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Carpal Tunnel Syndrome ( CTS ) Info

Discussion in 'Technique [BG]' started by Fergie Fulton, Oct 6, 2012.

  1. Fergie Fulton

    Fergie Fulton Gold Supporting Member

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    This post is to highlight and relieve concerns over Carpal Tunnel Syndrome (CTS )
    There are many mis-understood things about CTS, and as one of the more frequent topics raised here on TB there seems to be many misconceptions about it....so here is a simple definitive guide to what we know and understand and what options are available to treat it....and help prevent it.

    Overview.
    We cannot stop or prevent CTS as such, because it is an anatomical problem related to life and our use of the hands based on the mechanics of hand design,( for the use of a better word), and the growing uses we now use them for in a modern world for work and leisure.
    Our hands evolved their use over thousands apon thousands of years, the last twenty years has seen that use explode, and as such evolution cannot catch up to refine the hands to account for it and never will.

    The golden rule is " mis-use and over use are the main source of problems" so identify your own areas that may present or promote problems and deal with them accordingly.
    Muscles only pull, the work in opposite pairs, as one shortens the opposite one lengthens. So in your hands when you close your fingers they are pulled closed, when you open them they are pulled open. This means that the two opposite muscle groups work together, when one shortens as in to pull the finger in, the other side must lengthen to allow it, they must also both create "a muscle tension" between the two to find and hold the correct position for the finger use.

    This is where problems occur because in playing only one set of muscles really gets targeted in small limited motion, as we always hear and read about "economy of motion". This means a constant muscle tension is used so the hand is never relaxed as such. This is why warming up and stretches pay big dividends, they re-introduce a full range of motion again and help remove un - wanted or un-used muscle tension.....again muscle tension is needed for movement, what we do not need is un-necessary muscle tension....after all with out muscle tension in your body for example, you would not stand up, you would just fall over. But sleep and rest relieve and help remove that tension....as does exercise and stretching when awake.

    So what is CTS?
    The link below explains it in simple detail better than words alone. Info starts at .40 secs.

  2. fearceol

    fearceol

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    Mods ! Perhaps this could be stickied ?
  3. Fergie Fulton

    Fergie Fulton Gold Supporting Member

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    Apologies to all that found the links did not work, problem hopefully repaired.
    It was an IOS6 problem as i believe Apple and Google have not resolved issues between the two platforms...for some reason IOS6 and Safari does not recognise certain google applications which you tuble is one of. The link repairs were done with Windows, so hopefully they work on all platforms and operating systems now.
    Drop me a message if there are any problems...the links should come straight up so hit the play button so start.

    Again sorry for the problem.

    F.
  4. Pacman

    Pacman Layin' Down Time Supporting Member

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    Endorsing Artist: Roscoe Guitars, DR Strings
    Yes it can.
  5. Fergie Fulton

    Fergie Fulton Gold Supporting Member

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    LOL took me a while to sus out where the thread had gone till I noticed it had been stickied. I would like to add that anyone should feel free to post and CTS related experiences on this thread, how it affected them, and how it was resolved so others see and realise it is more common than they think and just not among bass players.

    The info is what I consider to be the "meat" of such a physical and emotional condition. Yes it is emotional to musicians because it threatens to take away a skill many have invested in, it could rob them of an artistic output and artistic licence to create........that fear drives some strong emotions to deny the presence of CTS or to continue and it will fix itself.

    The stretches target the main areas, so those three exercises will cover the groups most likely to be affected by CTS. Yes there are many more stretches, but the three in the video are by far the best for targeting the groups that can promote the on-set of CTS problems. The other ideas for exercises just promote the idea of a healthy balanced hand.
    There are many other conditions that can promote similar symptoms to CTS, but rather than muddy or cloud the waters, I left them out, and again, they can be dealt with in the thread if they are raised.

    I would like to thank Jaconot for a previous thread,

    http://www.talkbass.com/forum/f21/carpal-tunnel-syndrome-stretches-help-avoid-ease-919880/

    and the discussions we had, which prompted me to post this thread. Part of the reason I did not do one earlier was because all the info, reports, medical trials etc, I have on the subject needed to be correlated into a simple, usable, and understandable article. Part of the problem is putting info out there, can create as many problems as those it is looking to solve.
    One such example is the ECTR Surgery V Open Surgery, it is becoming more accepted that the ECTR, all though not widely available or known about, is the better option of the two for the patient. But when cost becomes a factor, then the provider may not invest in the skills and technology to provide it, if to them Open Surgery gives the same results for them.

    Those results are the patient leaves with the problem addressed, the same as they would if ECTR was used. For the surgical side effectively stops when the patient leaves the operating table ( apart for frequent returns to check the healing process.
    This may be done by the surgeon than done the work, the GP or doctor that referred the work, or an insurance assessor for the provider that financed the surgery ).
    As for the recovery or any return of use, and a return to work, this is not a concern to a surgical team, but maybe for the company covering the over all cost and loss.
    It can be viewed that the longer recovery time takes, the more the cost to cover that period till a return to work happens becomes more expensive in the whole time-frame that is covered.
    So in short an insurance company may view Open Surgery the best option over ECTR Surgery because the initial cost can be taken into account, but because the length of recovery time cannot be accounted for, any final expence and cost cannot be truely budgeted or accounted for, because any individual case can have variables due to complication or un-foreseen circumstances.

    Yes of course the same can be said for ECTR, but because it is less intrusive, the healing process is faster so those problems that would present themselves....do so earlier, so be delt with earlier and faster, so minimising complications.
    I think you get the idea.....the less intrusive the surgery the better for the patient in general is the rule.
    So if not offered as an option ask for it, and if refused ask why, and see if it is based on budget rather than patient preference. You can get a second or third opinion on a diagnosis, you can ask for references and testimonials on doctors or proceedures so you can best judge any decision you make. Ask question and learn to understand what is on offer and what your options are..ask questions.
    In the UK for example GPs in the NHS cannot reccomend private healthcare options as it is seen as a clash of interests. One example of this was when i needed some Physio on my back, i was told it would be at least 6 weeks before i could be put on a patient list to get a consultation let alone any treatment.
    When i asked about private treatment i got to see a Physio the next morning....but i paid for it.
    The cost was minimal in the scheme of things as i got back to earning money within days rather than months....so ask questions.

    All the info is based on currently what we know and understand, so if anyone has links or info that can enhance this knowledge please post it with links, the idea of this thread is not to suffer the condition and its related problems, but face it head on and get relief...remember it has an emotional drain on the body as well as a physical one.
  6. parmezans

    parmezans

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    Damned pornography!!!

    Just a joke, this post was long awaited here at TB and it deserved a sticky, very insightful.
  7. NorCal Dog

    NorCal Dog

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  8. JacoNOT

    JacoNOT

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    Fergie Fulton, ever the CATALYST. :bassist:

    You always give us something good and helpful to think about (and keep some of us out of DEEP trouble ;)).

    I did NOT watch the medical operations videos :eek:, but enjoyed the YouTube demo of your hand stretches. It's getting cold now where I live, and after working my way through your stretches/exercises my hands felt entirely relaxed (and tired :D), but more importantly, they became quite WARM. A clear indication that blood flow is increased, and that's very beneficial.


    Three things I'd like to add:

    1) Several years ago I read that balancing front-of-hand and back-of-hand muscle exertion is important in avoiding CTS. Directly in line with the points you make, Fergie, the idea is that we're always grasping objects, which contracts the muscles in the palm of the hand, BUT...we almost never do anything that aggressively opens the hand fully, thereby contracting the muscles of the back of the hand.

    The simple suggestion was: Bring all five fingertips together (so your hand forms a shape like the head of a bird) and put a relatively strong rubberband ("elastic" for you in the UK) around the fingers, near the fingernails. Then open your hand, moving all your fingers out, away from one another and away from the center. The back-of-hand muscles work against the rubber band and after a few sets of 10, you'll really feel it.


    2. I'm a new bassist, and I still practice in the first 5 postions a lot (frets 1-5). I still have to "look" a lot, too, so my head is constantly twisted way off to the left...and my left shoulder gets seriously trashed. After an hour of practice, I usually go to the Emergency Room for a couple of X-rays...

    So here's a YouTube vid on how to prevent CTS in an office work environment (cute girl, too). The video suggests that the pain felt in your wrist nerve may actually start as far away as your NECK, and demonstrates simple stretches for the other upper-body sites where "nerve entrapments" can occur:

    a) Pectoralis Minor (chest muscle at front of shoulder)
    b) Scalene Muscle (muscle from side of neck to top of shoulder)
    c) Neck Flexor Muscle (stretch by forcing your head/chin directly backward)
    d) Nerve Flossing - MIGHT HELP COUNTERACT MY NOOBISH "PRACTICE INJURIES" (watch the vid, you'll see).


    3) And like Fergie says, the closer your hands are to their natural resting positions, the better off you'll be. I find the following to work well for me (a right-handed bassist):

    a) Holding your left elbow away from your body helps keep the left/fretting hand in a more natural position relative to wrist and forearm. And raising the headstock up a bit for more neck angle increases the benefit.

    b) Rotating the bass toward your right (so the headstock is not pointing straight out to the left, but is instead pointing out in front of you more) helps keep the right hand in a more natural position.


    Thanks, Fergie
  9. Fergie Fulton

    Fergie Fulton Gold Supporting Member

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    This is one of the most simple and effective exercises you can use.
    I posted on this concept a long time ago here on TB about the use of elastic bands to exercise the hand and more over...how to use them correctly. So I will quickly re- cap it again.

    Elastic bands come in different grades that relate to there thickness, length, and width. The idea is to start with loose then work up to a resonable tension..then stop. The idea is not to keep on moving to more resistance, but find your own resistance level then use that for ever.

    The resistance is just part of it, not all of it. Get this part wrong and rather than un-doing tension, you are re-introducing it. We have to remember it is the action that is important not the resistance, the use of the elastic bands introduces a very important muscle movement which is to relax the hand.
    It is the elastic band that closes the fingers, not the Flexors. So without an elastic band we pull open with the Extentors, and pull close with the Flexors, two very distinct actions using a balanced muscle tension.
    But with the elastic band in place we pull open with the Flexors, then relax the hand and allow the tension in the elastic band to close the hand. Then open the finger again and repeat for however you feel necessary. Watch out that the finger use is evenly spread, do not allow the thumb to dominate the stretching, in other words ensure that the thumb is not just stretching the elastic band against the combined resistance of the fingers.
    Make sure that the fingers move away from the thumb as well, and it is not the thumb moving away from the fingers that is stretching the elastic again this will cause problems at the base of the thumb...so look very carefully at the action you use.

    The elastic band should negate the use of Flexor action, since this is the one we are trying to balance against the under use of Extensors, to allow a more balanced exercise of the hand.
    In the UK the red elastic bands you find on the street, discarded by postmen, are ideal in size and resistance....and are free.

    From my point of view and personal situation, I have used many different exercises to my hands, as well as develop exercises to help in many areas of playing, as well as apparatus, with in-sight from some of the leading medical specialist in the UK.
    So very quickly here is part of my story and how a freak accident gave more insight about the body mechanics and medical knowledge I have.

    I am not a registered medical anything, all I have is over 30 years experience, study, reading and private research in to such matters, tied to the 40+ years I have been playing.

    Being a musician, especially on the road, is travel intensive, so back then before iPods, Internet, etc. we read books, and the books I read were based on anatomy, physiology and health, APH for short. A subject introduced to me in school and one that stayed with me to this day
    My situation came about as a result of a car accident in which I broke my neck and in the years of recovery and re-habilitation.
    My situation was way beyond CTS, my right arm was paralysed, and my left arm weakened. This was due to the nerve damage in my neck robbing my muscles of stimulation, and without stimulation muscles lose, elasticity, mass etc.
    But because of what I do and the information, experience and knowledge I had..I knew I could fix it to a degree of basic use if the nerve damage could be addressed.
    So as the swelling in my neck started to reduce after 5-6 weeks so the sensation returned to my fingers, and then the hard and long road to developing the hands again begun.
    Here I am over four years later, playing teaching, writing etc again, but in a very managed capacity. The nerve damage I have is permanent, but manageable because I understand its parameters. I do not have the skills I used to have, but I now use the skills I do have, I drew a line under the old playing me, and started again on the new playing me to make the most of what I get back. That was a big mental approach that helped speed my recovery because I was being positive about my situation, not negative, resentfully, self pitying...but positive because not only did I survive, but I have got arm and body use many crave but will never have because their injuries were worse than mine from the same crash situations. ( please note, lucky for me I was a passenger, asleep in the back seat after a show returning home in the early hours of the morning...I knew nothing of it till days after words and I was sort of concious enough to be told of it )

    To cut a long story short one of the devices I "developed" was this thing in the pictures below.

    [​IMG]

    [​IMG]

    [​IMG]

    Now the device looks scary, but its purpose was to exercise the hand and the hand only and was used lying down, as I was at the time, and was constantly return to, in my recovery. You can see the sweat mark on it where my forearm lay in using it. But once it served its purpose I stopped using it, there is no real benefit in continuing it ( I switched to a bucket of silversand, which is fine sand,it my fingers together, pushed it into the sand, then opened them...the weight of the sand now provided the resistance ) as it had, and was only beneficial for the use.
    What I needed was a way to move my fingers without activating other muscle groups in my arm.
    This was simply because when my upper arm moved the interconnecting muscle/nerve process put pressure directly on the area where I had the nerve damage, this in turn caused the nerve to compress and the hand shut down again. So I had to find away in which I could lie back, only use my lower arm (forearm, hands and fingers) in isolation. As I am lying on my back looking at the ceiling I cannot see what is happening, and as I cannot feel my fingers I cannot be sure anything is happening.
    So I used a mirror to see my hand, and the different colour elastic bands have me a visual reference to what finger should be responding and what fingers should not. Now the colours were a very important part of it,un-known to me at the time, as I found out later on from a neuro-surgeon.
    The colours helped reinforce my brain with a visual reference of what I was doing. The fact was brain now had another reference in as much as, if I cannot feel the finger to move, it could see it. The tied association of colour was just another sub-conscious layer being used as my brain tried to make sense of why things are not responding.

    Again to cut a long story short, I used the same idea to learn to play again. My problem now was to work out "how can I play an instrument I cannot feel"?

    This is where the similarities to CTS start.
    For me an operation to free the nerve was looked at, through MRI and CTS scans, deep nerve condition test, and action reflex tests. Because my neck was broken in the C7 area of the spine ( this is where the main nerve branch leaves the spinal column, (central nervous system) to become part of the Peripheral nervous system, which serves the upper limb amongst other things) an operation to try and relieve was ruled out because it was right on my spinal cord.
    As I was making such a great recovery, most of it under my own guidance, the general opinion was that because I have movement of source, any operation runs the risk of doing more damage than good if it has complications.

    Now this is part of the problem that applies to CTS as well, the doctors and medical team were not there to help me play guitar, they were there to see of they could improve or help the recovery to become stable. As far as the were concerned I had movement of sort, and that was good enough, because the sort of movement I had was way beyond the expectations of all, and was exceeding the prediction of the medical reports expectations. So I had to get other opinions, seek out new advice, till I got the full picture that, yes they all agree that an operation may not be any more beneficial than time itself.....I was healing, so let it continue and see how far that goes.
    So CTS sufferers may find a similar thought process, in as much as it is about the hand not its use. In this day and age an insurance company may view that because you play and instrument then you are not covered...that is may do.
    The insurance company that commissioned my medical reports for an operation had two options, one was a keyhole option to go in and try and scrape off some of the bone thickening around the fracture to see if that made an improvement. ( where the nerve passed though the bone, the fact in repairing itself the actual new bone material had closed the opening the nerve used so that was contributing to the problems I was dealing with ) Or a full open, go in through the front of my neck, move the windpipe, oesophagus, a few spinal discs etc, to come at the problem with my spinal cord to the back of the area. Rather than risk trying to pass it or work without to the front of the operation area.
    Due to costings the keyhole was ruled out because if they were to operate it would be only once and they would take the option that best suited them.....NOT ME. It seems the have a legal right to base treatment on costings to them, if they need to, rather than any costing to address the full outlying problems created by the injury. They then ruled out any medical procedure.

    So if you suffer CTS symptoms, you may have to consider not playing till it gets better, then understand and mange your life to keep its interference in it to a minimal. An operation is an option, and a good option if it fits the criteria regarding the current state of the injury.
    It's about how bad the damage is and whether it is to late for any treatment to be effective. It is also about your attitude to deal with what is needed, at some point if you do not make the decision to stop playing and rest, your body will do it for you and not give you that option.

    CTS is not the end of the world, it is a warning shot for you to modify your hand use, change or adapt to minimise its intrusion on your life.
    Not all tingles in the hand are CTS, but if you never get it checked out, if you keep putting it off, then you will never know what the problem really is, if it can be treated, or if what you do to get round it, actually makes it worse not better. A bit of a long post, but hopefully if you read that I got passed my problems, then if you suffer CTS it is not the end of the world if you are prepared to do what is needed for the sake of your hands, rather than any playing situation.....after all without your hand use any playing situation no longer becomes an issue, because your body has made the 'decision' for you and you no longer have any say in it.
  10. JacoNOT

    JacoNOT

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    That's INSPIRING, Fergie, on several levels.

    Medical issues absolutely CAN lead to insights for healing one's own body (a blessing in disguise). I know from personal experience. For me, research and application of alternative methods has worked wonders. Beyond that, I've come to believe that FAITH and GRATITUDE does the real healing. In my case, it took a serious kick in the pants to get my attention and put me on the right track. :D

    FOOD FOR THOUGHT: All the crap that happens to you is really a series of LESSONS. How you RESPOND determines what happens next.
  11. Tbranella

    Tbranella

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    I had it in both wrists...
    had open surgery for it about 16 years ago (endoscopic surgery was not an option then) and it's been GREAT ever since.
    took me about a full year to get my full hand strength back.

    I know a guy that had the endoscopic surgery for CTS about 6 years ago and he was playing bass with no problems about six weeks later!
    get the surgery if you can.;)
  12. bill reed

    bill reed

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    I had CTS in both hands and had to have surgery on my left hand as it got so bad i could not even hold a fork when eating. the strange thing was after 8 week my left hand was fine an i only ever get a little numness and tinging in my right hand now.
    again i would recomend Surgery if its really giving you a lot of bother as it made a huge diffrence to me andf that was almost 20 years ago.
  13. Fergie Fulton

    Fergie Fulton Gold Supporting Member

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    Just a quick up-date for any UK sufferers, both forms of release surgery are available on the NHS, via the GP consultation and referal services.

    According to the specialist i spoke to over the weekend (and who put me onto the link), Endoscopic surgery (keyhole) is now being recognised as a better option to use, where available, as it leads to less complications and after care via out patients services.

    Notice the wording now states,
    Keyhole surgery usually has a slightly quicker recovery time than open surgery and may cause less scarring and tenderness. There are no long-term differences in the outcomes of the two approaches.


    I have posted the NHS page for anyone looking for more info.

    http://www.nhs.uk/Conditions/Carpal-tunnel-syndrome/Pages/Treatment.aspx
  14. ahdowns

    ahdowns

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    I have CTS in both wrists and had to put my bass down. I am lucky that nerve study showed no nerve damage. Going to see a surgeon, who has a really good track record with the endoscopic procedure.
  15. duff84

    duff84 Supporting Member

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    yup carpal tunnel is no joke, i thought id never get it and just recently about a few weeks ive developed it, and its caused me to no longer be able to play as well with my fingers anymore, it actually caused me to start taking pick playing seriously and properly learn that technique, hopefuly it goes away but from what ive read it can or cannot depending on severity. This is a no joke condition. Taking pain relivers helps but the numbness and almost paralyzing feeling i get when playing with my fingers now is scary. i hope it goes away.
  16. Fergie Fulton

    Fergie Fulton Gold Supporting Member

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    CTS can be relieved through surgeries, managment or both depending not so much on the severities but the underlying causes.
    CTS is a flaw in our anatomy because the hand use we have now could never ever have been accounted for in its design and development...this is an on-going development.
    So the surgery will address the physical symptoms at source, and managment well help reduce the impact of the use.

    Take out any ideas that this is a physical limitation, what it is, is a physical variation, you have to change how you play, what you play, and when you play.
    So look honestly at what you do in life with your hands and adress that use.
    For example do you really need to practice the length of time you do?
    Can you reduce it the physical side of it, and therefore reduce the hand use?
    Do you use a keyboard of some sort?
    Are you set up correct for it?
    When driving are you gripping the wheel, holding the wheel, or touching the wheel. If touching the wheel you can control it using the hand open rather than closed in a gripping or holding fashion.

    So many ways to manage our hands use if we examine there use.

    We can suffer many neuropathies for a number of reasons at various times in our lives, from illness or disease that are temporary and contribute to any weakness we may have or are developing.
    The problem with a neuropathy is it is an underlying cause, a secondary or referred symptom, so where we feel the effects is not the area of cause.

    First stop is get a diagnosis, see a medical doctor, and get the condition diagnosed. Then look at your options, surgery is a good option in the right case using the right procedure, and look management to reduce the effects the hand use has on the Carpal Tunnel area in the hand.
  17. mrb327

    mrb327 Just say No to Tort Supporting Member

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    The gliding technique works for elbow too, as I have the same problem there (tennis elbow).

    With your arm out straight and to your side, palm up. Namely the wrist curls down and up, while opening fingers with your hand down, closing as your wrist comes up. This glides thru the elbow joint.
    Next curl your forearm in the same manner, wrist curling down on arm extension, wrist curling up with your arm curl. (Like you are lifting weights for your bicep, but empty handed)

    In my case, all my fingers go numb and I drop stuff, not awesome. These were Dr recommended exercises
  18. deckstirparnell

    deckstirparnell

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    After seeing all the info on here I can see there are several experts on the subject in this thread. I'm not trying to run anyone's knowledge down. Just speaking from experience.
    I've been playing bass a lot for 48 years and I developed CTS in both hands from I assume playing my bass up high with a short strap which worked best for me. I had the surgery on both hands in 1990 and I was scheduled for the endoscopic surgery from one of the pioneers of that method. Just prior to the surgery the endo cutters were recalled by the manufacturer so I had to go with the open method from the same hand surgeon. He stated that he could do a better job with the open method because he could see better. The scars were 1/4" long, right in the crease of my palms and I defy anyone to find them today. The band leader made me come back to work 3 weeks (recovery time supposed to be 6 weeks per hand) after the second hand was done because he thought my replacement sucked. I was a little sore but did fine.
    The moral of the story is the endo method is good and quick but don't be scared of the traditional method if you can find a good cutter. Go to a "Hand Specialist" not just an ortho Doc and don't play your bass with the strap too high. I lowered my strap a couple of notches (still higher than many play) and the rest is history. :bassist:
  19. ahdowns

    ahdowns

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    I had my bilateral endoscopic surgery 39 days ago and still have a lot of pain. My Dr. said the nerves are irritated from the surgery and it may take a while. He said it could be 3 -6 months, as everyone heals in a different time frame. Also, I am almost 67. I am on some general pain pills, one that is for nerve pain and one that is suppose to work on nerve inflammation. A few days ago I was wondering if I can ever pickup a bass again, which is a rather depressing thought. All I can do is hope for the best.
  20. joebar

    joebar Supporting Member

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    i had both wrists done over three months ago two weeks apart
    i got cut open.
    my right hand is so much better.
    my left hand is still swollen every day and i worry about it.
    forgive my language but f*****g CTS took away at least 3 years of my life and i am still not there.
    listen to your bodies-they will tell you when it isn`t right.
    do not ignore it.

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