"This is an Archived Ergoweb Forum page -- Submissions are no longer possible"

Home Forums Medical Management Typing pain even after surgery for CTS. Suggestions needed for painless typing

This topic contains 26 replies, has 16 voices, and was last updated by  glen_smith 10 years, 10 months ago.

Viewing 12 posts - 16 through 27 (of 27 total)
  • Author
  • #39172


    You may be right Mark but a good therapist as you have mentioned should be able to evaluate the upper quarter for any possible trigger point involvement. We relieve upper extremity symptoms including the hand on a regular basis that are caused by points in the scapular area—note the referred symptom patterns documented by Travell and Simons.  Might be worth looking into.





    Yes, I think that it is scar tissue and adhesions about the ulnar nerve that Dennis is dealing with.  While I cannot disagree with your assessment that muscle tension and the effects of static posturing, etc., I think that, at this point, the best thing that Dennis could do is seek qualified treatment.  It is probably more confusing and frustrating just getting information from folks like us over the Internet.  Also, don’t overlook the workstation, and get an ergonomist to look at that, too!




    Hi Dennis,
    As an ergonomist and a chiro with 26 years experience, can I suggest that you get your first or second costo-vertebral joint adjusted by a chiro. Trigger points in the levator scapulae, rhomboid, subscapularis and trapezius can all cause ulnar radiating pain. These trigger points with vertebral fixations can result in ulnar nerve irritation.Forward head posture and lateral scapula movement( round shoulders) all reduce the thoracic outlet that can result in your symptomatology.
    I agree with other authors that you need a thorough ergo assessment with regular micro breaks.

    Good luck and find a chiro familiar with upper thoracic biomechanical issues.




    The type of symptoms Dennis is talking about are similar to those we treat daily with great success. Read the first 80 or so pages in the text written by Travell and Simons and you’ll note the exact pattern of symptoms he’s reporting may be from specific muscles in the scapular area. In their text T&S list common diagnoses that are often actually muscular trigger point problems and this is what we see regularly in the clinic and treat successfully, in many cases after the symptoms have been present for years or even decades. Check out the referral patterns in the text and you may be surprised to see the similarity to CTS,TOS, sciatica and others. Not everything is muscular but it is often overlooked and easily treated. A brachial plexus problem should be exposed with testing and hopefully would have been by now. Trigger points develop as a result of various stimuli including static muscle use as you stated, trauma (including surgery) —basically any pain source will do it over time.  I think it would be a mistake to assume an entrapment as we see paresthesias  ( and T&S thoroughly document them) on a daily basis from trigger points. Hopefully he’ll find a practitioner that will do a comprehensive eval  and fix him.


                                          Appreciate your thoughts,   Kurt



    Also I forgot to mention this (of course) I had a partial clavical resection about 10 years ago. I had separated and dislocated my shoulder a few times and i started to get a protein deposit on my clavical from all the grinding of the bones so they took 2 centimeters off the clavical and cut out the protein deposit. I am pretty sure that is what they did but it was so long ago i have forgot. since then my left shoulder has sucked big-time. I cant sleep on that side, etc. this is the same side as the ulnar nerve resection was done.

    Funy huh?

    Anyway I am going to look for a specialist I think to address this issue.

    Thank you all for all of your information you have provided.



    [private user]

    Hi Dennis,
    I feel for you (no pun intended)  My first thought in reading this was Dragon Naturally Speaking.  I really think you should consider VR Software.  Have you given it any thought?



    Dennis —

    I am reading these posts from over a year ago and wondering how you are doing now, and what interventions you used? From all these suggestions, I would be interested to know what (if anything) helped. Thanks.

    MSteed, OTR/L



    Good morning Dennis

    Interesting question in that it is a very commonly posed one.  The issue here as I see it as both an Ergonomic Consultant and Physiotherapist is that of pain versus function. 

    It may help for you to commence reading some articles about chronic pain which can occur long after healing has occured even post operative healing as is the case with your CT Release surgery.  Your issues are more that of learning to live with and cope with on going pain as thousands of people do across North America.

    Surgery corrects or tries to correct the underlying mechanical reasons for your symptoms such as loss of muscle mass and strength, loss of sensation.  The goal of surgery is not foremost to be altering pain levels as it is the brain which interprets pain not the hand.

    Over time and with some of the ergonomic suggestions provided to you this may improve.  In the interum start wtih some reading by Melzack & Wall who first started the research about pain and the gate theory of pain out of the University of McGill in Montreal.

    Best of luck with this – this is a matter of changing your thinking about the presence of pain – keep your functional  levels as high as you can with work, play and day to day life, despite the presence of pain.

    JE Sleeth Sr Ergonomic Consultant, Orthopaedic Physiotherapist




    Hi Dennis,  Sorry your surgery didn’t fix the problem. I’m an orthopedic PT with 28 yrs of experience, so-owner of  3 clinics in northern WI. I see cases similar to yours fairly often (sadly). I suggest you search;  trigger points, Travell and Simons, Dommerholt, Gerwin, Shaw among others for information on trigger points and the many referred symptom patterns related to them. A recent patient of mine had a diagnosis of CTS confirmed by EMG, severe right and moderate left wrists. Contrary to her surgeon’s opinion she suggested trying PT. I released many points in the upper back and forearms over the next ~4 weeks and she was symptom free. Actually she stated she couldn’t wait to go back to tell her surgeon.  If you look into the concept of trigger points and their referred patterns you’ll get a glimpse of what we see on a regular basis. I’d be happy to discuss this with you in detail if you like.

    Kurt Klemm PT  Cert MDT  CEAS 



    HI Dennis – here is the best advice which many health professionals tend not to tell you from a prognostic perspective;  do not expect to be pain or symptom free just because you had surgery.  This is rarely the case as surgery like any treatment is not a panacea for MSI issues.

    And don’t forget if you have returned to the same activities and same set up at your workstation then you will of course encounter similar physical issues as before – the surgeon cut the ligament at the carpal tunnel but don’t forget scar tissue then forms in the area which acts like the ligament all over again.

    So, 1. manage your expectations of how you should be feeling and do not expect to be pain free all of the time 2. make sure you have an ergonomic expert assess your workstation and job demands – and to then make cost effective changes for you which may include alternate pointing devices, voice recognition software etc. 3; check with your Physiotherapist to see if scar tissue is interfering with your healing & functional process

    Best of luck – let me know how you do with this.

    JE Sleeth Senior Ergonomic Consultant OPC Inc http://www.optimalperformance.ca


    [private user]

    Read about thoracic outlet syndrome and double crush syndrome.




    All good advice above another good read is the Mayo clinic book on chronic pain. Have you looked around for a clinic that specialises in chronic pain management? Depending upon the ‘type’ of chronic pain that you have can depend upon the treatment modality.

    E.g. (grossly simplified)

    1 myosfascial=muscle and fascia winding up

    2 central sensitisation=changes in the brain resulting in the brain ‘misinterpreting’ the signals it receives

    3 Neuropathic =damaged nerve

    4 Etc

    If you treat central sensitisation the same as myofascial pain you can exacerbate the pain.

    Research has identified acceptance as the biggest factor with chronic pain, if you cannot find any other way to manage the pain. E.g. myofascial treatment works and the pain goes away.

    Grading of task so that you do not have the all or nothing situation occurs is also important. Frequently people with chronic pain will perform a task in excess of what their body is now capable of and then spend a number of days in bed in pain.

    The Mayo book explains the problems quite well as this is a very complex area to treat with other issues the often need to be addressed. There is also a good book that is available her in Australia if you want the title I can see if I can find it.


    Cheers Glen
Viewing 12 posts - 16 through 27 (of 27 total)

The forum ‘Medical Management’ is closed to new topics and replies.