Surgery and recovery

My, I've been quiet! In the first of what should be two closely spaced posts I'd like to take the opportunity to talk about the operation and recovery.

The procedure

The surgical solution is frighteningly simple. The symptoms of Carpal Tunnel Syndrome are caused by the median nerve being squeezed for space in the carpal tunnel. This tunnel has a roof formed by a ligament attached to the bones on either side of the hand. To give the nerve some more space the surgeon opens up the hand, cuts the ligament in two and sews the hand back up. As I said, frighteningly simple. For more details, including videos(!), just search for carpal tunnel release surgery.

My experience

I was very apprehensive on the day of the operation but I have to say that the hospital staff made the whole thing a lot easier. I was most amused during the pre-op checks when I set off the alarm by having a pulse rate that was too low! The benefits of cycling....
As the procedure was done under local anaesthetic I was aware of all that was going on. It's a very strange feeling when you know that the surgeon is working away on your hand but there is no associated pain. The theatre nurses were amused at my calming method, I spent time on the table imaging I was climbing the Inn Pin on Skye!
When the surgeon was finished I declined his invitation to "have a look". No thank you.... And then, very quickly, they had my hand all wrapped up in an enormous bandage with my fingers sticking out.

Not the best photo - but you get the idea...

Then, once I'd had a little time recovering (with toast and coffee), it was time to go home.

Initial recovery

I was instructed to keep my fingers mobile and take painkillers as required. Apparently you don't want it all seizing up. I was allowed to reduce the dressing after 3-4 days and I did this. Mostly so my hand would pass through my coat sleeve, allowing me to go out for a more comfortable walk than when I tried to with my coat wrapped around the spare arm. Reducing the dressing ended up with me getting a glimpse of the wound. Not pretty, and I was glad to have it wrapped up again. Given the way my hand felt over the next few days I did wonder if I should have left the bandages alone. In the end I think it was ok.
After 10 days I had the stitches out. To be honest this was probably the worst bit. The picking and pulling around the cut was not pleasant.

Onward recovery

With my stitches out I was back to work. At this stage I was somewhat wary and slightly concerned that the wound would split open. It's very disconcerting. By now I also had my exercises to do. I will admit that work was being done with one hand mostly. But it was good to be back at the desk.
Improvement, since then (9 weeks ago), has been steady if not as fast as I would like. The interesting bit has been the regular step-wise improvements. I would be worrying that no progress had been made for a week or so and then, overnight or over the course of an evening, a rapid change would take place.
It's not perfect yet but I've only had a couple of re-occurrances of my symptoms and they've not hung about. The surgeon did say it might take up to a year, even 18 months, for it to settle down properly. It's nice to be sleeping with one splint only. I haven't tried riding a road bike yet; the small amount of residual swelling is still putting me off. I've not tried golf either. But a lot of "normal" activities are exactly that now, normal. Every now and again I do something that reminds me all is not as it once was and feeling the tendons floating about a bit is strange.
So, for now, it's onward with the exercises and the trike riding. I will wait and see how it goes  before committing the right hand to the same treatment. With it being in better shape than the left one was it might be a while before it is even necessary.

Carpal Tunnel and the Trike

The medical bits

It all started with being woken up in the middle of the night with a numb hand. Night after night. And not a usual numb hand either. Before this all started if I woke up with a hand that had also gone to sleep then I would just move and the feeling would go away while I dropped off again. However this was different. The feeling wouldn't leave the hand, usually requiring me to get up and walk about for a while before it would let me get back to the land of nod. Sometimes it would wake me more than once.

As it went on I did some www research. The symptoms seemed to point to carpal tunnel syndrome. But last time I'd thought I'd got something similar I didn't and some physio sorted something out in my back relieving the symptoms. So I went back to my physio. But, while the manipulations and stretches helped, the symptoms didn't recede. So, off to the docs I went.

And one appointment with a specialist later and I was diagnosed with suspected Carpal Tunnel Syndrome. And sleeping with a splint on my right hand. It certainly helped with the night time symptoms but the odd numb hand on the bike, when typing at work and random other times didn't go away. It's a very odd feeling when your hand just goes all pins and needles for no apparent reason. The really odd thing is the feeling of pins and needles on one side of a finger and not the other. CTS is caused by an impingement of the median nerve and, as I know now, this serves the thumb, forefinger, middle finger and one side of the ring finger. The un-affected ulnar nerve serves the little finger and the other side of the ring finger.

The really odd thing for me was that it had always been my left hand that had gone numb on the bike but that hand appeared to be ok. Well, it was. Until one day on Skye, after a long tandem ride. And then the same thing started with it. I couldn't find a splint on Skye but I did manage to fashion one with a Buff and a teaspoon.  This amused the specialist!

Ah, yes, him again. This time he was convinced enough to send me for nerve conduction tests. Another specialist, another hospital and a diagnosis. CTS for sure. The tests were interesting though. Essentially a series of electric shock used to measure the speed of the nerve signals in my hands. And because the speed is slower from the thumbs than the pinkie CTS is a good call. Moderate in the left, slight to moderate in the right.

And then another trip to the first specialist. And a decision to go for surgery, carpal tunnel release. I'm going to have it done in the left hand first. If that goes well then we will consider doing it to the other hand too.

Riding

For the most part bike riding has been ok. Rough surfaces, routes with heavy braking and the tandem in general have given me problems. One or other hand going to sleep. Changing gear is a bit of a lottery when you can't really feel your fingers. Braking isn't quite so bad, but I'm not sure I'm able to modulate it well with dodgy hands. The odd sharp stop has been entertaining! Getting a drink or food has been fun on occasion too.

I'm sure cycling has had some part in the development of the problem but I'm also sure that 27 years of typing, loads of goal keeping and golf have played their part.

General

One of the strangest things is the display of symptoms. At night I realise is because a lot of us sleep with our hands and wrists curled up. That puts pressure on the nerve and makes the hand go to sleep. Fair enough. But it's the other times that surprise me. Holding a coffee cup, hand goes numb. Typing, hand goes numb. Holding a mobile phone, hand goes numb. Doing nothing, hand goes numb. It's just odd.

Although may be not as odd as one of the specialist's tests. He took my arm and tapped down the inside of the arm from the elbow to the hand. Bingo, the hand goes numb!

Then I found clapping also set it off. Hard to enjoy a pantomime if you can't clap along... :-(

Looking forward

I can't say I'm looking forward to the surgery even if it is only a 20 minute procedure. I'm also not looking forward to the recovery either. No work until the stitches are out (minimal typing), no riding obviously. I'm just hoping TV will be good.

Then, once the stithes are away, I need to be careful. Cycling will need to be introduced very slowly to build it up again. And, of course, the right hand is still affected.

And, now, one reason for the trike will be much clearer.  I'm hoping it will allow me to keep my legs strong while I keep the weight off my wrists. And that might keep the Stoker happy. I can do upright riding on the tandem.

Well, that's the plan. Hopefully it will all work out just fine.