Failed decompression? Complex case


I used to work as a masseuse doing deep tissue massage full time for many hours & 12 years. I experienced numbness in the median fingers quite often, which ceased when I stopped massaging & disappeared completely when I changed profession except for the left hand when holding the telephone - my fingers would go numb. My symptoms returned at night with tingling/numbness & I worse splints for approx 2 years. They became worse menopausally - last menstruation June 2013.

I have worked as a dental nurse for 8 years but only had problems for the last 2.5-3 years. I have not returned to nursing since the decompression 6 months ago. I tried to manage the pain without medication because I have been treated homeopathically for the last 20yrs by my GP. I have now had to give in & take Amitriptyline for the last 3 weeks because I cannot cope with the pain anymore. I refuse to take Gabapentin.

I was diagnosed with mild carpal tunnel bilaterally post nerve conduction study, having suffered pins & needles, numbness at night/driving/holding telephone for some years. I developed intense pain in the left inner forearm on the ulnar side from elbow to wrist at night. I had 2 steroid injections over 2 years & was advised by my GP to opt for surgery because of 'risk of permanent nerve damage'. Although I consider my left hand to be more problematic, the last steroid injection to the right was less successful, so I was due to have surgery to the right hand in March 2015.

Six days prior to the surgery, I had a recurrence of the intense pain at night on the left (always with complete numbness), this time to the whole of the hand instead of the forearm. It took 2 hours before any feeling came back into the hand. For this reason, I asked for the surgery to be done on the left hand instead.

At consent, the orthopaedic registrar who performed the decompression consulted with the orthopaedic consultant, who listened to my description of the pain problem, said, "I don't know what that is" and agreed the surgery could go ahead on the left hand instead.

The surgery took 13 minutes & throughout this time, I had nerve pain from my armpit, down(or up??) the arm which stopped at the anaesthetised hand - I think the cause was the position I was lying in because abducting my arms horizontally produces nerve pain from hand to armpit. I was shown out of theatre, and fitted for a sling by another nurse. Despite the numbness to my hand, resting it in the sling was having some sort of effect on my ring/little fingers. The sling was altered 3 times, to no effect, the suggestion was to elevate my hand without the sling.

I had pain the next day, but presumed that was normal. It continued, a triangular area around the scar was swollen, red, hypersensitive, with burning sensations, glass shard stabbing sensations & occasional electric shock shooting pains. I also developed burning sensations in my ring/little fingers.

At some point (I don't recall exactly when), I was lying in bed & realised the burning was also in the ring/little fingers of the right hand but also in the 4/5 toes of both feet.

I self-diagnosed de-sensitisation to the area around the scar, worked with it & this is resolved with the exception of occasional hot needle pain persistently to mid-scar, which I have to rub, which reduces it to intense itching. This seems to result from positional causes - carrying shopping.

What has remained & not resolved, burning or pain to mainly ring/little fingers but can be all fingers & now all areas of feet. I note that the nerve pain down both arms when abducted to horizontal, worse on plantar-flexion, continues.

I have been reviewed by one consultant who advised:
Desensitisation (which I didn't get referred for but continued on my own)
Repeat NCS - see below
MRI of cervical spine - showed osteophytes mid cervical but nothing C8/T1

My next review with the main consultant was difficult. As well as the burning sensations peripherally, I have deep aching pain to the ulnar side of the scar, sometimes ulnar side of the palm, this alternates with burning. The pains also move from elbow to wrist on occasion when driving & in bed. The feeling I get from my left hand is that it is damaged.
The main consultant advised:
Referral to hand therapy
Spinal opinion
Neurology opinion
Referral to rule out Thoracic Outlet Syndrome (TOS)

The last NCS results from my GP state: Ulnar NCS are within normal limits, no evidence of ulnar neuropathy at either elbow. Evidence for mild CTS on the right hand as before, & no evidence of CTS on the left.

What I cannot equate from seeing consultants:
Orthopaedic Assessment prior to surgery: Positive Tinel's test both wrists, positive over the \Guyon canal on the left, Compression test revealed symptoms immediately & reproduced left 5th digit symptoms.

First Orthopaedic review post surgery: Compression test on the left is positive, Tinel's test around the ulnar side & the elbow positive as well.

Assessment Specialist Musculo-skeletal Practitioner, Orthopaedic Assessment Service: Positive Tinel's & Phalen's on the right for median nerve.

Second Orthopaedic review - main consultant: NCS of the left hand still suggest some electrophysiological changes of CTS but shown no changes with an ulnar neuropathy at the elbow.

Consultant for TOS: Abduction & external rotation did not effect radial pulses, hands pink throughout but did develop ulnar paraesthesia. Review of neurophysiology showed no evidence of ulnar neuropathy at the elbow with mild carpal tunnel delay on the right. MR of cervical spine was pretty significant with disc osteophytes compressing C3, 4 & 5 root on the right. This doesn't fit with her neurology & he agrees with spinal review.

Spinal opinion (yet to receive letter) - agreed with positive Tinel's & positive Phalens to both right & left hands. She has asked for a repeat of NCS & referral to hand/upper limb team.

I am due to have appointment with neurology in November

I have had 2 sets of blood tests (I asked GP to try to rule out any other possible reasons for neuropathy). Not sure what primary ones were but they are writing to Rheumatology for opinion. Then asked for further blood tests which I am yet to obtain the results from.

Complicated. Largely, I am wondering if there is an opinion about my left hand???? I was refused an MRI of it by the main Orthopaedic consultant because it would probably show nothing & he mentioned if it is scar tissue causing the problem, surgery wouldn't be an option because it would result in more scar tissue. What could an MRI show?? I would like a definitive answer...


That is indeed a complicated story and quite a few of those features are atypical for CTS of course. I put very little store in Tinel's sign in the context of nerve entrapment so I don't think the various TInel's observations mean anything. The thoracic outlet person seems from that description to have been thinking more about vascular thoracic outlet rather than neurological but that may just be the way it came across. I think I would want to see all the nerve conduction studies before going any further. Like your orthopaedic consultant I rather doubt that MRI of the left hand will give a simple answer. If you can lay hands on your NCS results - the actual measurements that is, not just the bottom line conclusion, then I can have a think about how they fit in with that story. JB


Thank you so much for your reply. I will try to get the measurement results of my NCS when I next see my GP...

This site uses cookies. By continuing to browse the site you are agreeing to our use of cookies. Find out more here.