty painful. But the doctor said that he didn't really see damage but was going to look over and calculate everything. I know I have the pain, and every symptom of carpal tunnel. So if it does come out negative, what do you think the next step will be? Is it possible for it to come out negative when it's really positive? It's just that this is a workman's comp claim and it's been on hold, and they I guess need some kind of solid proof that something is wrong. Only I know how much pain it is. But thanks again for the advise.
Tingling and numbness in both hands, is EMG important?
I have recently had tingling and numbness in both of my hands. It gets extremely painful at night. I woke up one morning and my left hand was totally numb and it took over an hour for feeling to return. Blood tests that I have had in the past (unrelated to this) have had some form of indication of possible lupus or other disease as the doctors ask to do another test that will rule out these things. When the tests are run, the results are OK. I am being scheduled for an EMG for the hands and the information in your forum has been very helpful in knowing what that is all about. I'm just wondering if these blood tests are telling us something and we're just missing what it is? There is also extreme cramping in the hands and feet. Thanking you in advance for any reply.
I believe that your doctor is working in the right direction to reach a diagnosis. The EMG study, however, should be very valuable to rule out any nerve entrapment at the wrist (carpal tunnel syndrome), as your symptoms do really suggest that.
Prognosis of severe Carpal Tunnel Syndrome & repetitive motion syndromes
I had bilateral Carpal Tunnel Syndrome surgery, and a right DeQuervain's syndrome surgery with a ganglion cyst removed at the right carpal tunnel region back in April 1994. My right hand has not been the same since. My Left hand recovered fine. For the past few years, it has been getting progressively worse. I recently talked to my doctor about the problem, and she sent me to have another EMG. Conclusions were 1. Mild to moderate delay of right median motor and sensory latency consistent with right Carpal Tunnel Syndrome. 2. Chronic denervation and giant fasciculation suggestive of injury or continued irritation of right distal median at the wrist of the branch to thenar muscles. The problem I'm having is in my thumb pad and my ability to grip, hold and open things. I am having really painful muscle fasciculation in my thumb pad. At times, my right hand and fingers start having really painful charlie horse symptoms - cramps - sudden tightening of the muscle involuntary twisting movements, and uncontrollable hand motions. Any reason I may be having this? What are my chances that surgery will help? Please give me some advice. This is really affecting my life.
DEQUERVAIN'S SYNDROME is an inflammation of tendons that control movement of your thumb, caused by repetitive actions where the thumb is required to move up and down, such using a computer keyboard. It leads to pain and swelling along the thumb side. Rest and cold therapy (to reduce swelling initially) can help, as well as splints. Your symptoms sound like a combination of the DEQUERVAIN'S SYNDROME and CTS. The splint can, anyhow, help both. However, regarding the surgery, you may benefit, but it is the decision of your doctor or the surgeon.
Thank you for helping me understand what my symptoms mean. I had a EMG/NCS (Needle)(Nerve Conduction Study) last week, and I did go see a surgeon, and they want me to have surgery again, but I am hesitant. I went through a lot back in 1994, and had to give up a good job because of all this. I worked in a factory as a machine packer, packing 300 sweet-tarts per minute, and picking up / gripping (using my index finger and thumb) each box putting them on the conveyer belt. I developed DeQuervain's syndrome, CTS, and a massive ganglion cyst due to this repetitive work. My doctor diagnosed me with repetition motion syndrome. I stayed off work for 6 years due to this injury.
I figured I would try and find a job this past year, and work part time. I wanted to gradually get back to work, and get use to using my hands again. The job I took was just part time 4 hours a day doing light data entry. That is when I started noticing my right hand having really painful muscle fasciculations in my thumb pad. At times, my right hand and fingers started having really painful charlie horse symptoms - cramps - sudden tightening of the muscle involuntary twisting movements, and uncontrollable hand motions. One other thing that started was my hand would get so cold, and lose all of it's feeling, where I couldn't even feel my hand. Like it was dead. The rest of my arm past my wrist was normal temperature. This has been getting progressively worse over the past year. You can feel my left hand and it is normal temperature warm, and my right hand is ice cold. I also find it very hard to write, and after holding a pencil or pen for very long, my hand starts having painful cramps and gets ice cold and becomes lifeless. I find it challenging to drive a car, open doors, pick up my grand daughter and a lot other daily activities are almost impossible.
May be all these new problems are because I've tried to go back to work, and my hand isn't use do this type of use. My concerns are: do I keep trying to work? I don't want sound over concerned about all this but my doctor back in 1994 told me he thought I might have waited too long in seeking advice and it may have caused permanent damage. After the testing last week my doctor said my muscles at the base of the thumb are starting atrophy and some of my sensation is permanently lost. All this is so discouraging and frustrating! Why is this happening? Am I going to loose total use of my right hand? Why do more problems keep arising?
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As you said, you have long standing problem causing your symptoms. However, the idea of the surgery in your case to salvage as much as possible what is remaining of the median nerve. The surgery should also stop the pain. But the return of sensation after surgery takes quite long time to recover, if any, all depends on the degree of damage prior to surgery. That is, I believe, why your doctor is after doing the surgery for CTS again. You may go to work but in very gradual fashion afterwards.
CTS and Thoracic outlet syndrome?
I am concerned that my CTS might indeed be TSO, I have heard they can be confused, would an EMG be a tool to arrive at a definitive distinction? If not in your opinion what would be a useful diagnostic tool?
Thank you. Careful history, symptoms and signs can often differentiate between them. Also, the electromyographer can quite easily tell between CTS or thoracic outlet syndrome (TOS) by nerve conduction tests and EMG. It is the best diagnostic tool to diagnose either. However, you may need other investigations (radiology) to see if there is extra rib (cervical rib) that could be the cause of TOS. Practically, CTS is very very common while TOS is very rare.
Elbow brace wearing in ulnar entrapment
I just had an EMG and the Doctor told me that I had a severe pinching of the ulnar nerve. I have had numbness in two fingers since Christmas. Having difficulty picking things up and typing. He suggested I wear an elbow brace for one month and see him again. My question is what are the chances that a brace will work? Has it worked for anyone? Won't I be able to tell if it is working by the feeling in my fingers? If the brace does not work and surgery is required, how long is recuperation? We are going to Scotland to golf in April and I sure would like to be healed by then. Thanks for any information.
EMG result should be taken into consideration, among other factors, before we could say anything about recovery time or surgery. However, in general if the ulnar nerve compression is mild then you would feel that brace works perhaps in a week or two by having less or disappearance of numbness. But if the lesion is severe, it takes longer time, months (variable according to severity), or it might not work then it is the decision of the surgeon.
Partial hand sensory loss after fractured 5th metacarpal
My son was in an MVA fracturing the base of his fifth metacarpal on his dominant hand. Sensory deprivation in ulnar nerve distribution of right dominant hand below the wrist. Protective sensation absent, although NCV and EMG findings report nerve is healed. He is now having difficulty with 4th and 5th digital adduction and MP flexion with IP extension. If the EMGs and NCVs are normal what would be an explanation for his sensory loss and progressive motor loss? an aneurysm?
I am not too sure whether the problem is in the ulnar nerve or digit bones. I am inclined from your description to say that it is NOT the ulnar nerve, as its study is normal. But to explain the sensory loss, it may be due to very distal lesion of digital sensory nerves that could be missed by standard studies.
Thanks for your prompt reply; What test other than standard EMG/NCV would be appropriate?
I would not have other tests or to suggest any. Just a careful neurological examination of the power and sensation should be very helpful to rule in/out any sensory loss or motor weakness.
Really painful muscle fasciculation in my thumb pad involuntary twisting & CTS
I had a EMG/NCS (Needle)(Nerve Conduction Study) in Jan, and I did go see a surgeon, and they want me to have surgery again, but I am hesitant. I went through a lot back in 1994, and had to give up a good job because of all this. I had bilateral Carpal Tunnel Syndrome surgery, and a right DeQuervains syndrome surgery with a ganglion cyst removed at the right carpal tunnel region back in April 1994. My right hand has not been the same since. My Left hand recovered fine. For the past few years, it has been getting progressively worse. I worked in a factory as a machine packer, packing 300 sweet-tarts per minute, and picking up / gripping (using my index finger and thumb) each box putting them on the conveyer belt. I developed DeQuervains syndrome, CTS, and a massive ganglion cyst due to this repetitive work. My doctor diagnosed me with repetition motion syndrome. I stayed off work for 6 years due to this injury. I figured I would try and find a job this past year, and work part time. I wanted to gradually get back to work, and get use to using my hands again. The job I took was just part time 4 hours a day doing light data entry. That is when I started noticing my right thumb having really painful muscle fasciculations in my thumb pad. At times, my right hand and fingers started having really painful charlie horse symptoms - thumb cramps - sudden tightening of the thumb muscle involuntary twisting movements, and uncontrollable thumb motions. I find it challenging to drive a car, open doors, pick up my grand daughter and a lot other daily activities are almost impossible. I recently talked to my doctor about the problem, and she sent me to have another EMG. Conclusions were 1. Mild to moderate delay of right median motor and sensory latency consistent with right Carpal Tunnel Syndrome. 2. Chronic denervation and giant fasciculation suggestive of injury or continued irritation of right distal median at the wrist of the branch to thenar muscles. The problem I'm having is in my thumb pad and my ability to grip, hold and open things. I am having really painful muscle fasciculation in my thumb pad. At times, my right thumb pad starts having really painful charlie horse symptoms -thumb cramps - sudden tightening of the thumb pad muscle involuntary twisting movements, and uncontrollable motions of my thumb. Any reason I may be having this? I did have another Carpal Tunnel Syndrome surgery, on Feb 13, 2001. I know I should not expect too much this soon, but I called my doctor because my thumb pad is still twitching and jumping around and having thumb cramps. He is telling me I have a rare condition and he is not sure how to diagnose my condition. He wants to send me to another Neurologist. I do feel my Carpal Tunnel Syndrome will be better with the surgery I had. He said I had a lot of scar tissue, and that was probably my problem, but my thumb pad is still painfully twitching and jumping around. I just wish I could find out what is wrong with the twitching and cramps in my thumb.
It seems like you need to wait for possibly few more weeks to see some improvement because your condition is chronic. Now, if your surgeon is also suggesting a neurologist, then go ahead and see him.
EMG for Elbow and failed Carpal Tunnel
Please explain which areas of the limb are tested for these problems, I need to be prepared.
Presumably by failed Carpal Tunnel, you mean a failed Carpal Tunnel release (surgery). The carpal tunnel is located at the wrist, so if your doctor is planning an EMG for the elbow area, he must be looking into other causes for your pain/numbness. Typically an EMG for any arm/neck problems would involve shocks (nerve conduction studies) in the lower half of your arm, and needle examination (no shocks, but a "microphone" type needle to "listen" to electrical activity present in muscles) of the arm and possibly neck muscles. Discomfort felt during an EMG is quite dependant on the individual. Each exam is different for each patient. Skill of the technician or physician administering the test can also have a great deal to do with the degree of discomfort.
Lost distal UL sensations with normal electrodiagnostic studies
My husband had an injury which left his right hand from the elbow down with no feelings and cannot use it. The Drs. have no idea what it is, all tests came back negative. It has been 6 months now and we are very frustrated. We just got back an EMG report which states all is normal except for a decreased interference pattern in the first dorsal int. muscle and a motor unit interference pattern with a normal firing rate in the right abductor pol. brevis muscle. Does this mean anything?
EMG result would rule out "significant" nerve or muscle lesion that explain absence of sensation of the right arm. However, the reduced interference pattern is not specific and may be explained by weakness, pain or poor cooperation by patient. The weakness can be due to peripheral (nerve or muscle diseases) or a central lesion. The peripheral lesion seems to be out, supported by normal EMG (apart from reduced interference pattern). But it is not clear if the central lesion is excluded or not. This of course would need careful neurological consultation and appropriate radiological tests.
Thank you so much for your reply, could you possibly recommend what tests he should have so far he had an cervical MRI, MRI of the upper and right arm (they originally thought a brachial plexus injury) a cat scan without contrast of the brain and will be having a MRI of the brain soon. He had a neurological exam, which was unremarkable except for loss of sensation in his arm, decreased sensation in his left leg and serve back pain. The neurosurgeon released him since there was nothing for him to fix. We are very frustrated with trying to find out what this is. Thanks for your time and reply.
The sympathetic nervous system may have an abnormal function after an injury or trauma for unclear reasons. All investigations are normal. I must emphasize that is difficult for me to say that it is reflex sympathetic dystrophy, but because no clear diagnosis was made and some features may suggest it. Therefore, your treating physician must see, assess and document both history and, if present, clinical findings, in order to support the diagnosis, as he is looking at the patient himself in better position.
Thank you, we will look into that.
EMG rules out Ulnar Groove entrapment?
I recently had a EMG, ordered by my PCP, to rule out causes of a peculiar 'cold' feeling on the pinky side of my right hand. No pain, no tingling, no weakness, no apparent loss of sensation. The neuro did what I thought was a pretty exhaustive study of sensory and motor conductions all up and down both arms. She did needle exams in several places: deltoid, biceps, pronater teres, triceps, oppenens pollicis, dorsal interosseous, flexor carpi ulnaris and cervical paraspinals. The EMG came back 'fairly' clean. There was minimal slowing of ulnar sensory conductions across the right wrist, no motor slowing. The needle test was clean with two exceptions....
1) The Neuro stuck my right dorsal interosseous once and got some insertion activity, 1+ on both pos waves and fibs. She stuck it several more times and was not able to reproduce the effect. On each of the several re-tries, it was clean. She theorized she may have hit a nerve end plate the first time, causing the insertion activity.
2) Left side cervical paraspinals/posterior rami showed +/- insertion activity +/- pos waves and +/- fibs. Right side was clean. She attributed this to a possible old nerve irritations, or possible mild lower cervical radiculopathy w/o any affect on the upper extremity muscles. My PCP seemed pretty unconcerned about this EMG/NCV result. In large part, I guess so am I? I have had clean needle exams on lower extremities in the past, except for mild irritation in the bottoms of feet, which I understand is quit common. However the insertion activity on the left paraspinal does bother me. I have been diagnosed with Benign Fasciculation Syndrome in the past.
A few questions;
1) What is cervical radiculopathy?
2) What, if anything, would you recommend I do to follow up on that finding?
3) Is it common to find minor abnormalities in otherwise healthy 48 yr old males?
1. Cervical radiculopathy is pinching of nerve close to spinal cord, after its exit from spinal cord. It is called nerve root. It is commonly caused by spondylosis or protruding disc.
2. Regular physio/exercises.
3. This is hard question, but in careful way, "yes" possible in the feet, as in your case (in selected muscles), and "no" for the changes in your arm. However, the management depends on how much symptoms and signs are there. Thank you.
Regarding title question. Yes EMG is used to exclude ulnar nerve entrapment at elbow.
I wonder if those paraspinal insertion noises could be a result of my recent training for a 300-mile Appalachian Trail Backpacking trip. I've been carrying a backpack weighing around 50 lbs. I have no other symptoms of a spinal problem. I am quite active, physically.... swimming, running, hiking, setups, pushups, etc.... I also carry my golf clubs over my back around 12 miles/week.
oh well, as long as it's not indicative or some serious MND and I feel fine, I'm inclined to ignore it.
still trying to get a clearer indication on what I should do regarding the 'old nerve irritations' or 'mild cervical radiculopathy' on my left side paraspinals. As I've noted, I have no symptoms of any spinal problem, with the possible exception of occasional lower back pain, for which I already do a 'set' of exercises.
You indicate a set of 'physio/exercise'. I'm very active anyways.
- Can you be more specific re: exercise?
- What other possible causes, if not radiculopathy, spring to mind?
Thanks for your reply and this wonderful web site,
Well, I cannot be more specific, sorry, the exercise, its quality usually recommended by physiotherapist. The other causes, such as trauma, fractures, tumors. Of course radiological investigation would show that.
Ulnar nerve entrapment operated
I have been experiencing numb, cold, muscle loss and pain in my right hand for years. I have had 4 EMG, XRAYS, MRI SCAN BLOOD TESTS, seen numerous Specialists. It has been over a year ago since I had an operation on my ulnar nerve to release it??? Since then the pain has progressively increased and on my last two EMG they have found that I have it in my left arm. Please can anybody offer any advice, I am only 22 and trying to study photography which is proving impossible. I would really like to talk with someone who has or is going through a similar situation as I am finding dealing with my life very hard.
Ulnar nerve entrapment at elbow can cause weakness and muscle loss in the hand. Try to avoid leaning on your elbows. Keep them straightened particularly during sleep. Finally, I would recommend consulting a neurologist to make sure nothing else is wrong, if you have not seen one yet.
Thank you very much for such a quick response; I have received an appointment to see a neurologist next week. If I have the problem in both my arms could it occur in my legs? I have not that I can remember, knocked or damaged both my elbows to cause the entrapment of the nerves. If there is anybody who has or is going through a similar situation please leave a message. Thank you
Not necessarily so, I mean you may not get anything in the legs. However, it depends whether there is underlying disease. As a matter of fact, that is why I advised a neurological consultation. Please keep us updated after seeing the neurologist. All the best.
Hi: I had both elbows done (ulnar nerve release, decompression & transposition) and a couple of years later the problems got worse. Both hands and feet. Part of the problem turned out to be cervical disc problems. I had 3 level fusion and most of the problems seemed to go away but there still seemed to be nerve problems. The nerves may never regenerate I am told and to add to all this, they say I have a polyneuropathy, probably attributed to diabetes. I guess the point of this note is that it can be a very complex problem with symptoms & findings masking other underlying causes. Good luck, feel free to email and ask any questions
Curious about EMG testing in CTS
My Doctor wants me to have an EMG test. I have carpal tunnel syndrome in both hands. I've heard it's very painful and many times not 100% accurate. Is the test very painful? and how accurate are they? Is there a surface test that can be done that's less painful and just as accurate? Please answer my questions as this test just around the corner for me, and I'm scared. Thank You
The study is divided into 2 parts; the nerve conduction studies, NCS, (surface test, no needle), where there is little electric shocks to study the nerves. The other part consists of inserting electrode (needle) in the muscle, little distance and it would induce little discomfort and pain. This pain is quite variable between individuals, but in vast majority both tests are tolerable and no squeal. It is important to do in patients with carpal tunnel syndrome (CTS). It is highly sensitive and accurate in CTS. I would, personally, say more than 90% (scientifically difficult to say 100%). Now, it is up to the examiner to perform both tests or would get away with the nerve conduction without the needle part. Actually, not every patient with CTS needs the needle part. It depends mainly on the patient's symptoms and signs, and obviously, on the obtained results of NCS, as well.
EMG Results with ulnar neuropathy in Guyon's canal
I was involved in a motor vehicle accident in Dec. of 2000, and have had pain at the right wrist and hand ever since. Surgery was suggested after a EMG was done. I decided to wait to see if it would get any better without surgery. The results of the EMG were mild to moderate, acute and chronic, ulnar neuropathy at the wrist on the right. The lesions are most likely a Guyon's type 1 at the proximal wrist on the right. I am still having some pain in that area, and wonder after six months if I should expect to see any more improvement without surgery. Will this be a chronic problem or will it continue to improve over time?
What usually happens after a traumatic nerve lesion is that the surgeon would wait for several months before embarking or deciding for surgery. I am not expecting further improvement following this kind of lesion after 6 months. However, see your doctor to discuss this further.
Numb hand - please help!
I have one numb left hand. I guess I should start at the beginning... I am 52, and in relatively good health. I am a budget analyst, where I do moderate computer work, and bartend about 8 hours per week. About four years ago, I experienced numbness in both my feet and hands. Within a few weeks, the numbness in all extremities except the left hand disappeared. However, the left hand numbness bothered me a lot, especially because I'm left-handed. I saw a neurologist who could not diagnose it specifically. He did nerve conduction tests over the next few weeks. Many of them. He never did narrow down the cause, except to say that he suspected the ulnar nerve. He determined that I have no loss of strength. I just can't feel my hand. But that was it. No treatment was suggested. He pretty much said to learn to live with it. The numbness subsided (but never disappeared) over the years, and I therefore got used to it. (There is no pain associated with it.) Suddenly, however, the numbness came back with a vengeance about three days ago. My hand is almost completely numb. I can't feel anything in my hand, and drop things a lot. Typing this is difficult, because I can't feel the keys--I have to be very conscious of things in my hand. I therefore grip things too tightly sometimes, and smash them, and my handwriting is at best jerky. The numbness radiates upward along the outside of my arm to the elbow. I've just today noticed that I am also numb one the underside of my upper arm and a little down the back. All this only on the left. I also should say that the neurologist ruled out carpal tunnel syndrome because at the time the numbness radiated to the wrong fingers. Now the entire hand is numb. It's as if I've slept on it and just waken up, but the hand won't--feels sort of thick and clumsy. I hope I haven't been too wordy here. Just want to be very specific. I will admit that today I've gone into the panic mode. Don't know where to turn. Will acupuncture help? What shall I do about this? I see no point in going back to the doctor because I feel as though he'll just write it off as peripheral neuropathy again. I think that diagnosis is used sometimes as a grabbag diagnosis when they can't figure out what's happening. Someone please help me out here. Any suggestions? I'm afraid this condition will soon affect my work.
First of all, seeing a neurologist is not that all bad, they do help. Not all neurologists similar to each other. So, you need to see, perhaps, another neurologist. The aim not only to diagnose your case (possibly the exact cause) but also to assess the severity. Then to find the best treatment modality. I must say that some nerve lesions are severe enough to need surgery. So, please seek another neurologist advice. Best of luck and keep us updated.
Thank you, Dr. I didn't mean to imply that visiting a neurologist is bad--only that I learned very little from my last experience. I do plan to make an appointment once again, and this time perhaps I'll be a little more demanding of answers. In the meantime, will you even hazard a guess as to what's going on?
Also, I've been thinking about the idea of acupuncture. What is your opinion of that providing relief?
I know that acupuncture does help, but in certain problems. I am not too sure about your case whether acupuncture would help or not.
In need to understand some terms in NCV report for CTS
I have had a nerve conduction study of the upper extremities: revealed prolonged terminal latencies of the Rt. median motor, sensory, midpalmer bilaterally; left mid sensory mildly prolonged as well. Abnormal nerve conduction exam of both upper extremities are suggestive of focal median nerve entrapment neuropathy across the wrist (CTS) bilaterally, Rt. > left. I have yet to actually see the neurologist, appt set up; however in the mean time, what's the translation of terminal latencies prolonged, abnormal exam. What is a large fiber diffuse peripheral neuropathy, (states no evidence of). The only repetitive motion I have in my life is 6-8 hours (intermittenly) on my job, I case and deliver mail. I have filed wc/occupational illness. I had the NCS done before filing so to have proof of condition. Talk to me someone! I am in braces 24/7 weight limit 15lbs lifting until owcp gives an answer. I'm concerned...surely my job duties has caused this, right? Intimidation is not a pleasant experience.
To be precise and go to the first point, "the terminal latency prolonged" means that, there is pressure or entrapment of the median nerve causing slow of conduction or response on electrical stimulation of the nerve. The second point, "large fiber diffuses peripheral neuropathy"; there are 2 kinds of nerve fibers; small and large nerve fibers. The usual nerve conduction studies deal only with large nerve fibers. Therefore, when those nerve conductions are abnormal, then we refer to large fiber affection. Now, the last point. The CTS is very common condition all over the world. It is related to repetitive actions. Thus, it can be an occupational illness.
Thank you so very much for the response. This is about all the response I can muster right now.