2 completely separate issues...but seeking advice

Hi everyone! I've been off the forum for a while - busy with work, life, and nursing some ongoing injuries. My first issue is with my hands. I continue to have numbness and pain while riding and it has made me down right miserable. I have logged over 8,500 miles this season...and I can honestly say that not ONE of those miles were ridden without some degree of hand numbness and pain. I finally broke down and went to see a doctor (a physiatrist) in November. He performed an EMG and diagnosed me with moderate bilateral carpel tunnel. I sought out a second opinion from a highly recommended orthopedic hand doctor. He wasn't completely convinced that it was 100% carpel tunnel, so he did his own little "experiment". He gave me a cortisone injection in my right wrist only, and told me to go out and ride the upcoming weekend. He wanted me to report back to him if I felt any difference between the hand with the injection compared to the other hand without it. While the hand with the injection wasn't 100% pain-free or numb-free, I DID feel a substantial difference compared to the non-injected hand. My left hand was "gone" within the first 20 minutes of riding, while my right hand still had feeling to some degree, throughout the entire ride. A large enough difference for me to notice, for sure. So based on these findings, along with the results from the EMG...this second doctor feels that carpel tunnel release surgery is my only chance at being able to ride "relatively" pain and numb-free. We have not scheduled the surgery yet, but if I decide to do it...it will likely be in mid-January. I would have my right hand done first, and then a few weeks later, the left hand done...with the assumption that by the time I'm back on the bike (probably late Feb/early March) on a regular basis, I will be fully recovered. For anybody that has had carpel tunnel surgery, is this a "conservative" assumption? Or am I looking at a longer recovery time? I'm a bit scared at the prospect of this procedure. I have never had any type of surgery before (except dental), so naturally I am quite nervous. My biggest fear is going through all of this, and ending up worse off than before the surgery! I know that is probably not a likely scenario, but it DOES cross my mind.

My second issue is my left foot. Back in August, I was diagnosed by a podiatrist with tendonitis of the peroneal brevis tendon in my left foot. I did 6 weeks of physical therapy. My last PT session was on Dec. 6th. My foot STILL hurts today. It throbs with pain nearly everyday. After doing some of my own research, I'm beginning to think I might be dealing with a stress fracture of my fifth metatarsal. Of course, I have no proof of this...yet. I'm considering having an MRI done to see if anything shows up. But that would be a costly hunch if the MRI ends up showing nothing. Has anyone ever been misdiagnosed as having tendonitis when all along it was really a stress fracture? Any advice here? I know there isn't much that can be done for a stress fracture other than resting and ice. But I'm open to hearing any other options. Thanks!!!

Linda

Linda, I'm sorry you're going through so much. I think the hand surgery, while scary, sounds like a good step for you, considering how much pain you've been in for so long. I know nothing of the recovery time though.

As for your foot, what imaging of your foot have you already done, if any? Xrays do often miss stress fractures until they've started to heal, but perhaps that would be a cheaper place to start. If it turns out to be a Jones Fracture (base of the 5th metatarsal) then I'd want to know if it's likely to recur based your biomechanics. There are surgical options for that if you're prone to stress fractures in that area.

Aw, Linda, being injured s*cks - so sorry you're having to go through that. :(

My main hesitation on the CTS surgery would be that it won't correct whatever caused the issue to begin with. I've known people who worked in a factory with poor ergonomics, who've had surgery multiple times on each wrist, and as soon as they went back to work and started using their hands in the same way, the problem came right back again. I'm not sure what the best solution might be, since you've probably been through your bike fit six ways to Sunday already. :( I guess I'd really try to nail the surgeon down on how long term of a solution he thinks surgery might be if nothing else changes.

Whatever you decide I hope it gives you complete relief and that you heal up quick. (((((Linda)))))

My spouse had terrible carpal tunnel and cubital tunnel problems. He had endoscopic surgery, which has a quicker recovery and I understand better long term success than open surgery. We had to drive 150 miles to the surgery (we went to a specialist that only does this stuff ) and went there and back the same day. I just had to do the driving. He has recovered but has permanent damage due to long delay in seeking surgery. At least his condition did not continue to get worse. I think one key is not going back to riding until you are entirely recovered from the surgery. I don't know what your recovery period would be but don't push it and go back to riding before you doctor give the ok.

This is a good article: http://www.ninds.nih.gov/disorders/c...pal_tunnel.htm Recurance is rare.

Have you considered a recumbent bike? I know it's not the answer you want to hear, but it would certainly take the pressure off your wrists, at least as you are regaining 100% function if you have the surgery. It might be a back-up bike for you after that. Just something to think about if you haven't.

I do empathize as I have recurring/chronic pain from a pelvic fracture in 2005. I've logged many pain-free miles since then, but just as many with aching pain. It's been a long process of determining what triggers the pain and how to best avoid it through bike selection and set up (more upright is better) and ride selection (too many hills in one ride has a tendency to trigger the pain). I hope your pain will be a thing of the past soon, but it's good to have alternatives just in case.

Good luck!

Linda, have they checked your neck? My hand/arm issues turned out to be compressed discs in my neck, along with a narrowing of the spinal canal.

Thanks for all the responses, everyone! I meet with the doctor on Jan. 4th. I have MANY questions to ask, and one of them will be in regards to my neck. I do experience quite a bit of neck pain and stiffness in the last few years, so I too, have also wondered about that.

I have researched the endoscopic version of the surgery, as well. My doctor does the "open" variety, unfortunately. But, I suppose it would not be out of the question for me to find one that does endoscopic. There are a few that I did find. The downside to that, is having to go through all the preliminary evaluations all over again with a new doctor...which means more time wasted. I was really hoping to have this done sometime in January, so that I would be ready to go once riding season is in full swing. I have spoken to one gal at my gym, who had the open surgery back in August on both hands, and she is doing very well. She is a plumber (so she uses her hands for her work everyday) and says she was back at work the very next day and hasn't had any recurrence so far. Her outcome gives me a lot of hope.

A recumbent bike is not an option for me. For one, I just purchased my current bike - a custom Ti that was VERY expensive, back in February. There is simply no way I can afford another bike, nor do I want one. The stationary recumbent bikes at the gym hurt my back after riding it for just 10 minutes. I need to ride the bike I have.

Can anyone suggest some good questions to ask the doctor when I meet with him next week? I don't want to forget anything. Thanks!

Linda

My husband swapped surgeons. He did not have to do a bunch of retesting, he looked at the reports for the EMG and nerve conduction tests. Spouse switched because he did not want the open procedure and given that he had substantial nerve damage he wanted the best doctor we could find. We spent some time looking for such a person.

I would ask you doctor about recovery time and about whether the procedure he does will be entirely suitable for you, given that bike riding is extremely important to you.

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Originally Posted by goldfinch

My husband swapped surgeons. He did not have to do a bunch of retesting, he looked at the reports for the EMG and nerve conduction tests. Spouse switched because he did not want the open procedure and given that he had substantial nerve damage he wanted the best doctor we could find. We spent some time looking for such a person.

I would ask you doctor about recovery time and about whether the procedure he does will be entirely suitable for you, given that bike riding is extremely important to you.

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Just curious...does your husband ride? How long ago did he have his endoscopic surgery and how are his hands doing now? I understand that you said he does have permanent damage, but aside from that...is he happy with the outcome of the surgery?

I am checking into a few other Chicago-area hand surgeons that specialize in endoscopic carpel tunnel release. Are there any downsides to going with the endoscopic route, that you are aware of?

Linda

Just thinking...someone mentioned the possibility of neck issues that might be casing hand problems. I'm not sure that a hand specialist will necessarily take that possibility very seriously given their focus on hands. Doctors can be surprisingly un-systems oriented. If it is a neck issue, hand surgery won't likely help.

Take care and get the whole picture before you go the hand surgery route. I might be inclined to try less invasive options forest, including acupuncture and chiropractic. But that's just me and you know your situation best.

I really don't know much about EMGs, but isn't one of the things they're supposed to be good at sorting out is whether something is a nerve root (spinal) or branch (peripheral) issue? Is that why the hand surgeon wasn't convinced it was entirely CTS?

I am so impressed with the osteopathic manipulation I've been receiving. It's so different from any treatment I've ever had before, very effective, extremely non-threatening and side effect free. Basically by gentle pressure on the ligaments, they realign the skeleton. That would be another thing to consider. Not all DOs do OMM, but if your surgeon is a DO he might be able to refer you. Otherwise try the Cranial Academy website.

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Originally Posted by nscrbug

Just curious...does your husband ride? How long ago did he have his endoscopic surgery and how are his hands doing now? I understand that you said he does have permanent damage, but aside from that...is he happy with the outcome of the surgery?

I am checking into a few other Chicago-area hand surgeons that specialize in endoscopic carpel tunnel release. Are there any downsides to going with the endoscopic route, that you are aware of?

Linda

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My husband had very serious nerve damage, to the extent that his hands lost a fair amount of muscle. He rides but does not ride a lot. He cannot use drop bars and has to use a very upright position. However, he is very satisfied. The doc was very upfront about the fact that he had permanent damage that he would not recover from but that they could stop further damage. The damage has stopped and in fact he has less nerve pain. His recovery from the serious nerve pain took almost a year. He is a special case though, type 1 diabetes for 50 years which is not only a risk factor for carpal tunnel syndrome but increased the likelihood of permanent nerve damage due to neuropathy.

I do know that there are generally less risks with the endoscopic procedure as compared with the open procedure. However, when looking for a surgeon we learned that endoscopic hand surgery is highly specialized and it is important to get someone with experience. That is why we ended up going to Minneapolis for the surgery.

I just wish he would have had the surgery sooner. He was stubborn and waited too long.

I was unable to find a hand surgeon in the Chicago area that does endoscopic, but I did find a highly reputable hand surgeon from Midwest Orthopaedics at Rush, that does what is referred to as "mini-incision" carpal tunnel release. I booked an appointment for a consult with him on January 9th, so we shall see what he has to say. This doctor has some pretty impressive credentials:

Mark S. Cohen, MD (Midwest Orthopaedics at Rush, Chicago). Dr. Cohen is the director of the section of hand and elbow surgery at Rush University Medical Center in Chicago and a consultant for the Chicago White Sox and Chicago Bulls. He has an expertise in performing minimally invasive surgery, mini-incision carpal tunnel release, wrist and elbow arthroscopy and using bone cement for treating wrist fractures. In addition to his clinical practice, Dr. Cohen regularly conducts research on topics such as wrist fractures, elbow trauma and arthritis and wrist ligament tears. He has written more than 80 professional articles and written a text book on hand and wrist injuries. Dr. Cohen has been recognized by the Society for Surgery of the Hand for having the best scientific paper at the 2009 annual meeting. Dr. Cohen earned his medical degree from Harvard Medical School in Boston and completed his residency in orthopedic surgery at the University of California San Diego Medical Center. He also completed a hand, upper extremity and microvascular fellowship at the Indiana Hand Center in Indianapolis.