Seven weeks ago one my neighbors’ had a carpal tunnel release. Three weeks later I met her, and she told me she still had a sore hand. She expected that the pain from the operation would have settled by then, but she was worse than ever – she was awake every night because of pain and the painkillers she was receiving were not very helpful. The surgeon had seen her, he was pleased with the operation site and was happy that the carpal tunnel had been decompressed. One of her sons had advised that she go to accident and emergency and another suggested she get a sling and stop using the hand. She was clearly asking my advice and I couldn’t resist trying to help.
The hand was slightly swollen, cool and dusky. Though she described numbness, she did not like it being touched. Most of the pain was in the fingers, the index and middle fingers in particular. I suggested some simple repetitive exercises she should do at home in addition to her other treatments.
Last week I met her again, she described resolution of the pain, restoration of sleep and function.
This anecdote illustrates and number of points I will deal with in the first of the webinars:
- Not all pain is the same
- Most, in this case all, diagnostically useful information comes from talking to the patient
- The patient is the best witness.