CTS Complications
I had endoscopic CT release surgery on my right hand which is my dominant hand on 05/04/2018. I had my first post-op on 05/10/2018. They took stitches out and said I could resume normal activity as long as I could tolerate and I could return to work on 05/14/2018. On 05/12/2018, I was doing some yardwork. I took a shovel, scooped up a shovel full of mulch and put it into the wheelbarrow I was using. I did it about 5 times and on the 5th time, I felt this God awful pull in my hand and a lump instantly showed up. I put everything away and elected to ice, elevate and rest.
I called my Doctor on 05/16/2018 at 4:45PM as the lump was getting really painful, they got me in the very next morning. He just looked at my hand and the lump and said it was scar tissue. Then he scheduled me for Physical Therapy and prescribed ultrasound therapy. I told him I wasn't convinced the lump was scar tissue and asked for an MRI and/or ultrasound to which he said they weren't necessary. I let him know I was in a lot of pain where the lump was and he dismissed it and said PT will take care of it. I called my Doctor on 05/18/2018 to report I had fallen in the parking lot of my job and landed on the hand that I had surgery on and told him my wrist instantly bruised up and the palm(lump) got larger and it is quite painful. He said to ice it over the weekend and elevate and then PT will should help. He wasn't alarmed. I wanted him to do an MRI, X-Ray, Ultrasound etc., but he said it wasn't necessary and it will only show the changes he did during the surgery. I was in tears while talking to his Physician Assistant as I am in so much pain. Well they called in Tramadol and told me to call them on Monday 05/21.
I went to PT on 05/24/2018 for my intake/consult. Then I had PT on 05/25/2018 and 05/29/2018 they did the ultrasounds therapy both times. On 05/21 my Doctor's Physician Assistant called to see how I was doing. I told her that I am in pain and the pain is getting worse everyday. She said to stick with the Ultrasound Therapy and it will help . I asked why are they dismissing my pain and they said it is all scar tissue. I told them to convince me it is scar tissue. They won't do any ultrasound or MRI or anything. I called my Doctor on 05/30/2018 to report the lump is the source of my pain and it is excruciating. Again, I spoke to the Physician Assistant and I told her I am two days shy of being 4 weeks post op and the pain it worse then before. She said it will take 4-6 months before I begin to feel better. I told her I am concerned about the lump that showed up when I did my yard work the week after my surgery. She said it is scar tissue. Please note I am back to work since the 05/14 and I type from 8am to 5pm.
I am in so much pain and I believe it is the lump that is causing me pain. It is getting worse instead of better. Any ideas what it could be? Any suggestions on what I can do to get rid of it? I am so upset that my doctor is dismissing this.
I am open to anything you suggest.
Thank you so much for getting back to me. I feel validated by what you said about the scar tissue. I also have a hard time believing it is scar tissue. The lump is located at the base of the palm. It started out being round and the size of a pea. Now it is oval and it goes from the base of the palm up to the center of the palm. It believe it got larger because of the fall and I put that hand out to break the fall. You asked if any of the doctors examined my lump/hand. The answer is yes on 05/17/2018 which I mentioned in my original post. And all my Doctors did was just look at it, he didn't do an MRI, Ultrasound. etc., Since then I have called many times and they kept saying we will see you on 06/06/2018 at your next appointment. The lump is pinkish to red in color, it is hard and not very mobile. It hurts to touch it and it constantly throbs, and about 5-7 times a day, I get a sharp pain that shoots from the lump all the way to the finger tips and it last for 3-4 seconds each time. When I have to go to PT and he does the Ultrasound therapy and the deep tissue massage, I am grinding my teeth because it hurts so bad while he is doing it. Then it hurts worst afterwards since it was aggravated. Getting back to what you said about scar tissue should be mainly around the incision area. Well there was scar tissue around that area and when the Physical Therapist used the Ultrasound therapy on that area, it sure loosened it up. It never loosens up the lump though which really confirms my thought of the lump being something other than scar tissue.
As far as work, I type all day. It does hurt especially the lump area, I have asked my Doctor to pull me out of work again as I cannot do it and he said he cannot justify pulling me out of work for scar tissue. How does he know it is scar tissue when he hasn't even done an MRI or Ultrasound to see what the lump is? I feel so unheard and I feel my Doctor doesn't care. So, I got a biker's glove and I wear this while I am working along with taking ibuprofen every four hours which and of course I shed tears throughout my day because of the pain. I am off work today. I am seriously considering going to the emergency room but I am not sure if it is considered an emergency. What do you suggest?
I have been dealing with bilateral CT for over 20 years. When my Doctor did the EMG and Nerve Conducter Test, he said in my dominant hand(right) I was moderate to advanced CT and he suggested surgery. The left hand it was very mild, so he suggested a cortisone shot and he would give that to me while I was under anesthesia during the surgery.
As far as initial symptoms, numbness, pins and needles and pain I had for the last 6 months straight in both hands. Nothing worked to get rid of those symptoms. The surgery on the dominant hand sure took those symptoms away and it gave me back my sensation almost immediately after the surgery. The same with the cortisone shot in my left hand. I am happy about that.
Well the response of the original symptoms to treatment is reassuring - it suggests that they have adequately treated the CTS, thugh I think doing CTS injections while the patient is under anaesthesia is a bad idea because the patient cannot tell you if you hit the nerve with the needle. I think my best guess as to what the lump is might be that it is a haematoma - a blood clot - resulting from a leak from a vessel weakened by surgery and damaged by your subsequent episodes of trauma but it is of course impossible to be sure on the internet. You might be able to spot this on utrasound examination but I wouldn't guarantee to. Another possibility that could come up quite acutely might be a ganglion cyst but they are not usually very painful. A haematoma would be expected to resolve slowly without aggressive treatment. If they are reviewing it again on 6th June then that ought to be a good chance for them to think about it and if it's still getting bigger at that point then some imaging is probably appropriate in an attempt to get a clearer diagnosis. JB
Thank you so much for responding and providing feedback. If the lump was a haematoma, wouldn't it be turning colors? How long do they last? Does the lump go away? Could I have damaged a tendon or ligament or even the median nerve? Where the lump is located on the palm is right near the median nerve.
I went to the Emergency Room this past Saturday morning because the lump did get larger and the pain is excruciating. The ER Doctor wouldn't even look at it, she said I needed to follow up with the surgeon. I thought maybe she thinks I am seeking pain meds which is why she won't help me. So I made it clear that I don't want meds of any sort because that is like putting Band-Aid on it. I told her I just want an ultrasound and/or an MRI done to let me know what the lump is. I begged her to do this but she wouldn't budged. She discharged me quicker than you could say my name.
You might not see any surface bruising if the bleed is deep in the wrist/palm and they can take many weeks to absorb. The most difficult thing about this is the degree of pain you are describing. In my own clinic we would undoubtedly look at the ultrasound imaging in the hope of getting a clue what was going on but that is essentially a research interest of ours so not something I would necessarily expect to be done routinely elsewhere. Apart from anything exlse expertise in interpreting images of this area is thinly spread even when there has not been surgery to further complicate the images. Lets see what your surgeon says on the 6th - only two days away. JB
I am sorry it took awhile to respond. I wanted to update you. On the 5th, I called my surgeon's office and told them I want an ultrasound done of my hand to see what this lump is and that is what I am going to push for at my appointment on the 6th. Well, the afternoon of the 5th, I got a phone call from the lab and they wanted to schedule me in for an ultrasound since they got the order from my surgeon. The Ultrasound was scheduled for 8th and my appointment on the 6th was pushed to the 13th to discuss ultrasound results.
So, on the 8th I go to the lab to get the ultrasound and found out the ultrasound he scheduled was of the arm. From the wrist up to the neck and it was checking for blood clots. I was so upset I started to cry. I called my surgeon's office immediately and told them this ultrasound has nothing to do with the lump on my hand and if the surgeon would have looked at my hand the few times I showed up at his office begging him to look at it, he wouldn't have scheduled the ultrasound of the arm. His PA told me that the surgeon doesn't believe the lump on my hand has anything to do with the surgery or recovery and he is checking other things to see what is causing it. And then she said, he is leaning towards scar tissue which is what he has been saying all along. I said, how could he even say its scar tissue or it has nothing to do with surgery/recovery when he refuses to examine it? I then told her I want an ultrasound done of my hand to see what this lump is and why it is causing me so much pain. I then put the technician on the phone and after she talked with them, the Doctor amended the order to do the ultrasound of the hand. As they were doing the ultrasound of the hand, this ultrasound is checking for edemas and blood clots. When it was done, the radiologist talked to me and said she doesn't see any edemas or bloodclots.
I then called my surgeon's office to find out what the next step is and asked if he would be scheduling an MRI. And I was told no he isn't going to order and MRI and he said for me to continue with Physical Therapy. I was so mad, I hung the phone up on him. I then called my family Doctor and asked if he would order an MRI. He said he would be he would need to see me. So, I scheduled an appointment with him on the 11th. I then called an Orthopedic that I had gone to 6 years ago to see if he accepted my current insurance and to see if he would see me. The answer to both of these questions were yes. So I scheduled an appointment with this Orthopedic for the 12th and 9:40AM.
I saw my family Doctor on the 11th, he scheduled the MRI for Monday June 18th at 3:30PM. I then saw the new Orthepedic yesterday at 9:40am and he said the lump is not scar tissue, he said it is one of three things. It is either a hematoma, ganglion cyst and/or a giant cell tumor. Then he said he wants to order an MRI to see what it is. I told him one was scheduled for Monday. Then he said he will call the place that I am having it done and let them know how necessary it is and he said we need to have you rest that hand.
So he put a splint on it and kept me out of work until the MRI is completed and we have results. I will get results at my next appointment with this new Orthopedic which is June 21, at 9:30am.
You were right when you said a hematoma. The three things he mentioned, will they all go away on their own? Do you think I will need surgery again?
I am scared now.
if you are right that the lump came up very quickly during exertion then it is unlikely to be a tumour and haematoma or ganglion cyst seem much more probable. A ganglion cyst should have been recognisable on ultrasound but as I said earlier, standards in ultrasound examination are very variable and the wrist and palm area can be very difficult to interpret after surgery so I'm not too surprised that someone who was really expecting to scan your arm for blood clots etc might not have been able to make much of the operation area. I wouldn't be much good if asked to look at something outside my area of expertise such as a cardiac or obstetric scan. It will be interesting to see if the MRI provides any clearer answer - it may or may not I'm afraid. I think it's impossible to say remotely whether further surgery is likely or not but I remain interested as this is a very unusual story - I would love to know what your second surgeon thinks once the MRI result has come through. JB
I know it was a long shot asking you if I will need to go under surgery again. My anxiety is sky-rocketing with learning what this lump my be and the very thought of going under surgery again make my anxiety even worse. Thank you so much for being honest though. I appreciate it and am very grateful that you are there listening to what I am going through and being responsive.
Yes, this lump showed up immediately upon over-exerting myself on 05/12. If ganglion cysts are harmful, why are they so painful?
I now, cannot wait until Monday the 18th to have the MRI finally.
I will definitely keep you in the loop with what my new surgeon says once he reads the MRI results. I will reach out to you on the 21st after my appointment with the new surgeon.
Thanks so much JB. You have been my angel. --Colleen
Ganglion cysts are not usually painful in themselves, but as with any other lump, if they happen to be in a site where they press on something they can be a problem.JB
It's a very odd story and as there is an obvious physical examination finding in the form of a lump which you have noticed I think it's very hard to comment without being able to examine it but that is certainly not a typical history of problems with scar tissue after surgery, especially not endoscopic surgery. Have any of the involved doctors/practitioners actually examined the hand recently, as opposed to just talking to you about it on the phone? What has happened to the original CTS symptoms - all resolved? Where exactly is the lump? Is it red or hot? Is the pain local to the area of the lump or does it spread more widely. Is it aggravated by poking it? It see,s you have been able to get back to work - how come it is not preventing you working? JB