Numbness after CTS surgery and original symptons are worse

jlk69
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It is about 2 weeks after CTS surgery on my right hand and have persistent numbness to the right side of the index finger and left side of the ring finger that was not present before surgery. Also the symptoms that were present before surgery pins and needles numbness of the same two fingers that would worsen with use of fingers and hand or position of the arm but were not persistent have actually gotten worse and now produce a noticeable pain in the palm of the hand. I had CTS surgery years ago on the left hand by the same surgeon that went with out any problems and remains symptom free to this day. I have a follow up appt. with the surgeon next week on the 21st to remove the stitches. At my first follow up appt. with the surgeon after the surgery I reported my symptoms to him and he shrugged and said to come back next week. I did have a nerve conduction test shortly before surgery. I will check with the neurologist to get a copy of that test and report back with the reading when I get that. I am not in the medical profession so all of these medical terms are new to me so forgive for that help me learn so that I can ask the proper questions when I meet with my heath care professionals concerning this matter. Thank you such for time and expertise.

Sincerely, Jon

jeremydpbland
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It ought to feel at least somewhat better by 2 weeks unless it was catastrophically severe before surgery. If it is still this bad when the stitches are removed I would think about organising a new set of nerve conduction studies for comparison with the pre-operative ones. Have a look at the graph for the usual pattern of improvement in symptoms that you can find in the surgery pages here. JB

jlk69
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Thank for your quick reply. Do you think the surgeon will want me to wait longer for more tests? What is the minimum time after the surgery would you suggest for more tests to be run?

jeremydpbland
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Personally I think repeat tests are indicated if there is no improvement 6 weeks after surgery but most surgeons disagree with me it seems. Many surgeons are prepared to argue that we should not bother testing patients at all before surgery too but it is almost impossible to interpret post-operative tests if you don't know what they were like before surgery. JB

jlk69
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OK, 6 weeks. Better than the 3 months I was fearing. Thank you once again for your medical opinion.

Cheers, Jon

jeremydpbland
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If you can obtain the pre-operative NCS then that would give us a better idea of how fast recovery should be proceding. I hope it does begin to improve. JB

jlk69
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Well, I would like to update on what has happened since I last posted. I had stitches removed by the surgeon and told him again about the symptoms. He did a couple of strength tests (I have never had any symptoms of reduced strength) and then simply said he was sorry. I asked if he had taken any notes during surgery and he said no he never does.

After this I went to see my Primary Care doctor and told him of my symptoms and we talked at length about his experience treating CT patients and what exactly is done during the surgery. He told me my new symptoms are in his opinion are a result of the unavoidable contact with the nerve during surgery and he expects a full recovery from the persistent numbness eventually, but healing may take months and progress slowly. He said all nerve injury's heal slowly and that NCS will lag far behind that (3 weeks or more) to show changes.

I asked him about injections in the area of the surgery and he says that they don't work and would "gunk up" the area around the surgery.

I asked for another NCS to be performed and I got an appointment for the 27th of this month.

He looked at the test results of the NCS performed before the surgery and said they were "moderate".

He asked me if I wanted to take a anti-inflammatory medication which I indicated yes. He prescribed Dexamethasome 4mg tablets taken a half a tablet twice a day.

The first 3 days after taking the above medication my symptoms decreased by %30 and I was hopeful of a quick healing and the numbness to disappear. However, after that I have had little to no decrease in persistent numbness that is the most concerning of my condition

I had a follow up appointment one week after and told him about my improvement and he said that was very encouraging and gave me refill that cut the dosage in half.

Yesterday I met again with my PC doctor and told him about my symptoms not improving and he said that was not any way alarming and that it will probably be around 4 months post op for the symptoms to fade away. He said that is when he would expect NCS to give reading that would be indicative of how successful the surgery was.

I asked about Ultrasound to help accessing the results of the surgery. He said an MRI might be option much later down the road if the symptoms don't get better, but dismissed Ultrasound as a viable diagnostic tool for nerves.

I have an appointment next week on the 11th with my PC doctor and will get a copy of the NCS performed before the surgery and will post the numbers then and any symptom changes.

I am still out of work and not sure when I want go back as repetitive use of the hand and certain wrist positions result in what I would describe as a "nerve stinger" which is quite uncomfortable and can even result in a jerking motion as I respond to the sensation. I am in the food service industry and this is my primary hand so I am concerned about performing my job duties while these symptoms are present.

I do think that the nerve has been fully released because the symptoms before the surgery were triggered in part by the position of my arm (holding the steering wheel of my car with my right hand would bring on the pins and needles numbness in my hand). Now I when I drive I haven't noticed that sensation.

Thank you for your time,
Jon

jeremydpbland
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You seem to have been told several things there that are contrary to the published evidence I'm afraid but beyond saying that I'm not going to get into third party arguments with my colleagues. We can have a more serious think about this once we see the pre-operative NCS results - someone describing them as 'moderate' unfortunately means nothing. JB

jlk69
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You can view my pre-operative NCS here https://ibb.co/k8ag9a

jeremydpbland
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Thanks. They show a grade 3 CTS (out of 6) so this should show prompt improvement after surgery and if it's feeling worse now then something is amiss and they should be repeated. They also show a small ulnar motor potential with a delayed ulnar distal motor latency but no ulnar sensory nerve deficit - was this commented on? JB

jlk69
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The only comments can be seen here: http://tinypic.com/view.php?pic=28k0s9s&s=9#.WWgO-bieZiU Next NCS will be July 27th. Will report back when I get those results. If I have any significant change in my condition I will come back here to update. The persistent numbness of the inner two fingers (and the stiffness of these two fingers) is the most concerning symptom still bothering me.

jeremydpbland
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Looks like they didn't notice the ulnar result. Whether it means anything is hard to say - one thing I would do is compare with the other side. Your description of the worst affected fingers has changed a bit from the first posting to now - can we clarify exactly where the numbness is worst? It can be hard to be sure what people mean when talking about fingers as people use different terms for different digits. Personally I like the terms  thumb-index-middle-ring-little - in order across the hand as the majority of people seem to agree about which ones those are. JB

jlk69
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The persistent numbness is the right side of the middle finger and the left side of the ring finger on the right hand. The numbness is not that bad on the right side of the middle finger. The area that is the worst is the left side of the ring finger near the tip of the finger. Also both fingers feel stiff when I bend them. When I use my right hand I get pins and needles numbness in the same area and sometimes a nerve "stinger" in the palm of my hand. This symptom is about what I was experiencing before the surgery. I said before that some of the symptoms were better than before the surgery, let me clarify I no longer experience the pins and needles numbness while driving, but general use of the hand still causes the pins and needles numbness as before but now with the occasional added nerve stingers.

I did request NCS test to be performed on both hands in my upcoming July 27th appointment. This will be performed by the same doctor who performed all my NCS tests.

As more time goes by and my symptoms still seam pretty much the same as right after my surgery I am beginning to suspect maybe there was not a complete division of the tendon and maybe some part is still applying pressure on the nerve. What my real fear is that there is some sort of permanent damage to the nerve that will not heal completely and the numbness never goes away. I am also concerned that if there was an incomplete division, could permanent damage to the nerve happen if left too long before a possible second surgery to fix it?

Cheers, Jon

jeremydpbland
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I think that means the adjacent sides of the middle and ring fingers are affected (left and right depend on which way up you are looking at the hand). If that's right then it would make anatomical sense as that corresponds to a single branch of the median nerve. Careful neurophysiology might be able to pick up whether that particular branch is performing less well than the others but it can be difficult. If it's the non-adjacent sides of those fingers then that is anatomically odd. When the ligament is incompletely divided at surgery most patients seem to feel that the symptoms are actually worse afterwards but, as with everything in medicine, that is not an absolute rule. Apart from incomplete release it is possible to traumatise individual nerve branches during the operation. The most useful thing here is going to be comparison of the before and after NCS results (at least in my view). Sometimes ultrasound imaging can also help but few people have the expertise with ultrasound in this particular clinical situation I'm afraid. JB

jlk69
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You are correct, it is adjacent sides of the middle and ring fingers. Yes the symptoms are worse, before the surgery this persistent numbness was not present at all.

jeremydpbland
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OK Looks like the next thing is the follow up NCS then. JB

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