Post-surgery Pain
Hello Dr. Bland,
I had bilateral open CTR one month ago and I still have considerable pain that I am increasingly concerned about. In addition to the pain, it is causing me anxiety and would very much appreciate your opinion on my recovery status.
My surgery appeared to be without complication. I had what I considered fairly minimal pain in the 2-3 days post-op. The incision site was quite sore and I basically couldn't use my thumbs, pinkies, and ring fingers. I also felt stinging pain proximal to the incision when bending my wrists or fingers more than just a little bit. My left hand was less functional and more painful than my dominant right, but both hands exhibited these symptoms. This all seemed pretty normal right after surgery.
When I removed the bandages after 48 hrs, as instructed by my surgeon, I discovered my left hand incision had bled a fair amount into the bandage and my entire palm showed bruising. There was no external bleeding and very little bruising on my right hand. On days 4-6, my range of motion continued to improve, but there was no improvement with the stinging/burning in my wrists and palms. I attributed this to my needing to use my hands to do some necessary tasks of daily living, as I live alone and had no choice. I also spent a fair amount of time using my computer, as there was little else to do and my "mouse fingers" were reasonably functional.
At my return visit with the surgeon to remove the stitches, I told him about the burning/stinging pain not getting any better and he said that's to be expected during recovery. I was able to make a fist and range of motion was improving noticeably, so I was not overly concerned at that point and he seemed pleased with my progress. I asked him if there were any exercises or stretching I could do to help speed along recovery and he said 'no', but did write me a referral for physical therapy if I felt it was necessary in a week or two. Also, the numbness I experienced while driving prior to surgery was noticeably absent, so he said that's an indication of success.
The next 10 days showed continued improvement in range of motion, though very slow progress on pain when using my thumbs, pinkies, and ring fingers and also when putting pressure on the incisions. The burning/stinging pain in my wrists did not improve.
In week 3, the burning/stinging became more frequent and this was when I started to become quite concerned. I was able to see a PT on week 4 and she started me on a program of tendon glides and scar massaging. I've been doing this for the past few days with no improvement (if anything, my fingers ache a bit from this, but it's fairly mild).
Today, I still have soreness and limited use of my thumbs, pinkies, and ring fingers, though I'm able to perform most tasks not requiring strong grip/wrist strength or considerable wrist flexion. My palms are still sensitive to pressure and am unable to push myself up from my chair or do pushups, etc. These symptoms are now improving at a seemingly glacial pace. However, the most troubling to me is the burning/stinging pain in my wrists (particularly my right hand) has not improved at all and may actually be getting worse. The pain isn't constant, but gets worse the more I use my hands and seems to be getting more frequent. From what I've read on the internet, this appears to be symptomatic of nerve damage?
My apologies for writing such a lengthy post, but wanted to be as thorough as possible describing my situation. If you would be so kind as to provide your opinion about the symptoms I've described, I would be very grateful. I'm hoping this is all within the normal range of recovery, as I've read that certain pain issues can takes months to finally resolve, but I've also read that my symptoms could be indicative of nerve damage and/or "Regional Pain Syndrome" and, if so, should be treated sooner rather than later.
Thank you in advance for your time and any opinions you are willing to share.
Best regards,
jjones
PS: I never had any of this type of pain prior to surgery. Numbness was the primary symptom and finger/hand ache with overuse was secondary. Also, nerve conduction tests indicated I had "moderate-severe" CTS.
Thank you so much for your response, Dr. Bland. Yes, my original symptoms have improved, so that's definitely a good thing. The pressure sensitivity on the incision feels like I have a small walnut in my palms when I press down on a flat surface. Could that be an indication of excessive scar tissue or is that a normal sensation from the incision? I'm also unable to flex my wrists/fingers back far enough to do a pushup (though it's close). Stretching my fingers back that far causes a sensation of tightness in my palms and wrists and with it the stinging/burning pain. I've been trying to stretch my fingers and wrists ever since the surgery to make sure I retain full range of motion. Also, when I bend my wrists inward, there is a feeling of pressure and tightness on the inside of the wrists at the point of maximum flexion, though no stinging/burning sensation.Making a fist is not a problem, though my fingers do feel a bit tight. My PT felt that I had good range of motion for being 4 weeks post-op, but of course anything less than full use at this point is troubling to me.
In regard to the stinging/burning sensation in my wrists and around the incision (really, most of my palm around the incision, but particularly on the incision itself), it is definitely better when I immobilize and rest my hands. I also continue to ice them, which provides good pain relief. Something that seemed odd to me when I discussed this with my surgeon at 8 days post-op is that he said the reason why I still had pain there is due to him cutting tissue above the incision into my mid-palms and also well below the incision across my wrists to maybe an inch or so below my wrist creases. It was my understanding that the only cutting would be of the carpal ligament, which I thought pretty much ended at the base of the palm, so I'm not sure what meant by cutting beyond that point. Does that make any sense to you? I have an appointment to see him again in a few days and will definitely ask him more about exactly what he did in there. In the meantime, do you think it could be productive to splint and rest my hands completely for a few days to see if there's any improvement?
I will admit that part of my extended recovery could be my fault, as I've been using my hands more than I should have ever since the surgery. Like I mentioned previously, I live alone and there are certain tasks that must be performed as part of daily living that caused considerable pain, but were necessary in my situation; the same kind of burning/stinging pain that I still feel today. In retrospect, I was perhaps naïvely/foolishly of the mindset that this type of surgery had very little risk of complication outside of the surgery itself and didn't think I could be putting my recovery in jeopardy by performing tasks that caused pain. What kind of risks/complications are there if the hands are overused in the days following surgery?
Lastly, other than asking my surgeon to explain exactly what he meant by cutting well above and below my incision, are there any other questions you suggest I ask at my next visit?
It's a difficult one to advise on. I suspect most of these symptoms are essentially related to the local trauma of the surgery. Different surgeons do different amounts of dissection and general interference in the area during carpal tunnel decompression, even though procedures such as internal and external neurolysis have generally fallen out of fashion. I also don't know for sure how much difference it makes what the patient does in the few days after surgery. What little decent evidence there is suggests that early mobilisation is not a problem - though you probably don't want to be doing very strenuous things that risk tearing the scar open. I would proably be inclined to continue with gentle exercise and massage myself, at least in the absence of any definite evidence of anything specific to treat but primarily I think you have to be guided by someone who can see and examine the hand. JB
That sounds like good advice. Certainly part of my immediate concern is exacerbated by increasing anxiety over my condition. I'm hoping to get some good direction and reassurance when I see my surgeon again, which will be soon. If not, then maybe it's wise to get a second opinion if my symptoms don't start to improve.
As others have commented, you are providing a very helpful and much appreciated source of information on a subject that seems to have very limited information available. Thank you for caring so much about all of us!
Best regards,
jjones
Thankyou. A part of the problem, as someone else observed, is that there is too much information out there on the internet and the ordinary reader has few resources to help them tell what is good and bad. Let me know how your story turns out please - it's a rather unusual one so if it gets better that will be reassuring next time I meet it, or if an explanation (or even treatment) is found then that will also be useful for future reference. JB
First of all if like to say thank you to Dr Bland for all the info posted on different posts on this forum, I have read a few posts after my carpel tunnel release and found them very interesting.
I have the exact same symptoms as JJones in my right hand and I had my opp back in September 2015(5 months ago), I am still having the burning and sharp pain in my wrist and the same pain as JJones in my palm. 5 months post opp and the swelling in my hand is still there but not as bad as one month ago(it took 3 months for the swelling to start to subside).
I've had my post opp conductivity test done and it appears to have been fixed. I have constant pain on the edge of my palm below the pinky finger and thump. I have been off work since and have been told I might not be able to go back to my normal job as an electrician, does this sound correct or will I be able to get back to normal duties?
2 weeks ago I stopped taking pain killers as they were making me tired and depressed, and I was relying on them even though they weren't helping with the pain. Not long after stopping them I started getting angry, anxious and down right unbearable. My Dr gave me a referral to a phycologist which I'm hoping to make an appointment with this week.
My original problem was numbness and pins and needles in my right hand, the surgery fix this but left me with more pain than I was post opp. Is it common for the pain to last this long? I did everything physio and surgeon told be to do, I still see the physio 3 times a week which has improved my movement(still not 100%) but he can't do anything for the pain.
Thanks and hope to hear back soon.
GeorgeH
The general surgical view is that 'most' of these instances of prolonged pain related to the surgery resolve in time but I can't get the surgeons to put any definite figure to what 'most' means. There are now a handful of people who have come on the site here with this problem over the nearly 5 years since we went online so it might be worth us trying to email them all for a long-term follow-up. There are a few surgical papers which claim to report long-term outcomes but they are surprisingly unhelpful when it comes to your particular patient group.
In answer to your final question, no this is not 'common'. You are one of quite a small minority of CTS surgery patients who still have this much of a problem at 5 months. So far as I can tell at present this is mostly a matter of bad luck I'm afraid. As for treating it, as I said to Jones, it is largely an evidence free area - no-one really knows the best way to deal with it so almost anything is worth trying. JB
If I have this right then the original CTS symptoms have definitely improved, which suggests that the transverse carpal ligament has been successfully divided - the most important first thing to establish? The pressure sensitivity on pushing up on the palm/heel of the hand is recognisable and is probably a side-effect of the act of cutting the ligament referred to as pillar pain - that is common but fortunately only a long-term problem in a few patients. More puzzling is the stinging/burning, which you seem to be describing as being in the wrist proximal to the incision? That is an odd site for nerve injury and sounds a bit more like a local problem directly related to the surgery though it's a bit of a hard problem to analyse. I wish my colleagues wouldn't use terms like 'moderate/severe' in describing nerve conduction results for CTS - these terms are so vague that you can't really know what they found. A month after surgery, faced with a patient with persistent symptoms I would repeat your nerve conduction studies and take a look at this with ultrasound, just in case an obvious explanation was evident, but with this particular story I would not necessarily anticipate finding an easy answer - it's an odd one. JB