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I drive 18 wheelers for a national "package shipping" company. In November 2014 I fell out the back of a trailer while delivering some freight to a customer. I attempted to catch myself and severely broke my wrist and dislocated my distal and unla bones in my arm. My physical therapist says it's the worst wrist break she's ever seen. I have pictures of the x-rays if you want to see them.
I had surgery 2 days after the fall and had been in recovery since then. I had been going to physical therapy 2–3 times a week along with doing an hour every morning and night by myself at home. After a month and a half of this with seeing zero improvement I was beginning to get concerned. My hand was still numb and I had about 10–20% range of motion in my forearm.
After reading about CTS I believe the entire time that I thought the numbness and swelling feeling in my hand was just from recovering from the break was actually CTS but I didn't realize it because it probably happened when I broke my wrist.
I ended up having a nerve conduction test done and I had "severe" carpal tunnel. I'm guessing that means I was a grade 5 or 6 – don't know which one exactly.
Sooo, last Monday I ended up having another surgery for carpal tunnel and also the Ulna shortening procedure done at the same time. I understand that with my CTS being severe that I am still going to experience numbness. My fingers do move better, my only concern is that my hand still feels essentially the same as before the surgery. But I guess that's expected because of the numbness?? Also my fingers still feel stiff even though I can move them.. It's kind of hard to explain.
Any idea how long this numbness may last – and when/if I do get feeling back is it going to come in the form of tingles and pain like when I first GOT CTS?
Looking forward to your response
Thank You
I finally got my nerve conduction test results. Is there a way to attach a file instead of re-typing everything? There's a lot of info.
If not, what information exactly do you need?
Thanks
If you want me to take a look at them the best thing to do is scan (or even photograph nowadays) them and email to me. I can then post a comment on them back on here. Email address is in the section of the site Info for Kent Patients - Contacts. JB
Thanks for sending me those. I guess this is from the USA as only the right side has been tested. It's good to see the lab's normal values in the report though. They show a grade 4 CTS in the right hand and normal ulnar and radial nerves for comparison. I gather we are now about 4 weeks post surgery and if they were repeated at this stage I would be expecting to see some improvement in the distal motor latency. However you did have quite severe sensory abnormalities and it's probably expected that the numbness may be relatively slow to improve. This is a situation in which I think repeating the NCS can be reassuring as they can show that recovery is occurring before you necessarily feel any great difference but I suspect that many of the organisations paying the bill for the test might disagree with me. As long as it doesn't actually feel worse I would be inclined to sit tight and wait to see what happens to this for a while. Surgeons I have spoken to about this generally seem to wait about 3 months before they start to get concerned about slow recovery - it's one of many aspects of the treatment of CTS that deserve some more research really. JB
Thanks a lot for your informational response. Yes, you're right.. I do live in the US. It's good to know it was "only" Grade 4 CTS. I was thinking 5 or 6 which I know 6 doesn't always have the best healing percentages. The surgery was actually 1 month ago today. Fingers are still numb but do feel different so I will give it a couple more months.
Thanks again.
- JH
CTS is quite a common complication of wrist fractures so that's a very plausible story. Sadly my colleagues around the world are highly inconsistent in the way they use words like 'severe' when writing electrophysiology reports - to the extent that one eminent electromyographer has suggested that expressions of severity should be banned to avoid causing confusion. My approach is to use a neurophysiological scale which has tightly defined meanings for each grade but relatively few labs use it, even though it was designed to be 'portable' between labs with different normal ranges and different test protocols for CTS. The upshot of that is that we cannot know quite what your electrophysiologist meant when he/she said 'severe' - though if we could see the measurements we could probably have a pretty good guess at the grade. It could probably have been anything from grade 3 to grade 6, though the presence of permanent numbness before surgery does tend to suggest a higher, rather than a lower, grade, That range covers a widely differing prognosis. Grade 3's usually recover swiftly and generally completely, grade 6 cases take a very long time to recover sensation and muscle strength in the thumb, if they improve at all, though tingling and pain usually settle quickly even in grade 6.
At present then the lack of change after surgery means one of two things - either it really was grade 5/6 before surgery and is simply being slow to recover OR they haven't succeeded in taking the pressure off the nerve. The most useful thing in trying to distinguish those to begin with would be your pre-operative nerve conduction result if you can get hold of them. If we are seeing slow recovery from grade 6 then you might well go through a period of tingling/pain during recovery JB