Are We Ever Really The Same After an Injury?

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July 8, 2013

The statement is often made by patients I see that “I know I’ll never be the same as I was before the injury”. This is usually not a correct assumption. Though there is not an absolute relationship between stage of disease and magnitude and quality of correction, early treatment in general yields the best results depending upon what is being treated. In the case of nerve injuries, we are predominantly treating nerve entrapment syndromes where pressure is applied to a nerve such as carpal tunnel syndrome, cubital tunnel syndrome, and tarsal tunnel syndrome. The majority of people who are treated end up with no residual complaints or impairment. The longer a person has pressure upon a nerve the greater the potential for nerve cell damage. A co-existing illness such as diabetes, alcoholism, and advanced age may affect both the delay in presentation to the doctor and the results of surgical treatment. Thus, it makes sense to offer definitive treatment earlier in the course of an ailment rather than waiting until the symptoms and physical findings become severe. Placebo treatment in the treatment of carpal tunnel syndrome such as wrist braces, vitamins, copper bands, crystals, liniment (“carpal tunnel cream”), and PT (exercise of the wrist), which have no proven long-term benefit, just prolong the duration of pressure on the nerve and the potential advancement of the disease. The magnitude of this problem cannot be highlighted better than in the case of cubital tunnel syndrome wherein the ulnar nerve is pinched in the retrocondylar groove or just beyond it as the nerve enters the flexor carpi ulnaris at the elbow - Early symptoms of tingling intermittently and perhaps some clumsiness progress into continuous numbness and weakness and ultimately there is measurable weakness, profound numbness, and muscle wasting (“claw hand deformity”). People with objectively verifiable weakness and profound abnormalities of sensibility often times do not get completely back to normal or take at least a couple of years to achieve that normalcy. Muscle wasting never regenerates in the case of ulnar nerve entrapment at the cubital tunnel. It is of paramount importance to establish the correct diagnosis early, thus we must encourage people to be seen early, we need to examine them thoroughly and outline the choices and recommendation based on the available science.