I am new to this site, and I have a couple of questions.

1. When is it time to think about surgery versus conservative treatment?

I have been having pain in my hands, wrists, forearms and elbows for about 3 months. I got my CuTS diagnosis about 6 weeks ago. Before that, I was wearing wrist splints (like for carpal tunnel). For the past 6 weeks, I have been in elbow pads 24/7. It seemed to help at first, but about 2 weeks ago, it started all over again. The tingling of the hands, and intense pain from fingertips to elbow.

I am taking NSAIDs, but they don't seem to help. I'm going back to my neurologist next Tuesday.

2. What doctor is best to see (neurologist or orthopedic) for CuTS?

Little info about me, too: This is bilateral for me, right worse than left. Also, I'm a sign language interpreter, so cutting out the repetitive motion is nearly impossible without a career change. I'm off right now for the summer (I work in the school system), but I go back in about 3 weeks, and I'm not sure if I will be able to make it through 8 hours.

Thanks for listening/reading! Any advice would be appreciated!

Beth

Hi Beth, welcome to the site!

Re: When is it time to think about surgery versus conservative treatment?

When the pain becomes severe enough to threaten your livelihood or otherwise disrupt your life. Given that you use your hands alot for your job, and that causes you pain enough to consider changing careers, it sounds like you need to fix your problem. Surgery does indeed help many people.

Re: What doctor is best to see (neurologist or orthopedic) for CuTS?

The best doctor for cubital tunnel syndrome will have significant experience in both neurology and orthopedics. More important than the doctor's title is their experience and success rate. Try to find a doctor who has direct experiencing treating and fixing cubital tunnel syndrome.

Good luck, and please stop back and let us know how it goes with your doctor appointment.

Well, today was the day for my follow up at my neurologist. When I told him there was no improvement and some symptoms (swelling, redness, discoloration and PAIN) were worse, he wasted no time referring me to a hand surgeon. So, unfortunately it looks like my "gut" was right- I'm headed towards surgery.

I can't get in for another 3 weeks with the hand surgeon, so I hope he's worth the wait! I talked to my physical therapist (from another problem) who has treated post surgery CuTS patients, and this was his highest of 3 recommendations of doctors, so I have a good deal of confidence already.

Does anyone who has had surgery or know more about surgery have any suggestions of "must ask" questions?

Thanks!
Beth

beth21580 wrote:

QUOTE:



Does anyone who has had surgery or know more about surgery have any suggestions of "must ask" questions?

Thanks!
Beth

Howdy Beth,

1. Have (to the doc) done this surgery before, and what is your success rate?
2. To what level will this help me given my present symptoms?
3. What method do you recommend and why? "release, transposition, etc.
4. Will this stop the progression of my symptoms?
5. Do you recommend physical therapy after surgery? How long - what do you focus on?
6. Elbow/Hand? Where am I having issues, and HOW did you come to your conclusions?
7. What are the negatives vs positives to having surgery?
8. If I don't do anything, what is most likely going to be the result to my arm and hand strength? -Worst case scenario
9. Based on what I do for work, how long till I will be back at work?
10. If I don't see improvement, what would be your suggestions?


There are more, but these *I* feel are the biggies for the doctor. I found that *my* doctor didn't ask what I did for a living without my volunteering what I do. Be frank, work, relaxation, hobbies - he/she needs to know to give you a good picture. Good luck. Keep all posted.

Hi Beth,

Brenda compiled a great list of questions to ask your doctor before surgery. In my mind, the two most important questions on her list were:

1. Have (to the doc) done this surgery before, and what is your success rate?
3. What method do you recommend and why? release, transposition, etc.

It's very important to find a doctor with as much direct experience with cubital tunnel syndrome (CuTS) as possible. There's simply too much misinformation out there to leave such an important surgery to a novice.

The other important question is which type of surgery does your doctor recommend. There's a huge difference between decompression and transposition. Decompression is much less invasive, recovery is much faster, and there's always the option of transposition later if decompression doesn't work. Recent studies have shown that decompression is quite effective for mild-to-moderate cases of CuTS, but many doctors don't know this (again, which is why it's important to find a doctor who's knowledgeable and up on all the latest studies and techniques). As Brenda can attest, it takes a long time to heal from transposition surgery, but transposition is the preferred option for severe CuTS.

Good luck with your appointment. Please stop back and let us know what your doctor says.

First, thanks for the great questions to ask. As it turned out, I didn't even need to ask any of them. The hand surgeon I saw said my CuTS was not that severe, and wouldn't want to pursue surgery because it's a mild case, and there's no atrophy or lack of feeling. I asked about the pain in my hands, and it turns out it's a different problem. Some kind of degenerative joint thing of my thumbs. Got a new NSAID (Meloxicam) since nothing else I've tried has worked so far.

I'm in new, stronger bilateral elbow braces/pads and bilateral hand/thumb braces - all made from neoprene (like a scuba suit) and hotter than you know what in sunny Florida!

Will keep an eye on the CuTS, and go back if it continues to get worse. I have a strong feeling it will because of my job - sign language interpreter. Oh well.....