Post-op problems
It is nearly 2yrs since I had an open bilateral carpal tunnel release procedure done. The condition was diagnosed on EMG but I never had positive symptoms on the test where the Dr bends the wrist back. No x-rays or scans were done prior to the op. The post-op recovery seemed straightforward. After my 3 month review I was given the go ahead to return to full actvities. I routinely have to lift weights up to 25kg and carry out heavy manual work. Once I started heavy work it triggered a lot of pain. Initially I was unconcerned as I thought that I probably just needed time to rebuild strength etc. However 2yrs on I have constant moderate pain. I have pain on the palm of my hand at the base of the thumb close-ish to the wound area and I can feel a lump there. I also have pain in the palm side of the wrist below the scar. In addition certain combinations of wrist and hand movements trigger intense electric shock type pain. Strangely the pain is in the same position on both hands. I have weakened grip and clumsiness in both hands. I find it hard to hold things such as a paint brush or steering wheel. On the upside I rarely get tingling now. I saw the surgeon again today who requested x-rays which were clear. I mentioned concern regarding swelling around the scar area but he said that the swelling seen was not exceptional and to be expected. He said that I had two options; one to carry on and put up with the pain or secondly to change my occupation. He said that I needed to give my hands at least 3 months rest (not feasible without losing my livelihood). I asked whether there was any diagnostic test that could be performed to identify the cause of the pain which might then indicate some way of treating it. He said that there was not. Currently I just try hot and cold treatment and wear wrist splints at night and when doing heavy work. I take paracetamol since NSAIDS cause GI symptoms. I am in my mid 50s and otherwise in good health apart from some osteoarthritis. I have requested a second opinion and he has recommended one of his colleagues at the same centre.
Straight to surgery and with no other diagnostic tests apart from EMG and a physical examination. The EMG indicated severe compression but the surgeon felt that my problem was moderate based on physical examination. I was having a lot of numbness and tingling and reduced grip strength . I had had tingling for over 15yrs on the right hand as I had seen my GP about it at its onset but she did not think it was a carpal tunnel problem and I was not referred. In fairness, as I said above, the test where the physician bends the wrist back was negative. The left hand was a more recent onset of numbness and tingling that came on at the same time as a sudden episode of foot drop and numbness and tingling in my feet! I was sent for EMG testing because of the footdrop. My hands were tested at the same time and my GP recommended carpal tunnel surgery due to the severity of the findings.
I had been sleeping in wrist braces for several months prior to the surgery though as I had seen this recommended on the internet.
On the positive side the x-rays showed no signs of arthritis in the wrists or thumbs. As a change in occupation is not feasible I guess it will just be a case of grinning and bearing it. I assume that I will not do further damage by carrying on using my hands as normal as they still "work" but just hurt a lot and have reduced strength.
The simultaneous development of a foot drop is an interesting bit of history - did they find an explanation for that too? The wrist bending test is pretty unreliable so I would not set too much store by that. One of many interesting studies that could be done would be for someone to look at whether patients who have had carpal tunnel surgery have an increased rate of development of wear and tear arthritis in the wrist in the long term - especially with continued heavy work - but no-one has done this as far as I know. JB
No explanation of the footdrop which resolved spontaneously over several months and has not recurred.
Many thanks for taking the time to reply.
From the description I would guess that you are describing the side effects of severing the transverse carpal ligament in order to release the nerve. This changes the structure and mechanics of the wrist joint and seems to lead to this sort of problem in some patients. Fortunately in many people who get this after surgery it does improve with time but some cases are persistent and difficult to treat - yours may be in this category after 2 years. I recognise the description of sudden electric shock like pains triggered by unpredictable movements of the hand from quite a few patients - some before surgery and some after but rather more of the latter. Your surgeon is right that there are no obvious diagnostic tests for this - it is mostly a matter of ruling out other problems. X-rays can show evidence of arthritic change and repeating the nerve conduction studies can confirm that the nerve has been released successfully. I am still learning what the ultrasound imaging can tell us in patients with post-operative pain but it is clearly not an easy answer to all our problems in diagnosis.
A second opinion is not a bad idea. There are case reports of attempts to reconstruct the transverse carpal ligament and of interposition of a fat pad or muscle between the nerve and the scar to try to reduce nerve sensitivity but these procedures have not been conclusively shown to be useful I'm afraid and are really the territory of specialist hand surgeons.
Out of curiosity - did they try anything else for it before operation or did they go straight for surgery? I remain curious about policy in other places. JB