8 months post op - should I still be feeling like this?
I had my first CT surgery on my left hand in Oct 2011 and the my right in Jan 2012. All seemed fine initially, but now the pain/tingling/numbness has returned :-( My consultant discussed my left hand with me at the final consultation when I told him the tips of my thumb and forefinger were still numb. He measured how much the nerve should have "grown" back and deduced that the nerve should have been at its fullest capacity and anything I have been left with, it basically it!!! If I lean on my left elbow, my middle and last two fingers go dead. The tingling in these fingers wakes me during the night and turning over in bed is excruciatingly painful in my neck. I also have some swelling at the base of my palm to the right of my scar. My doctor thinks maybe nerves attempting to grow back through scar tissue? My left hand fingers swell intermittently - when typing, holding a book or script and if I am out walking strangely enough - my fingers go tight and immobile, and my hands become blotchy and blue in colour. I am a secretary and my job has become untenable as I can't get through the working day using my hands without sharp twinges, numbness, tingling and swelling (need to get my wedding ring off quickly at the first sign!!) Is there anything that can be done or am I stuck with this? I'm almost tempted to go down the "ill health early retirement" route as I seemingly cannot do my job any more! Any advice would be most gratefully received. Thanks.
middle, ring and little - apologies - should've clarified. Thanks for the info
OK that side of the hand going numb and tingling is more suggestive of either problems with the ulnar nerve at the elbow (should be only ring and little really) or with the C7 and C8 roots in the neck, or occasionally of thoracic outlet syndrome rather than CTS so the current symptoms need a fresh look at the diagnosis. Was it the same distribution before surgery or have things changed? JB
You need some competent neurophysiology then. I don't know where you are, and arrangements vary in different countries, but you definitely need to see someone with clinical expertise in this sort of problem and the right tools available to investigate it. JB
I am going on nine months post op for endoscopic release done on both wrists at the same time. I had cts for almost anyear before surgery. I was pregnant when I developed it due to work. Post surgery I have had an oral steroid taper with no relief, corticosteroid injection in both with no relief, physical therapy with no changes, as well a second emg two months post op that showed a swollen nerve but improved readings, still abnormal however. Because it is work comp, I was recently reevaluated and doc says to try open surgery to explore. I am still in excruciating pain on a daily basis, have almost no strength in one hand, numbness and tingling still present, shoulder, arm, and neck pain. My surgeon today says he disagrees with doing open surgery as witt could exasperate symptoms with scar tissue and does not feelnthere is a problemnwith scar tissue now to be causing symptoms. He referred me to pain management Dr who thinks I could benefit from neurontin or lyrical. The side effects scare the crap out of me! Everyone I know who has taken neurontin has nothing good to report or have pain relief with nerves. I am confused on why I have not recovered,as well as who to listen to at this point. I am going for yet another emg/Jcs to see if there are changes from six months ago. I feel your frustration with having no relief. I have never held my now 14 month old with out being in pain from carpal tunnel. I go to bed every night with ice packs just to fall asleep only to toss and turn all night and wake up with "fat " feeling hands that tingle all day. Yesterday I did nothing but apply ice packs and do compression baths I was doing while in pt. Ive even had a tens unit during pt with no relief. I still have roughly 20 years in work force and quite honestly do not see how I can get through an hour of a workday when I cant do it pain free while at home.
It is that kind of story which makes me careful in recommending surgery for CTS. Fortunately most patients do get rapid and satisfactory relief from the operation but there is a small group who report this kind of persistent problem afterwards. My own approach to assessing these relies upon detailed history taking and assessment of serial EMG studies and ultrasound imaging. Interestingly, poor outcomes seem to be commoner when workers compensation is involved. The report of oral and injected steroid treatment after surgery is very unusual - I know of one American doctor who tries this but there are no worthwhile published studies of the use of steroids after surgery in this way. Bilateral simultaneous surgery is also fairly uncommon so you have described quite a few unusual aspects to your case there. It is hard to give any concrete advice though without knowing your detailed NCS results at least. The only thing that I would say is don't worry too much about trying the drug treatments for neuropathic pain - they do sometimes cause significant side effects but you can always stop them if they don't agree with you. JB
Thank you. Every medical person I have spoke with has had the same thought of how unusual it was that I had both wrists operated on at same time. I am hoping that this next ncs will five some kind of answer. As for the medication, I realize the benefits could outway the potential side effects. Its worth a shot. I looked over the website and found everything very helpful. You mention that you find the use of steroids unusual after surgery. I think my surgeon was trying to show that we've tried other measures to aid in healing since this is a work comp case. My surgeon has told me that sometimes it can take a year or two for the nerve to heal and there is a small percentange of people who don't recover completely. I forgot to meention that I had a cellulitis infection of three of the four incisions and have always wondered if that has any correlation with slow healing. I reside in the U.S. and am finding the different studies I read about very interesting.
Although it is unusual to operate on both sides there is one interesting study where patients were randomised to either sequential or simultaneous surgery and in that study the patient satisfaction levels were higher in the simultaneous surgery group. There are a few surgeons who do it but it remains unusual and we keep to one side at a time. Very bad CTS cases can take a long time to recover but 'bad' in this case means bad in terms of the NCS results so we would need to know yours to comment. It's impossible to evaluate the significance of the cellulitis I'm afraid. JB
What information from NCS is needed? I am seeing the doc tomorrow for a thorough ultrasound of my wrists. My most recent study showed mild cts but due to symptomology he is calling it more moderate. There appeared to be improvement in the numbers (what ever they mean!), but the "nerve slowing" is still present.A brief ultrasound showed possible scar tissue as well as something with the tendon...hence the need to do more detailed ultrasound. I received another steroid injection two weeks ago, and despite being hopeful, it hasn't done much but decrease the excessive swelling i had that day. There is still swelling as I cant touch my thumb to below my pinky as I can so easily on the left hand, there is what feels like tension when I fold my fingers along with space between fingers and palm, I try to to not shake hands due the pain when slightly squeezing my hand, my tingling is still there, driving is a royal pain, and things still fly out of my hands on a regular basis! Trying the gabapentin tomorrow for what ever good it might do!
My way of grading the NCS results is set out on a page of this site and is designed to allow results from different laboaratories with different normal ranges to be compared. In the USA, if your neurophysiology lab is following the recommendations of the American Association of Neuromuscular and Electrodiagnostic Medicine for how to carry out these tests then it will be possible to express the severity of your CTS in physiological terms on my one-to-six scale, which is simpler to think about than all the different measures that go into it. It is normal for there still to be NCS abnormalities after surgery - the more so the more severe the original CTS was before operation - which makes it very difficult to interpret post-operative results by themselves. Ultrasound examination is sometimes helpful after surgery but ultrasound for CTS is quite a new field and we are still learning - it can be hard to find someone who is familiar with the imaging findings in this scenario. JB
I have tried to make sense of these readings using your guide and am just more lost as to what's normal and what's not. My studies have listed the following:
motor nerve study median nerve
Lat(Msms) dur(ms) amp(mV) area(mVms) dist(mm) C.V.(m/s)
L R L R L R L R L R L R
5.2 7.1 5.5 6.5 8.7 4.2 27.0 14.6 80 80 wrist
8.8 10.7 5.6 6.6 8.1 4.4 24.9 15.9 190 210 51.8 58.6 elbow
2 1/2 months post-op ncs
3.8 4.3 5.9 5.4 9.1 5.3 31.8 15.8 80 80 wrist
7.4 8.1 6.2 6.2 8.6 5.0 29.9 17.0 190 200 53.0 53.3 elbow
The third ncs results I do not have but was told there's not much improvement on right as there was on left.
In December I had an ultrasound using a new hi-def machine as the Dr put it. The findings there showed a "dipping" area of the median nerve on both sides. When tapping right over this sight, the tingles worsened. Dr thought this could be from scar tissue.
I have recently followed up with my surgeon and symptoms of tingling have worsened in both hands. My doctor and I have thoroughly discussed our options at this point as corticoid steroid injections only supply relief for a couple days, tramadol gave me more pain from the migraines it gave me Gabapentin has done little as well except for unwanted side effects. I have considered the open release on my right hand and now my doctor believes it can help and he'll do it if I want. The worries of causing more scar tissue are there by both of us. I am at wits end at this point.
If the first two numbers there are the distal motor latencies to APB - 5.2 msec on the left and 7.1 msec on the right then the right hand was grade 5 (I guess you are right handed). The left hand was ether grade 3 or grade 4 depending on the sensory nerve conduction result. The 2 month post-op set look likely to be at most grade 2 both sides, could be better - again this depends on sensory studies. That kind of improvement usually correlates with the pressure having been successfully taken off the median nerve so there may well be not much more to be achieved by re-operating. Grade 5 cases often take a long time to recover after surgery but it is usually numbness and weakness which is slow to improve.
You have a particular problem with very troublesome pain I'm afraid and like your own doctors I find it very difficult to know what to do with such cases even when I have the patient in front of me and all the possible information to hand. If they do try open surgery then it would seem to make sense to do only one hand and I would be very interested to know whether it helps. JB
OMG, I'm so glad I found this site with people suffering everyday in pain like me! I had my first CT surgery on my right hand March 2012 and left hand was done in July 2012. Healing time I think was very slow. Maybe had something to do with going back to work 2 weeks after surgery. I had physio with helped a little. Before Christmas I feel like the pain has just come back 100 times worse. I'm not getting any sleep at night because of been woken up with pins and needles and pain in hands and wrists, I end up just getting up for the day at around 3.30- 4.00am as its just so frustrating laying there trying to go to sleep but in pain. I go to work everyday tired and cranky and don't know how long I can function like this. I feel like now I experience pain 24/7. I cant drive any longer than 20 minutes otherwise I am in so much pain. This Carpel Tunnel is really interfering with my life. I am forever dropping things.( Mainly it's the little things) I cant feel how much of a grip I have on things. This has started to happen at my workplace and it's starting to get embarrassing. Also the little things you take for granted that you can do with your hands I find the hardest. Like- putting petrol in the car, opening jars, using a can opener and hand writing. I find on a day when I use my hands a lot, my left hand near my scar blows up and gets really red and swollen and is very painful.
Nessck reading how you have neck pain, so do I but never thought about it until my hospital visit today. What would the neck have to do with it. Anways today I had my specialist appointment about my painful hands, I have to go and have more nerve conduction tests, MRI on hands and a Xray on my neck. Im the moment im just feeling very down and frustrated about my hands and at times I feel like im loosing the use of my hands, im only 37 so its scares me. Any advice or suggestions I would be very greatful.
I presume you have found the page of the site discussing the analysis of failed carpal tunnel surgery. I have great difficulty analysing cases without pre-operative and post-operative nerve conduction studies, especially when the symptoms continue to sound like CTS. You will also find quite a lot about neck pain in the double-crush page. JB
I would find it impossible to analyse what is going on there without some nerve conduction studies I am afraid - ideally with some pre-operative results to compare with. One thing you could clarify for me is what you mean by 'middle and last two fingers'. There is considerable difficulty identifying fingers in English as different people seem to mean different things by the same terms so I am always a little careful over this - my own preference for naming them is, in order, thumb (which everyone can agree on), index, middle, ring, little.
There is a guide to how to assess hands with an unsatisfactory outcome from carpal tunnel surgery on the site here and if you read through that you will find that it is structured as a series of questions to think about. Trying to answer those, so far as possible, may start to give some clues as to how to proceed. JB