"Sore paw"


In the course of my web research I have found your excellent website.
I'm a veterinary surgeon who works with large and small animals. My work requires everything from fine, detailed surgery to dealing with the complexities of cows calving, etc. I am also required to operate high revolution dental equipment.
Symptoms of my carpal tunnel syndrome were perhaps slightly different from the norm. I'm 60 years old, very dominantly right-handed, and over a period of years I had tingling in my hands, especially when doing things like driving, but I experienced no pain and therefore, as a busy self-employed professional, took little notice. However, in 2013 I became aware that my right thenar eminence had considerably wasted (as had my left, to a lesser degree), my hand was weakening, I had lost some sensation and I did not feel as comfortable performing a number of my veterinary functions as I had previously.
I sought medical advice, had nerve conductivity studies and it was recommended that I have surgery, which took place in 2014.
Since then, my right thenar eminence remains wasted, my hand function has remained much the same although the nerve conductivity did reflect some improvement which I was happy with.
I still feel I do not have the dexterity to perform many of the functions of my role that require fine motor control, and I lack the strength to accurately direct instruments over sustained periods with an outstretched arm in the compressed birthing canal of a cow, which is not infrequently required in large animal practice.
I'm largely unhindered in my everyday personal living (although my wife will testify to my increasing clumsiness!), but my profession generally requires far more of my hands than my home life does.
I have had my nerve conductivity studies repeated twice more now.

The results
R median: CV. - ; TML - absent
L median: CV 52.1; TML 4.0
R ulnar: CV 57.5; TML 1.96
L ulnar: CV 56.9; TML 2.1

Sensory - 13.7 mA; 0.1 ms; 0.1 Hz
R median: DIST Nil; LAT - ; CV - ; AMP -
L median: DIST 130; LAT 3.3 ; CV 46.4; AMP 2
R ulnar: DIST 110; LAT 2.3; CV 55; AMP 2.3
L ulnar: DIST 110; LAT 2.4; CV 56.1; AMP 2.2

R median: CV 28.7; TML 4.8
L median: CV 48.1; TML 4.2
R ulnar: CV 51.8; TML 2.1
L ulnar: CV 53.7; TML 2.1

Sensory - 11.8 mA; 0.1 ms; 0.1 Hz
R median: DIST Nil; LAT - ; CV - ; AMP -
L median: DIST 130; LAT 4; CV 38.2; AMP 3.8
R ulnar: DIST 120; LAT 2.5; CV 57.1; AMP 2.1
L ulnar: DIST 120; LAT 2.5; CV 60; AMP 2.7

R median: CV 41.4; TML 4.9
L median: CV 49; TML 4.2
R ulnar: CV 58 ; TML 2.3
L ulnar: CV 58; TML 2.1

Sensory - 14.6 mA; 0.1 ms; 0.1 Hz
R median: DIST Nil; LAT - ; CV - ; AMP -
L median: DIST 130; LAT 3.8 ; CV 40.6; AMP 4.1
R ulnar: DIST 120; LAT 2.5; CV 62.5; AMP 5.2
L ulnar: DIST 120; LAT 2.5; CV 63.8; AMP 3.4

A repetition of the surgery has been recommended. While I would be happy to have this surgery if I felt confident that it would achieve the desired outcome, I'm trying to get my head around my chances of regaining the strength, sense of feel and fine motor control to the extent I require.

I've read through the information on your website and you provide excellent information, but if you would have a moment to comment on the merits of a second operation in my own particular situation, from the information I've provided to you, it would greatly help in informing my consideration of the matter.

I can email any further documentation that might be of use.

Thank very much for your time.


That was grade 6 before surgery and grade 4 afterwards with little real change between the 2015 and 2016 results. I think there is hardly any chance of you regaining the lost thenar muscles with a story and results like this. If your main symptoms were pain and tingling at present then further surgery might help those but it is unlikely to improve symptoms which are essentially due to loss of nerve function - weakness, numbness and loss of dexterity. If improved abduction of the thumb would help then some hand surgeons would consider an 'opponensplasty' to repurpose another muscle to try and replace the lost function of APB but there is little systematic evidence on how successful this is and it would not make any difference to the sensory loss. I have to say therefore that I am pretty pessimistic about this - sorry. JB


Thank you very much for your reply to my enquiry. You have made the situation very clear to me..
It is most generous of you to make the time to answer so many questions for your patients and the public at large.


I'm learning from every patient I come into contact with - and that includes cases on the website too - so it's no trouble really. If you do decide to try further surgery however I would love to know the outcome. JB

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