CTS Symptoms Persist Post Surgery
Hi,
I am a 30 year old female and have an office job, spending most of my days in front of a computer.
Around six weeks ago, I started experiencing very sudden acute CTS symptoms, including strong pain, numbness and tingling in my fingers. A nerve conduction study confirmed mild to moderate CTS. Within 3 weeks, I was given steroid injection, which did not have any effect. Two weeks later a Carpal Tunnel Release surgery was conducted.
It has now been eight days since the surgery. My concern is that the pre-operation CTS symptoms still persist. Although, the pain is somewhat less sever (I manged to reduce the amount of painkillers and am getting better sleep at night), it is still rather strong, effecting my ability to perform day to day activities. Numbness and tingling also did not improve since the operation.
Most articles found online, indicate the CTS symptoms should disappear almost immediately after the surgery. I am therefore concerned if the surgery was effective, or if I could be misdiagnosed. I will really appreciate your opinion on this matter.
Many thanks in advance!
Many thanks for your reply. I do have a copy of the original nerve conduction studies. Please let me know how I can share it with you.
Thank you, your help is very much appreciated.
Email is usually easiest. Address in the contacts section or the new privacy policy for the site. JB
Thanks for the results. They would qualify as a grade 2 CTS on my scale. The results are a little odd in that the sensory studies are more abnormal than you would expect them to be from the motor results. If you are right handed it is also a little unusual that you have CTS in the non-dominant hand with absolutely no evidence of a problem on the right side. Combine that with the lack of response to injection, abrupt onset and short history, and there are beginning to be quite a few odd features. On the plus side, the marked sensory involvement on the NCS might explain why numbness is slow to resolve after surgery. If the symptoms persist I would start to think abut repeating the NCS and perhaps looking at the nerve with ultrasound at about 6 weeks post-op. In your original post you mentioned severe pain at the onset - where was that in the arm? JB
Many thanks for your reply.
All the symptoms, including the pain, numbness and tingling were- and still are- concentrated around the thumb, the index and the middle fingers. I do hot experience discomfort anywhere else in the arm.
There's nothing much to suggest that it's anything other than a median nerve problem then. I would sit tight and wait to see how it is at 6 weeks post-op, unless any new symptoms develop in the meantime. JB
Thanks for your advice. I will update with the outline of the progress in a few weeks.
One last question. As I mentioned before, my job mostly involves working with a computer. I have already been off work for four weeks. Considering my symptoms and medical history so far, would it be advisable to go back to work only when typing no longer causes additional pain/ discomfort? I think I may soon be able to power through a few hours of typing with use of painkillers. However, I want to make sure not to reverse the positive effects of the surgery and avoid causing any longer lasting damage.
Thank you
That's a tough one to call. There is no quality scientific evidence to say that typing after carpal tunnel surgery is either a good thing or a bad thing at any stage during recovery. My best guess would be based on two basic concepts rather than experimental evidence.
1) It's probably a good thing to keep the tendons moving. The human body evolved to move and there is a good deal of evidence that immobilisation causes problems. If you immobilise the hand after surgery I suspect that everything in the area of the operation just sticks together and causes more trouble. From first principles therefore I think that moving the fingers after surgery (of which typing is a good low force example) is probably a good idea.
2) Pain is usually (though not always) a sign of injury and if something you are doing causes markedly increased pain it's probably a good idea in most circumstances to ease off a bit - so type, but stop when it becomes markedly more uncomfortable to do so. I would generally discourage the use of painkillers to allow you to do things that would hurt otherwise.
Of course these two concepts can conflict. If it causes agonising pain to move a finger even slightly then there is something wrong somewhere that needs attention, but after most carpal tunnel operations there is little conflict and people can type comfortably for short periods within a few days as long as they maintain a good wrist position (ie pretty straight) while doing so. The majority of our patients having carpal tunnel surgery require no more than a few paracetamol for pain relief in the days immediately following surgery and I think as long as the scar looks OK a need for serious analgesia is a warning of problems. JB
Hi!
Quick update.
It has been three and a half months since the operation. The pain has subsided and is quite mild, but accompanied by an unpleasant numbness and tingling sensations.
In addition, on a few occasions, I have been getting similar sensations (numbness/ pain/tingling) in small and ring fingers in both, the left and the right hands. This happened about four times and would only last for a couple of days.
I completed the following tests: MRI (brain and neck), PET CT scan, lumbar puncture and another EMG. There were a few findings in MRI brain scan that appear to be incidental rather than directly relating to the sensations in the hands; the initial results of lumbar puncture did not show anything either (still waiting for the final results); and the repeated EMG did not show compression in the wrist or further up the arm (the initial EMG showed mild to moderate carpal tunnel); PET CL also came back negative.
I will really appreciate if you can share your opinion on the above. My concern is that, although significantly improved, the pain/numbness/tingling sensations still persist in my right hand three and a half months after the operation. In your experience, may it indeed just be taking than usual to recover?
Many thanks in advance.
I wonder if the repeat EMG showed improvement - which would imply that surgery did achieve something at the wrist. The new symptoms in the little and ring fingers are more suggestive of an ulnar nerve problem. Overall I remain a little suspicious that perhaps the CTS was not the whole original explanation for the symptoms but you do seem to have had a fairly comprehensive array of tests without a clear alternative explanation coming up. JB
If this really was mild to moderate CTS then the symptoms should indeed normally resolve very quickly after surgery. A complete lack of response to corticosteroid injection (if a sufficient dose was used) is however a bit of a warning sign and should usually prompt a bit of thought before diving in with the knife. 8 days is still quite soon after surgery to get very worried about however. If you have a copy of your original nerve conduction studies we can take a look and see how bad it really was. JB