Carpel Tunnel and wierd tendon problem or maybe no problem

AdamF
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I had mini carpal tunnel relase surgery perform on both of my hands about 8 weeks ago. I have two issues on my doctor explain one (pillar pain) and the second one I can't get straight answer.

1st issue.
Pillar pain. According to my doctor this may be lasting from few weeks to up to a year at times and it always goes away with time. I guess my will last little longer then few weeks since I'm 8 weeks post surgery.

2nd issue.
This is the one that I'm worry and not getting straight answer. All my fingers bend and functions fine, all have good sensation in them. Tingling and falling a sleep is totally gone, no more waking up in the middle of the night. Both of my hands if I grab my phone or tv remote for example. And have one corner resting in my hand palm all fingers grip tightely around the phone and tilt my wrist bottom left (right hand), bottom right (left hand). I can feel my tendon popping / snapping in area of my mini carpal tunnel incision. Now if I would release my pinky finger slightly or straighten it popping / snapping stops. So I know it is tendon that works my pinky. Both hand do it.

My doctor told me today to wear my splints for next 6 weeks day/night. I'm 8 weeks post surgery just want to know if wearing will help healing and have any effect or correction to my popping snapping. I tough that once they took restrictions off after 6weeks heeling was done?

Is there something my doctor is not telling me. Is this something that is know post surgery.I find it hard to believe that the doctor could make a mistake since both hand do it, but who knows. Is this going to cause any problems later? So may questions and can't find answers anywhere. I found this forum and decide to ask with hope of some answers.

Thank you
Adam

jeremydpbland
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1st issue - most pillar pain settles in time but in a few people it seems to be permanent - or at least I have seen people 10-20 years after surgery who still say it is more painful than it ever was before surgery. They are very unlucky though.

2nd issue - hard to be sure what this is from a description but it does sound rather as though you can feel the little finger tendon suddenly changing position when you place the hand in a particular position. This sort of thing is an unavoidable consequence of cutting the transverse carpal ligament - its function in the normal wrist is quite clearly to hold the tendons firmly in place so once you cut it they are free to move about more than previously. Most people do not seem to suffer greatly from the loss of the ligament in terms of function of the tendons but a few do find that their hand is not mechanically as good as it was before surgery. It may be the case that, as more scar tissue forms in the area of the cut, this will gradually reduce over time. Whether splinting it for another 6 weeks is going to help is anybody's guess. JB

AdamF
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JB,

Thank you for writing back.

Are there any excises or things i can do to get that pillar pain better?

Do you think that this will ever cause any issue if that little finger tendon will just move around a little. It dose not cause any pain. Would you recommended wearing splints? Am I still healing? How long dose the actually healing a take after surgery?

Thank you.

jeremydpbland
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No easy answers to any of those I'm afraid. Various exercises are recommended by different authorities but there is no high quality evidence that any of them work. I would not expect the little finger tendon to be a major problem. I have no idea whether splints would help but they are unlikely to do any harm if worn intermittently. Healing from carpal tunnel surgery takes anything from about 2 weeks to 2 years depending on the individual and is highly unpredictable. JB

AdamF
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JB

My doctor wants me to wear splints non stop for 6 weeks. He sad that that way more tissue will be created and should close the space that my tendon is moving snapping. Have you ever hear of that?

Thank you

jeremydpbland
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He/she is guessing - nobody really knows. Equally, I have no evidence to the contrary and as I said it's unlikely to do any harm except in terms of inconvenience. JB

AdamF
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Thank you JB

AdamF
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JB

Today I have experience something new. I was outside watching my son practecing baseball with his little league. It was quite chilly and very windy. All the sudden on both of my hands my fingers start tingling and my hand kind a start becoming numb. I run in to the car and turn the heat on and it start going back to normal. is this normal? is that something that will go away? I'm 12 weeks post surgery on both hands. My surgery was done via mini release.

This really freak me out. any suggestions? should i be worry?

jeremydpbland
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The most obvious explanation would be an episode of Raynaud's phenomenon triggered by cold exposure. I wouldn't worry about it after a single episode. JB

AdamF
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JB,

Thank you.

I had my fallow up today and I told my doctor that i still get my little finger tendon pooing/skipping when i use my little finger. some time i will get some discomfort as well, through the side of my hand where the tendon runs. He want me to wearing a splint and tape my two fingers together so they don't move for next 4 weeks. At times that dose not bother me but at time it dose. He thinks that that tendon is going over the bone in my wrist and coming back down, creating that skipping sensation. He sad that he never experience that and only option if its getting worst will be going in and maybe recreating carpal tendon. That is freaking me out. It was not there before. I cant afford another surgery and being off from work. I also don't want to develop any tendon damage. What is your take on this JB?

Is there any kind of way to see what is going on in my hand, while it poping/skipping, any kind of live imaging that can do? should i look in to second opinion?

There is complete decryption of my problem in the firs post if you need to revisit.

Thank you

jeremydpbland
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You can see that kind of tendon movement on ultrasound imaging if you can find someone who knows lots about ultrasound of the wrist. Personally I would be very conservative about treating it. If it's not causing you much in the way of pain or disability I would not have thought it was worth further surgery - a lot depends however on how much of a nuisance it is to you in it's current state. JB

AdamF
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Have you ever hear of moment over the bone ? Do you think with time it will get better? My right hand is completely gone. it was in both. Should I be concern?

jeremydpbland
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It's not a standard medical term - just a piece of descriptive english. All tendons 'move over bone' - usually in a smooth sliding movement but they can suddenly change position in some circumstances. Most commonly we see the 9 tendons in the carpal tunnel re-arrange themselves when one or two fingers are used and their tendons come under tension and push the other ones out of the way. If it has improved in the right hand then presumably there is a fair chance of it improving in the left given time. JB

jmceachan
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Outside chance this could be a trigger finger - quite common after CTS but not caused by the surgery - becomes apparent with a bit of swelling. Here's a link to the info sheet.

http://www.bssh.ac.uk/patients/conditions/18/trigger_fingerthumb

AdamF
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JB

Would that be all the way down in the bottom of my hand. Palm of my hand?

jeremydpbland
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Thankyou Jane! I did wonder about triggering but I suspect it is not.

Adam - Trigger digit - otherwise known as stenosing tenosynovitis - usually causes a finger to get 'stuck' in flexion, and when it is forcibly straightened it gives way with click or sudden release. It is caused by thickened sections of the tendons getting caught in the 'pulleys' which hold the tendons in place in the hand and it is quite strongly associated with carpal tunnel syndrome, though they are separate conditions. I have seen a 'trigger wrist' where a large lump was getting stuck in the carpal tunnel. However your description seems to be more that of a subjective sensation rather than mechanical sticking. That wouldn't completely rule it out though as we do see atypical cases which don't seem to fit the classic description. I keep coming back to the fact that your description suggests that whatever this is, it is not causing any real problems with using the hand at present and if that impression is right I would be inclined not to interfere too aggressively.

To give any really concrete advice you need to see and examine this - and I do think a look at the ultrasound imaging would be interesting - none of which we can do on an internet forum unfortunately. Please let us know if it does settle down. JB

AdamF
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Hello JB

I'm still getting one of my tenden snapping in both of my lower hands. It just been a very weird experience. I did come across this title on line but nothing about it. Here is copy and paste from the title:

"We present a case of snapping dislocation of the flexor digitorum superficialis tendon to the small finger over the hook of the hamate that was noted after carpal tunnel release"

From what I research and look up on pictures. It sound like what what is happening to me. Can't find anything else beside this title. What do you think? have you ever hear about it? It this is it, should I be working about long time damage or any problems?

I also came across "trigger wrist" and "Lumbrical muscles"

As always thank you ! You been tons of help.

jeremydpbland
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I have a copy of that paper - It's Itsubo et al "Snapping wirst after surgery for carpal tunnel syndrome and trigger digit: a case report" JHS 29A(3): 384-386. They may have been describing the same thing you have but it's difficult to be sure. I doubt if it will cause long-term problems but it's such an unusual symptom that I don't think anyone could make had and fast predictions about it. JB

AdamF
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JB thank you. What was the result of that in the paper you have? What was the outcome, was that ever repair or resolve? Was the cause ever determine of the snapping?

Is that paper available somewhere to read? is that related to other symptoms I mention in my previous post? like the trigger wrist? or is that something completely different?

Thank you

jeremydpbland
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I've emailed you the Itsubo paper. They surgically modified one of the small bones of the wrist to alleviate the problem, apparently successfully. JB

AdamF
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Thank you JB, interesting reading.

I have another question. I been experiencing tennis elbow. So my work send me to get it check. Now workers comp adjuster is blaming this on my carpel tunnel surgery. Is that right? can that be related to one another? or they just simply trying to get out of paying the claim?

Any input would be great.

Thank you

jeremydpbland
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I'm not aware of any literature linking tennis elbow to either CTS or to surgery for CTS. JB

AdamF
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JB

Great, thank you. Just as I tough just a diversion from not paying a bill.

Any advise or remedy on some help to get tennis elbow help?

jeremydpbland
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Most commonly treated with physiotherapy/rest and local steroid injection, occasionally surgery. JB

AdamF
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As always. thank you JB

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