Tinel sign after CT Release
Hi, I did CTS endoscopic release a week ago. Now the hand is bruised, but generally not painful apart from using it. However what bothers me is when I lightly tap on the tunnel area it gives me slight zaps down my fingers. Is it normal after the surgery? My doctor says that it could be due to irritated nerve after the surgery and should go away. However I'm worried because I had this before the surgery. Please kindly advise if anyone knows. Thanks! ))
Dear Dr. Bland,
It's been 5 weeks post-op. It's still a little bit painful and swollen in the wrist where the liagment was cut.
Plus I still have electric shots into the fingers when I touch nerve above the carpal tunnel (above the incision).
My doctor says that the nerve needs time to heal. Is it normal? He told me to come on Wednesday to start physiotherapy (laser and smth else). Please advise. Thank you!
That's still likely to be mechanical hypersensitivity of the nerve. It's very close to the skin at that point. As long as the original CTS symptoms have improved it's not an immediate cause for concern, though it is starting to get to the point where you could call it a 'complication' of carpal tunnel surgery rather than just standard healing. If the original symptoms have not improved then it's a slightly different matter. JB
Thank you! My hand did not get numbness before and after tough. Basically it's hard to say if the original symptoms have improved or not. I don't use this hand much. My main complains were pain in the wrist where the tunnel is when using my hand repetitively, fatigue/exhaustion even from light repetitive activity / work and these zaps into the fingers. They did ultrasound, it showed flattened nerve, xray was normal, emg was a little bit lower, but close to normal. I tried cortisone several times, it eased the symptoms but did not clear them out. I've been suffering from it for more than 12 months that's why they advised me to go through release. My right hand is also affected in the exact same way (pain, fatigue and zaps), but it feels better and the nerve is less flattenned. I use both hands, but now only work with the one (I type a lot, use smartphone, used to game a lot, using gamepad and a mouse). My doctor says it can take up to 6 months to heal after the surgery.
Lots of things to comment on there. Flattening of the nerve on ultrasound is not a very reliable sign of CTS. The most consistent indicator of CTS on the imaging is in fact swelling of the nerve, usually just at the forearm end of the carpal tunnel, though sometimes it is more evident at the palm end. The shape of the nerve doesn't mean a lot as many normal nerves look flattened at the carpal tunnel (including mine).
The response to cortisone is somewhat mixed news. Provided an adequate dose is used then about 80% of CTS cases respond well to steroids, and a good response to steroids tends to predict a good response to surgery and vice versa. So your partial response is somewhere in the middle of that. Another thing to consider is that CTS is not the only thing that responds to steroid injection at the wrist, we have had people report improvement in tendonitis, osteo-arthritis and even skin conditions like eczema and psoriasis after a carpal tunnel injection. You thus have to keep in mind that even if your symptoms were not primarily due to CTS they might still respond somewhat to steroids.
It may be worth me looking at the EMG results if you have them so see just how bad the CTS was. Very mild cases, in neurophysiological terms, tend to do less well with surgery.
Recovery after surgery can take anything from a couple of days to forever - ie never recovering fully at all so 'up to 6 months' is slightly misleading. The implication that it will all be fine in 6 months is not necessarily true.
Pain in the wrist itself - as a primary symptom in the absence of other things - is not really a typical presentation of CTS so I would wonder just how certain we were of the diagnosis overall. If you have answered the symptom questionnaire on here for the symptoms as they were before surgery then I can take a look at those answers and think about the problem a bit more.
Finally - it's worth noting that we are just moving the website from a server in the USA to one in the UK so access may be a bit difficult in the next 24 hours or so. JB
I passed the questionnaire; it says my chance of CTS is low. Thank you! However I want to give you my comments and a brief story:
First of all I work in the office with the keyboard, mouse 5 days a week. Plus surf a kot in my smartphone. Since 2011 I've been playing a lot of video games on my PlayStation. I could play many hours per week, spent hundreds of hours in different games. It had been all good until summer 2016 when I felt moderate wrist pain after just another game session. Took a break for a week, it went away. I did not pay much attention. In December 2016 I played 4 days 6-7 hours a day, maybe more. In the end of the fourth day my hands started to feel very bad, they felt sore, exhausted, it felt like they were burning. Plus it felt like cutting pains in the carpal tunnel. I used ibuprofen gel, rest, nsaid tablets. It did not help much. However the pain gradually started to go away during several months. I did ultrasound later on and MRI in different hospitals. They did not find any inflammation in tissues, xray did not show bone problems too. They both concluded that it was mild to moderate CTS. My wrist felt badly when I used it. Got tired and painful very quickly from repetitive activities like typing, ironing, mouse and cell phone using, brushing etc. Plus these zaps appeared. Nerves are so sensitive, that even if I easily touch it I feel these zaps. The more I use my hands the more sensitive it gets. It gets better when I rest. I stopped playing, gave as much rest as I could. Nothing really helped. Only several cortisone shots helped. The rest you know. I did surgery on my left hand since it was worse than the right.
The scientific literature on the relationship of activity/work to CTS is huge, confusing and contradictory. I think very repetitive, strenuous activities, especially with vibrating tools, slightly increase your risk of getting CTS but other factors are more important and these types of stresses probably cause other problems just as much as they cause CTS. Your symptoms include some features associated with CTS but are lacking others so you are not exactly a textbook case, hence the low diagnostic probability on the questionnaire. One possible reason for the so far uncertain response to surgery is therefore that CTS is not the only problem. It's still quite early days yet after surgery. JB
I would not worry about that 1 week post-op. There are still going to be lots of inflammatory chemicals floating about in the area as a result of your body's reaction to having a knife taken to it and these are likely to make the nerve irritable. JB