Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Hand pain anyone?

Informatin on carpal tunnel sugery. This is Mr Mike Hayton, Wrightington Hospital and Alexandra Hospital UK - this guy knows his stuff:-

Here's his surgery - note tiny incision. NO arm block. Simple local anaesthesic mixed with adrenaline. Only the *exact area needed goes numb, NOT the whole bottom half of the arm. France is way, way behind.

http://www.mikehayton.co.uk/article.asp?article=56

Carpal tunnel operation photos - mikehayton.co.uk
Carpal tunnel operation photos. The operation is performed under local anaesthetic mixed with adrenaline. The adrenaline allows a bloodless field and ...
www.mikehayton.com/article.asp?article=56

Definitely going to have Hayton do my left hand as and when.

Carpal Tunnel Decompressions now do not require the use of an uncomfortable tourniquet.
"Most surgeons use a tourniquet for carpal tunnel surgery. A torniquet is large blood pressure type cuff that is tightly applied to the upper arm once the blood has been squeezed out to allow a bloodless field for surgery. Mike was invited to give a number of lectures at the American Association of Hand Surgeons in Los Angeles. It was during one of the other key note lectures that he heard that surgery without a tourniquet is increasingly becoming popular in the United States. A quick survey of his recently operated patients revealed that the tourniquet was often the worst part of the procedure. Mike's anaesthetist mixes a drug called Adrenaline with the local anaesthetic. This has the effect of significantly reducing bleeding during the operation without the need for the uncomfortable tourniquet."

And see this -

http://www.mikehayton.co.uk/article.asp?article=49 - sutures should be removable on the palm of the hand and dissolvable /absorbable on the back of the hand. Takes WEEKS for stitches to absorb, so I am 'possibly' stuck with blasted stitches in my hand for weeks. This is ridiculous. Going to see IF I can get them removed at 10 days.

"Generally absorbable sutures are clear or white in colour (mine are white) They are often buried by threading the suture under the skin edges and are only visible as threads coming out of the ends of the wound (mine aren't - they are standard simple sutures) The suture end will need snipping flush with the skin at about 10 days (HaHa - no one has spoken about cutting 'flush' with the skin! Was only told they will 'dissolve in time'!) Sometimes the whole suture is completely buried, as shown in this photograph. These wounds are often reinforced with steristrips (butterfly stitches). Each type of absorbable suture dissolves at different rates. Some start to disappear at 10 days, others at 3 months"

He has a section on returning to driving... http://www.mikehayton.co.uk/article.asp?article=48

My golly, see this - even has the physio attend before surgery and during surgery...WOW.

Prehabilitation at the Alexandra Hospital (This must be pvt H. only. Don't know it. But there is a pvt section at the Wrightington)

"We are pleased to offer on most Wednesday operating sessions at the Alexandra Hospital, in Cheadle, a prehabilitation service. Mike Hayton's usual pre and post operative visits on the day of operation will be accompanied by his hand therapist, Rachel Delaney. Rachel will be on hand to offer free advice on any aspects of rehabilitation, including post operative exercises that will allow you to recover in the minimum of time.

"Rachel will then be in the operating theatre during the surgery to gain a better understanding of the specific characteristics of operation to tailor a bespoke rehabilitation if required.

"This face to face information, when given before your operation, and the information from the operation, will aid your recovery and ensure that you are receiving the best possible care.

"Rachel will also be able to ensure you are able to book directly into one of her post operative rehabilitation clinics if your surgery requires specific therapy.

"Mike is delighted with the development of this new service. He is convinced that the best possible surgical outcomes can be achieved when a multidisciplinary approach is utilised. A one on one interface with my hand therapist on the day of surgery is a very exciting new service that we hope will be of benefit."

Terrific. Now that IS professional. I am impressed - and it takes a lot to impress me! (I sure do soooo wish that I had waited, saved up and waited, to have my surgery done by Hayton in the UK. Oh well.)

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(Of interest - my burning question was re driving. Did not get a plain answer. Waited 10 days. I had a small sort of cast on the back of my hand to keep wrist in a supported position - was very comfortable. Had a thick padding on palm of hand, again, comfortable, the padding protected the cicatrice/sutures).

"Patients often ask when they are able to return to driving following hand surgery. There are a number of factors that contribute to the ability to drive following hand surgery and these usually are centred on safety.
The type of hand operation can vary from a simple procedure performed under local anaesthesia to a complex reconstruction requiring inpatient admissions.
There are a number of factors involved
Pain
Pain should not be at a level to impair the driver's ability to concentrate. Patients who develop pain on certain movements may be at risk if these movements are avoided due to pain.
Analgesia (Pain killers)
Driving should be avoided if the driver takes any medication that impairs an individual to use machinery. The information leaflet inside the medication packaging will inform you of this.
Anaesthetic
My anaesthetist advises that driving should be avoided for 24 hours following a general anaesthetic.
Plaster cast (splint)
Hand operations that require a plaster or a splint usually delay a return to driving. It is often reported that a patient should not drive with a plaster cast on the wrist. However many plaster casts and splints are low profile, and allow the normal finger movement that would be required to turn a wheel or change gear. I would recommend the individual patient contact their own insurance companies to clarify cover. A patient that is pain free and can operate the car safely, despite a splint, may be able to obtain consent from the insurance company.
Wound stitches
Hand operations will have wounds that require closing at the end of the operation. The stitches are often called sutures. I generally use dissolvable stitches on the back of the hand and non dissolvable stitches on the front of the hand. Driving is possible with stitches in place provided the patient is relatively pain free. While stitches are still in place, the wound should be kept covered to reduce infection risk. There is a small risk that a violent turn of the wheel in an emergency may burst the stitches"

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BTW I had no pain, at all. Only now getting discomfort from the cicatrice (very tender) and cannot use hand properly. Most annoying. Can drive, though holding wheel is uncomfortable after a time. Am getting nasty paraesthesia. All so flippin tedious.

My AS shows up first and foremost in my hands and feet, with spine hips a distant second. If I eat poorly my hands can hurt within a hour or two, spine usually takes a day to show up if at all. Good luck

Hi Mathie, just add my 2 cents of my crippling hands. My hands are a mess of Carpel tunel, AS, and OA. Problems from my C-spine usually cause pain and numbness in my arms and sometimes numbness in my hands.
What does your Rheumy say about your hands? Mine can tell me which joint, ligament, and tendon is effected by which disease or condition, interesting.
Cindy

I wondered the same thing. I mentioned to my pain specialist last week that I had tetany. My primary said this is what I had due to lack of potassium. I started taking potassium but my hand's and finger's will lock and I have to bend them back. My feet and toe's will do it too. Just wondering if it is due to A.S. I am now being referred to a Neurologist. I just don't want to pass everything off to A.S.

Pea

i have horrible hand pain in right hand but i figure its from tendonitis and repetitive stress from using mouse. i got a roller ball mouse and try to rest my right hand when it is bad.

As my mom says. Cheer up its bound to get worse. I think with AS or similar its the truest thing that can be said

Pea: Tetany - low calcium, hypocalcemia (electrolite imbalance)
http://www.bettermedicine.com/article/tetany
Also see: http://medical-dictionary.thefreedictionary.com/tetany

Think your primary was thinking of 'Staggers' a disease which affects cattle, low magnesium: Cattle Diseases - GRASS TETANY
Grass tetany is a serious, often fatal metabolic disorder characterized by low levels of magnesium in the blood serum of cattle. It is also called grass staggers and ...
cattletoday.info/grasstetany.htm

Horses get what is known as 'tying up' that is an electolite imbalance. Got to rest em, and give electrolites. Very nasty condition. Saw a horse die with it once - owner had pushed his horse far beyond its endurance in an endurance race. The vet pulled him (fellow was a Frenchman. We were horrified. We and the vet tried to save the horse, no go.)

I also get locking fingers and toes and have to bend them back. Also get muscle cramps. Basically: Cramp=low potassium. Tetany=hypocalcemia. ALL most unpleasant. Gotta up the supplements/electrolites - loath swallowing blasted pills!

NNC: Read my prior post to Mathie re doing the Tenel's and Phalen's tests for carpal tunnel; if you get a positive then suggest that you get a nerve conduction test to confirm or rule out. Always useful to 'know' exactly what is the underlying problem then one can address and possibly alleviate. IF CT, try doing the hand exercises, might help. Also might try the CT hand support for night time use.

Cindy: Right on. Your rheumy is *ace. Wish mine had addressed my problems as yours did, I had to go the round-about route. All such a flippin bind. Sigh!

Take care you guys -

I haven't talked to him yet, we had other things to discuss at my last appointment. Sometimes I feel as though I should be inviting him over for dinner or family occasions, we talk so often. But from the posts it sounds as though this is uncommon and is not something that will go away so I'll call him this week.

In another thread here I read something about low potassium causing people cramping and muscle problems, but I don't remember who it was.
For me, I can rule out potassium as a possible cause. I am suppose to avoid foods high in potassium because my potassium levels always comes back really high.

Mathie - this is a useful site. You can explore CT, ulnar nerve probs etc. The Q&A are nteresting as well.
http://www.teleemg.com/new/cts_and_ulnar1.htm

Here's a YouTube on testing for CT - Phalen's & Tenel's refers. Plus shows exercises - though I have not checked out the exercises.
http://www.youtube.com/watch?v=xuCjuLOSFK8

You are a wealth of information! Thank you so much!