Opinion on carpal tunnel surgery with PMR

[Leilagirl]

I don’t know quite what to do about a upcoming surgery. Carpal tunnel. It’s not scheduled as yet however MD is backed up for now .. another 6 weeks or so . I do have a fairly severe case of this nerve impingement based on nerve conduction test.But.. I had a steroid injection and other than a few fingers being numb no big deal.no pain thank Goodness as it was bad. The last thing I want is anything to bring this PMR to life as I am new to it 2 months now . I started on 10 of Pred and am on 9.5 now .. barely enough but doing ok during the day mostly. Just shoulder pain in am till meds kick in plus the other fatigue and general aches not all days however ..surgeon says he has no problem with me being on Pred less than 10 mg.. but I really have my reservations. Should I wait for a year or so .. especially if steroid injections do the trick or just go for it. I’m not feeiling confident about surgery if it’s not absolutely necessary. Thanks All!

[PMRpro Ambassador]

Carpal tunnel is a common part of PMR - it is possible that if you were on a better pred dose (10mg is a VERY low dose to start on) it might clear up the inflammation due to the PMR which is probably causing the carpal tunnel problem. Repeated steroid injections in a short time for a problem like this aren't recommended as they are local enough to cause problems with tendons. Are you using a wrist splint? That often helps the symptoms in PMR until a higher oral dose reduces the swelling.

Personally I would consider the surgery if it were shown to be a mechanical problem. Since it is alongside PMR I would want to see if better management of the PMR (i.e. a higher starting dose for a short period, you admit 9.5mg is barely holding things and the 10mg seems not to have cleared out the existing inflammation) would also achieve a good result.

[Leilagirl in reply to PMRpro]

Thanks.. Actually I have had pain and symptoms of CTS for many years.. splints worked at first.. but now to severe .. maybe I’ve had symptoms of PMR prior as well but really did not get properly diagnosed looking back on my history and pain. I am thinking the surgery may be necessary. So.. should l expect PMR to cause a flare when surgery is complete ? I know we are all different. And if so should I increase up to 5 mg for how long ? I just want to be prepared to manage things myself . Trying not to take to many steps backwards. I can go back on this site and research if necessary. Thanks ahead of time for this valuable information. Happy Mother’s Day as well if this applies.

[PMRpro Ambassador in reply to Leilagirl]

Applies to everywhere except the UK today and everyone fulfils a mother function somehow! Thank you.

I'm sure there is someone on the forum who has had carpal tunnel surgery but I can't remember who.

When the surgery is done they will probably give you a boost of steroid to cover lack of adrenal function - I suspect it is the lack of that that is most likely to cause problems. Your surgeon seems keen for you to have the dose low - so really you need to discuss it with him. I would expect someone who is only just getting by on the current dose MIGHT flare but it is impossible to say, everyone is so different. If it were me I would feel happier on a slightly higher dose but there may be no need.

Sorry not to be more help. All I can say is that some people have surgery, some as major as hip replacement, without any problems at all.

[SheffieldJane in reply to PMRpro]

What a lovely, true thing to say about the mother function.

[30048]

My recommendation would be to hold off. I was cruising along on 7 mg if prednisone. Doctor insisted I have surgery. It was a difficult go and I flared . Back up to 80 mg. And I have never gotten below 10 since. There may have been other factors involved but my other wrist has carpal tunnel also and I was told by the doctor at Stanford that it was part of my GCA and PMR. It does pain me when I need cortisol. I would just wait it out fo awhile.

[Hidden]

I had CTS for many years before having PMR. Like you I had splints and then a steroid injection. I finally had the surgery 6 months after being diagnosed with the PMR and I'm glad I did. It had no effect whatsoever on PMR symptoms (unlike the flares I get when doing too much). But obviously it has to be your decision.

[alice1940]

I too have had surgery for carpel tunnel on both wrists not at the same time though being on steroids made no difference and was advised to take pain relief after surgery but found l didn't need to as the steroids masked the pain and l recovered very well and l was so glad l had it done too . Hope this helps and good luck keep well Alice

[May10]

I have had numb and tingly hands since going on Pred....never had problems before. Consultant said it is CTS. I have had no pain but find it difficult to pick things up Had nerve tests and "no damage" to nerves. I hope it goes away if I get off steroids. May 10

[Telian]

Hi Leila

I am sorry to hear you are going through all of this, I feel for you as I've been there. I've had both carpals operated on (at the same time) but this was pre GCA/PMR. Only now am I wondering if I've had this illness much longer, as have had 10 procedures, mainly bi-lateral, in 10 years on wrists, hands, elbows and shoulder. I want to say think long and hard before having the op, particularly if the injections work but it's up to you, how bad are the symptoms day to day? If your pain is bad then go for it as the injections can work initially but might not work long term. I was never offered them.

To add further I was due to have one carpal done again, many years after the first time and coincidentally I was diagnosed with the AI only a few months following - again I still have never associated it with PMR but what do I know, I'd never heard of GCA/PMR!

However I never had that second CTS as had to have my lymph nodes removed on that side whilst waiting, so no go on that now. The pain can be a nuisance so again you do have a choice whereas I didn't the second time and I would have had it done.

I did have a flare following the breast surgery but we are all different and you might be okay. I got over the flare symptoms within a week - it just meant I had to restart my taper...

It is two pronged now you have the AI - you will have enough to contend with without pain in the hands/wrists as well. It's the lesser of the two evils coupled with the unknown I'm afraid - only you can decide by weighing up the for and against... I would chat with the surgeon then decide. Think I know what my decision would be now.

Best wishes Leila

[Leilagirl in reply to Telian]

Thank you for responding. Your journey has certainly been tough. I too am sorry for your bumps along the way. I will think long and hard about this. Pain is minimal in Rt hand.. just slight numbness after cortisone injection. It will probably never improve but it is manageable I believe.... if it should rear it’s ugly head in a bad way. I am leaning toward NO. Best wishes.. take care of yourself.

[Zampalion]

I have been diagnosed with carple tunnel after reducing to zero pred. 8 weeks ago doctor discussed surgery but gave me a cortisone injection in wrist worked fine as I also have arthritis in joints both hand even the stiffness in my hands improved still working after 6 weeks I wonder if I can get a way from having surgery if the injections work.

[Telian in reply to Zampalion]

Hi Zampalion

I have OA in my upper body and always needed the surgery in the end.

For you if the injections work then why would you be offered surgery? If it isn't broke then don't fix it comes to mind. You might have to have surgery ultimately but don't rush into it, it's the pain levels that will make you decide. All the best.

[Zampalion in reply to Telian]

Thanks for your reply, at the moment my symptoms i.e. pins and needles in fingers and thumbs both hands which which were present before have not started yet if doctors

Let me continue with injection

I would rather that than surgery.

[Telian in reply to Zampalion]

Good idea, you'll know it's decision time when it becomes too much, all the best.

[ExtraTuff]

I just posted about this to Kathleen18 (I'm new to this group so I'm just figuring out the connections with related topics) I have had PMR since March of 2016, I developed Carpal Tunnel symptoms during my first Prednisone taper about a year ago. I found a wonderful wrist brace made by Futero called the Night Brace. It has helped to entirely resolve my symptoms. I wear them almost every night. I would get woken by pain from circulation problem in both hands.

It's nice to pass along something that actually worked for me, I know we are all different so it's just an idea to try if you are on the fence about surgery. I wish for the best for you.

[Leilagirl in reply to ExtraTuff]

Thank you ! I appreciate the feedback! Take care.