worsening cts symptoms after surgery
Hi, i am currently 4 weeks post cts surgery. Before surgery i had 2 injections which didn't help at all. After having a few episodes of severe hand spasms whereby my hand would seize into a claw and remain so for a number of hours my gp decided that surgery was the best option. As well as the spasms i also had severe pain in all fingers and thumb as well as altered sensation in my hand and severe pain in wrist. Post surgery i am still experiencing pain in all fingers and wrist. Almost complete weakness and use of hand for daily activities and cannot lift or carry anything heavier than a mobile phone. I have pain in my elbow and shoulder also which i didn't have before surgery. The surgical wound itself isn't healing well and is still open. I have burning and stinging from the wound site and also in my hand and wrist. Is any of this normal post surgery healing or has something gone wrong or does it need further investigating? I have no scans etc before surgery, only the nerve conduction tests which showed cts in both hands. I am becoming concerned that something other than cts is going on. Regards, Katy.
Hello, thank you for the reply. I am not sure on the nerve conduction results, i can find out and come back to you. The doctor i saw seemed to be convinced it is/was cts, however like yourself i have had some doubt over the diagnosis. Especially since having the surgery i am still getting pins and needles in the hand and fingers, pain in wrist and arm also, which doesn;t feel like normal post op pain. Hand is moving better since first posted but after a full day of 'normal' use it is swollen and painful. I will come back to you with the results. Kind Regards, Katy.
If you can get hold of the NCS results we'll have a think about it. However, whatever the severity of the CTS the wound ought to be closed by now so if it's still gaping open that is a bit of a problem by itself. JB
hello, i have been unable to get hold of the ncs results so far and the wound has finally healed. However i have been back to see my GP as i am still experiencing pain/numbness in hand and fingers as well as pins and needles, pain around the wrist and now forearm and elbow. Also my hand looks/feels more lumpy than my left and i have a noticeable swelling on the underside of my arm mid way between wrist and elbow. My GP suggested trying physio. The physio i saw mentioned my neck was a problem and has referred me for more intensive treatment at the local hospital. I am concerned about this as in general i don't feel i have any problem with my neck and certainly no pain like i get in my hand. I have read that sometimes the problem is in the neck and causes cts symptoms but personally i feel by now that they should be considering scanning in order to determine the cause rather than sending for physio without fully knowing what is going on. I would be interested to hear your thoughts on this. Kind Regards, Katy.
This is complicated enough that I think it probably needs to be seen by an expert. Either a good hand surgeon or neurologist would be my choices. Floundering about with scans and physiotherapy in the absence of a clear diagnosis for the problem is not an ideal way to proceed, though sometimes when no diagnosis can be found physio is the only option. I would like to know a bit more about the forearm swelling - is it obvious enough to photograph? Other than that, as a neurophysiologist my starting point would be the pre-operative nerve conduction studies. One other obvious line of enquiry would be the surgeon who did the operation - do we have an opinion form them on what the current problem is? JB
Thank you for your reply, I may be able to get a picture of the swelling, but not sure if it would be clear enough to be seen, i will try. The surgeon who did the op is the GP i am seeing with it. He has said that the surgery wasn't as successful for the cts as he had hoped and that symptoms and other problems are still present. He has ruled out further surgery and referred for physio as he wanted to wait and see if that was any help. However i have been left more confused and more uneasy about the whole diagnosis since the initial physio consultation, they don't really seem to know themselves what is going on. I will call again tomorrow and ask if i can have a copy of the nerve conduction results, again at present he hasn't mentioned a repeat of these either. Is it time i maybe asked to see someone more specialised? Kind Regards, Katy.
I think repeat NCS are useful any time from about 6 weeks post-op in cases that have not gone according to plan. Who did the NCS - were they 'in-house' in the surgery or at a department of clinical neurophysiology? JB
Hi, the NCS was done in house at the cts clinic run by the GP who did the surgery. I have managed to take a few pictures of my hand and the area of the swelling, if i could forward these to you via email? Kind Regards, Katy
What sort of machine did they use for the NCS? There are several recognisable types. The things you are most likely to see in general practice are either somethig that looks like a laptop computer with various external boxes and wires attached or else a small hand-held unit - about the size of a large and unusually thick mobile phone - with a few wires attached. Anything you can get hold of can be emailed to Jeremy [dot] Bland [at] nhs [dot] net JB
It was a laptop with the wires attached. I will forward the pictures as soon as possible. Not the best as it's difficult to get a good angle but may give you more of an idea of what is going. Regards, Katy.
In that case there might well be some useful results to look at. I hope your GP does not mind sharing them. I've replied by email regarding the photos. JB
Much of that doesn't sound very like CTS at all, especially the complete lack of response to injection. How bad were the nerve conduction results? JB