What to expect after a Carpel Tunnel Release Operation.....How quickly do things improve

Sorry ...correction....doctor is keen to review the left hand after a month , then do the right hand

Also , on reflection, when I say numb...I really mean when I bend the fingers , individually or as a fist they feel "big" or "swollen"...I've actually got loads of feeling in them

Do patients get confused between numb and this "bigness / swollen " sensation

I suppose the real test will be when the hand has "recovered" and I do some heavier work...ie do the symptoms "explode" or not re-occur....hopefully the latter

So it all comes down to......IN WHAT TIME FRAME DO YOU KNOW THE OP HAS BEEN A SUCCESS

To a large extent the answers depend on how bad your CTS was, and the only way to assess that really well is with a combination of physical examination and nerve conduction studies - mostly the latter except in extreme cases. Did they carry out any nerve conduction tests before taking a knife to it?

If you had a grade 1, 2 or 3 CTS before surgery then the effect of surgery on symptoms would usually be instantaneous. People who have been waking up three times every night with CTS symptoms come back to you and say " You know doctor the night after the operation was the best night's sleep I've had in ages", so in these cases you expect tingling and pain to resolve straight away. Loss of sensation is usually slower to recover but that is less common in grades 1-3 anyway. If you had a grade 4 or 5 then you expect the change after surgery to be more gradual with the grade 5 cases sometimes continuing to improve for up to a couple of years after surgery. Unfortunately you cannot reliably distinguish grade 1 from grade 5 by examining the patient - by the time you can detect obvious muscle wasting and weakness you are pretty much into grade 6 in many cases and the grade 6 cases do comparatively poorly with surgery with less than a quarter being 'cured' by surgery. This is one of the reasons I recommend tests before ALL carpal tunnel surgery.

The sensation that the fingers are like sausages is very common in CTS and the English language is sometimes a rather poor tool for conveying what subjective sensations feel like so yes there is lots of scope for confusion in explaining symptoms to another person.

The best general advice I can give on web is - if it does not overall feel significantly improved 4 weeks after surgery then go and consult someone about it and get some NCS done to compare with your (hypothetical) pre-operative ones. JB

I was quite pleased to read your experience. I had my stitches out on 31 January and still have a very numb thumb and slightly numb first and second finger. I can't hold anything heavy or make a proper fist - when i try i get a pain from the middle of my hand up through my wrist and into my forearm. Was expecting instant results but on reading further, I had a 5 in my right hand and it appears that can take some time to return to semi-normality, so I'm trying not to stress about it. I just hope the shooting pain dies down soon and I can start using the hand properly. Having said that, the constant pins and needles experienced before surgery have totally gone which is wonderful.

Thanks Doctor Bland

Unfortunately no conductive tests were done.

I think I must have been in category 1-3 , because once I stopped the physical labour and wore the splints the pain stopped and I could sleep quite normally

I will wait till the end of Feb and review improvements / what to do

I had the left hand done first as it was the worst.....it feels at this moment , the same as the right...so possible subjective improvement in the left. In fact both hands are significantly better than immediately post the "physical labour" that sparked the severe symptoms. Infact sat still ,as I am currentlly ...both hands have the "bigness" "stiff" feeling (when balled only) and the ends of both thumbs tingle a bit . I'm sleeping with no problems/pain

I suppose the proof of the pudding would be what happenned if I did something really physical with the hands....ie did the right hand go berserk and not the left....but I will wait till the end of Feb before doing this

Anyway ...for everyone else...MORAL OF STORY>>>>>HAVE THE NERVE CONDUCTIVE STUDIES B4 SURGERY so you can assess progress afterwards

Alliejc

Your only 2 days post op.....I had a restrictive bandage on for 5 days after the op....I certainly couldn't ball my fist or lift anything heavy....I can ball my fist now , and thats when I get the "swollen" or "big" sensation...no pain

Now over 2 weeks later I just helped bring the shopping in and couldn't carry a large box of washing powder in , grasped in my left hand....I think strength takes time ...my Doctor here has advised normally succesful patients return to work after 4 weeks....which ties in with Dr Bland's comments

Good luck

Alliejc - if you are still getting those shooting pains up the arm 6 weeks after surgery we will take a look at it with the ultrasound scanner just in case there is evidence of adhesions of the nerve to the scar tissue - let me know how it goes please. JB

Jaynealex - You really cannot judge the neurophysiological grade from the symptom pattern so this could have been anything from 0-5. It sounds as though it did show some response to splinting, which is nice to hear, and I would wonder in these circumstances whether surgery was really necessary - but if you consult a surgeon with CTS you are likely to end up having surgery. JB

Thank you. I will keep you posted in the next few weeks.

Thanks Jaynealex, i am just over 2 weeks post op and the same as you, can't grip anything heavy so i'm sure that will improve in time. I'm due back to work next week - just hope I can use it a bit more by then. Good luck yourself.

I am also concerned about lack of improvement of symptoms after surgery. I had surgery on my left hand 5 days ago and although the wound is healing well my symptoms haven't improved (not perceptably anyway). I still have a mostly numb middle finger and a semi-numb 2nd finger and thumb.

Three months or so ago this hand was diagnosed with grade 3 CTS. Since then it hasn't really worsened except that the symptoms changed from on and off tingling to constant numbness/semi-numbness as described. Moreover, I had surgery on my right hand - which was diagnosed as grade 5 - and this improved almost straight away after surgery.

Do you have any advice apart from just waiting for 4 weeks? I have a stress-ball which I was encouraged to use after surgery but using this makes my numb fingers tingle and I don't know whether this is a good thing or not.

Any pointers/suggestions would be much appreciated.

Many thanks. DH

I would not start manipulating a stress ball until the scar has fully healed - usually by about 2 weeks post-op. Keep the fingers moving though - the idea is to keep the tendons to the fingers sliding backwards and forwards through the carpal tunnel to prevent them getting stuck in place by adhesions forming as a result of inflammation after surgery. You say that the left hand symptoms have not changed at all after surgery. There is no hard evidence to help guide what to do in these circumstances but my best guess as to a policy at present is that symptoms should be initially reviewed 14 days after surgery and if there has really been absolutely no change at that point then it is probably worth repeating the NCS - though you might modify this somewhat if it was grade 6 before surgery (who gave you the grades by the way? - I am always curious as to who else is using the grading system apart from Canterbury). If there has been any improvement in symptoms at 14 days then a review at 3 months seems to be a good time to assess progress. Milder cases should be essentially resolved by then and even grade 4/5 should have shown considerable improvement if al has gone according to plan. JB

Thank you for your swiftt response and the advice.

I will wait until two weeks is up before I decide to do anything such as ask for repeat NCS. Hopefully there will be an improvement by then. The grades were given by Dept of Clinical Neurophysiology at Kings College Hospital.

Re keeping my fingers moving - I take it that typing would be included in this?

My personal view is that a little typing on a modern elecronic keyboard should be OK within days of surgery and should not be discouraged unless found to be painful, though I probably would not want to be doing an intensive 8 hour shift. Grading from Kings should be accurate as I do work there as well! Let me know how it goes please as I have an interest in using ultrasound imaging to assess the outcomes of unsuccessful carpal tunnel surgery and can see you if necessary as you are in Kings catchment area. JB

Thanks v much for the offer. I will certainly keep you posted.

Re typing just so long as I'm not putting my recovery in jeopoary by going back to work which I intend to do tomorrow - this would involve a moderate amount of typing although I can limit it by using the phone instead of emailing and using the mouse with my other hand as much as possible instead of the keyboard. DH

Sounds like a good plan. To be honest, for most modern employment, the biggest issue in getting back to work seems to be driving to get there, though obviously for heavy manual occupations it is the job itself. JB

I had my stitches out yesterday - it's now 15 days since the op. The symptoms are pretty much the same, my middle finger is still quite numb. If anything there has been a very slight improvement but it's difficult to say really.

Should I wait a bit longer? My doctor's view was that it could take quite a while for the nerve to recover.

Is there any reason not to start to use a stress ball now, despite the symptoms remainnig?

If the scar is fully healed then there is probably no reason not to use a stress ball but that will not help CTS symptoms of course. Your doctor is right that numbness (loss of sensation) can take some time to recover but if the entire symptom pattern (not just numbness) is completely unchanged compared with the pre-operative studies and it was only grade 3 to begin with then I would be concerned about the operation and inclined to re-test it. In your case we have the additional bit of information available that the previously operated grade 5 hand actually recovered much more quickly if I understand correctly. JB

Thanks for the advice about the stress ball. I should say that my CTS is due to inflammatory arthritis. It came on very quickly in both arms starting in early March with a few tingles and getting rapidly worse within a few weeks to the point where I was forced to buy the gloves to wear at night. I was tested in April (date of the 2nd and last assessment was 23rd April) but after that it developed im both hands to the point where I no longer got tingling in either hand and instead there was just numbness and pain. The pain was much worse in the right hand (grade 5) whilst in the left hand the main symptom became numbness. The left hand is still a bit painful to use but I guess that's inevitable after the op. So yes the entire symptom pattern has remained very similar but mainly becoz the main symptom is numbness. And yes as I said the numbness went away straight away in the right hand when it was operated on. DH

OK - if that was my hand I would definitely book a re-test at this point, preferably with ultrasound imaging as well. You are not my patient as such however and I cannot tell your doctors what to do. They can quite legitimately hold their own opinions on the best course of action. JB