Carpal tunnel syndrome

[neilc1]

I was not answering your question, was I?

No, you were not,
but I thought a piggy back ride would be nice,

In your vast knowledge of lifting, training, and injuries associated or otherwise,
Would you be aware of any issues with modern Carpel Tunnel Release surgeries and continued lifting following the movements written in your tombs?
If it matters, I am a poverty lifter, with more excuses than drive, but I do always come back to the bar and restart a basic NLP,
DLs approach 300, Sq 250, Bench 150, and pressing 100,
62, 6-4, 270, male.

[Mizuchi23]

You also need the barbell prescription book too... But you don't seem to grasp the idea here. You just want an expert to give you permission to do DB exercises. So as a qualified expert I say go for it. You're already wasting time and money with the bodyblade crap so you may as well waste some more with the DBs too.

[Mark Rippetoe]

In your vast knowledge of lifting, training, and injuries associated or otherwise,
Would you be aware of any issues with modern Carpel Tunnel Release surgeries and continued lifting following the movements written in your tombs?
If it matters, I am a poverty lifter, with more excuses than drive, but I do always come back to the bar and restart a basic NLP,
DLs approach 300, Sq 250, Bench 150, and pressing 100,
62, 6-4, 270, male.

I've had very little experience with that surgery. We'll ask the board.

[JFord]

I've had very little experience with that surgery. We'll ask the board.

The worse thing I’ve seen following a CT release is it not successfully eradicating the symptoms. Admittedly, I haven’t seen a patient who self-identified as a barbell weightlifter but I’ve had multiple, very athletically-minded patients have them and be pleased with the results.

I’ve long, considered this to be one of the more efficacious of orthopedic surgical procedures.

If it were ME, the CTS was properly diagnosed, and it was truly interfering with my life; then I’d have it done. I don’t see it rendering you incapable of training in the future.

But stuff happens and if you want a moneyback guarantee, you ain’t going to get one!

[Will Morris]

The worse thing I’ve seen following a CT release is it not successfully eradicating the symptoms. Admittedly, I haven’t seen a patient who self-identified as a barbell weightlifter but I’ve had multiple, very athletically-minded patients have them and be pleased with the results.

I’ve long, considered this to be one of the more efficacious of orthopedic surgical procedures.

If it were ME, the CTS was properly diagnosed, and it was truly interfering with my life; then I’d have it done. I don’t see it rendering you incapable of training in the future.

But stuff happens and if you want a moneyback guarantee, you ain’t going to get one!

The lack of improvement in symptoms (in my experience) tends to stem from the fact that CTS is diagnosed without enough diagnostics to rule out cervical disc herniation or, in the case of regular trainees, pronator teres syndrome. The presence of median nerve entrapment symptoms does not necessarily mean CTS, and the double crush phenomenon posits that a disc herniation or compression of any part of the nerve roots that make up the median nerve, or the median nerve itself, makes the nerve more sensitive down the course of the nerve.

When diagnosed properly, I have yet to see someone not have good results from it. It's not a terribly involved procedure and the recovery timeline is quite short.

[JFord]

The lack of improvement in symptoms (in my experience) tends to stem from the fact that CTS is diagnosed without enough diagnostics to rule out cervical disc herniation or, in the case of regular trainees, pronator teres syndrome. The presence of median nerve entrapment symptoms does not necessarily mean CTS, and the double crush phenomenon posits that a disc herniation or compression of any part of the nerve roots that make up the median nerve, or the median nerve itself, makes the nerve more sensitive down the course of the nerve.

When diagnosed properly, I have yet to see someone not have good results from it. It's not a terribly involved procedure and the recovery timeline is quite short.

Agreed. That’s why the “the CTS was properly diagnosed” caveat was among my criteria for proceeding with it.

I love referring patients to a good ortho surgeon when I diagnose this because the efficacy of CTS release is so high.

That said, unfortunately, I have seen “failure to improve” follow the procedure in patients with classic median nerve distribution pain/numbness in the hand, a positive Tinel’s sign, and a positive Phalen’s sign (all confirmed by good orthopods) who didn’t get better but that’s the worse thing I ever saw. However even failure to improve is super rare in my experience.

Admittedly, in the years of practice when I was practicing more in a primary care setting, nerve conduction studies to confirm the diagnosis was not the standard of care and I rarely saw specialists order them to rule out CTS.

Pardon me for nerding out in what is to come but I have this question Will: I can understand how cervical radiculopathy can conceivably explain a distal median nerve pathology, but how can it explain positive Tinel or Phalen’s signs? As I understand it, those signs elicit evidence of actual entrapment of the distal nerve underneath the flexor retinaculum in the wrist.

As an aside, to lend credence to your statement that “its not a terribly involved procedure” I’ll add this: when I was a 4th year medical student rotating through what was then called Walter Reed Army Hospital, I scrubbed in on one and the hand surgeon had me do the case from start to finish.

Not only did the patient survive the ordeal but he had a great outcome. Trust me, if I could successively do one and not kill the poor bastard, then it cannot be a difficult operation!

[neilc1]

thankyou both, Doc Ford, and Will, for the continued discussion,
your 1st messages more or less confirm what my GP(who I do trust a bit) and the ortho hand surgeon said,
"simple, easy recovery, "
now you're geeking out over my head, but we did ask , ,

I had both cervical MRI, which cervical ortho and hands said was not conclusive enough to suggest surgery there,
and electo shock discovery,
which I recommend for everyone(NOT),
best part being when Frankenstein said, "we were done, and oh, by the way, your bleeding, clean up"
damn Frankenstein.

right hand is not as bad as it was prior to Cort injection, but on its way back, so , , ,
maybe after New Years,

[JFord]

thankyou both, Doc Ford, and Will, for the continued discussion,
your 1st messages more or less confirm what my GP(who I do trust a bit) and the ortho hand surgeon said,
"simple, easy recovery, "
now you're geeking out over my head, but we did ask , ,

I had both cervical MRI, which cervical ortho and hands said was not conclusive enough to suggest surgery there,
and electo shock discovery,
which I recommend for everyone(NOT),
best part being when Frankenstein said, "we were done, and oh, by the way, your bleeding, clean up"
damn Frankenstein.

right hand is not as bad as it was prior to Cort injection, but on its way back, so , , ,
maybe after New Years,

The fact that a localized cortisone injection helped convinces me that your problem is indeed local to your wrist. If you were me, I’d get the surgery.

1) The geeky stuff was really meant to elicit a response from Will Morris who is what we Jews call a mensch and who in fact I get advice from.

2) I hope that the anecdote about my experience as a young medical student wasn’t too geeky and that it gave you a little more reassurance about the simplicity and safety of the procedure!

[neilc1]

The fact that a localized cortisone injection helped convinces me that your problem is indeed local to your wrist. If you were me, I’d get the surgery.

1) The geeky stuff was really meant to elicit a response from Will Morris who is what we Jews call a mensch and who in fact I get advice from.

2) I hope that the anecdote about my experience as a young medical student wasn’t too geeky and that it gave you a little more reassurance about the simplicity and safety of the procedure!

chances are that I'm the geek here,
it was / is good to see the discussion,
and yeah, i'ld let you cut me

[JFord]

… and yeah, i'ld let you cut me

Given that I’m an internist, that’s a place where nightmares dwell…