Bilateral CTS for >10yrs. Dx NCS (L): severe; (R) moderate but 'complicated' by mild mid-line palmar paraesthesia over thenar / hypothenar eminences. Bilateral open CT release 3/52 previous. Both transverse ligs. demonstrated at surgery to be fully resected prox & dist. Underlying basis of problem: morphological. (R) required dissection through substantial thenar muscles that had crossed the midline. (?bleed) Prompt post-op bilateral resolution of nocturnal Sx. (a real delight!)
Recovery (L): v.nice healing, v.minimal swelling, some incisional tenderness. Grip, excellent; finger pince grip, excellent; wrist mobility and tendon glide full and excellent; mild paraesthesia as before over median distribution but absence of nocturnal sx. Anticipate continued good recovery.
Recovery (R): v.nice healing, mild swelling, incisional and thenar anaesthesia extending to volar pad and lateral aspect of thumb. Grip, poor/moderate; finger pince grip, moderate and weaker at 4&5 with pain in CT. Continual 'squeezing' neuralgic pain felt at wrist, and along course of median n. to medial arm and axilla. Intermittent sharp pain in the deep dorsum of the forearm and hand. Sx markedly > by activity, particularly more static tension eg. playing piano, which results in > neuralgia and profound anaesthesia/dysthesia in the thumb pad and odd swelling sensation. Relieved after a night's rest, though sleep may be disturbed.
I concede I may have been doing 'too much' - eg. mowing grass 2 days after surgery etc.. but based on the superb recovery of the diagnosed worse (L) side, which involved prolonged dissection to release a heavily compressed ribbon like nerve, and which presented no post-op difficulties at all, I pressed on. The (R) side is a frank cause of anxiety with the brachial neuralgia (median n.) varying from a persistent quiet throb to awe-inspiring. It may be brought on by keyboard work (within 1 min or playing piano, within 3 min). It has improved since surgery, when immediately afterward the neuralgia in the arm was truly severe and only relieved by staying completely still. In any event, these are entirely new (R) hand and limb sx since surgery.
Surgeon's comment at suture removal and post-op check was dismissive. He offered no explanation and less interest. I regard the surgery as 'successful' but the development of troublesome and new symptoms in the right extremity are personally concerning.
Due for 6/52 post-op follow-up end Jan.
I would deeply appreciate any insightful comment please. Clinicians make the worst px!
My own feeling is that a cutaneous branch of the (R) median n. may have been injured. This may explain the distribution of the anaesthesia. The (R) brachial neuralgia appears more difficult to explain. Could it have been associated with a bleed? A sense of prognosis (on the R) would also be helpful based on your extensive experience.
Many thanks in hopeful anticipation of your response.