Carpal Tunnel Surgery
I would like to find out if it's normal to experience pain during CT surgery. My wife had CT release surgery a couple of days ago. During surgery when the surgeon was cutting the carpal ligament, my wife experienced severe pain and at the same time, the surgeon indicated that he was having trouble cutting the carpal ligament but did succeed in doing this. She is now recovering from the surgery I don't want to put people off but I am concerned that she had pain during surgery.
Firstly, thank you very much for your reply regarding my wife's recent CT release surgery. It has now been just over two weeks, and we are concerned as my wife now has numbness in her thumb plus pain. Also she has numbness on the tip of the middle finger with pain in the her wrist and fleshy part of the palm near the wrist constantly. And to make matters worse my wife has little grip when trying to use her hand. I must point out that she has suffered from Fibromyalgia/Arthritis for twenty something years in most areas of the body including the joints in her hands. Could please advise if these symptoms are the norm as she is very concerned as her surgeon at the time advised surgery on both hands.
We would much appreciate your input in this matter.
It's hard to provide very concrete advice through the medium of the internet on individual cases. My general approach to assessing post surgical symptoms is described on this page. You will see that I depend quite heavily on knowing what the patient was like before surgery, particularly the nerve conduction study results. If this was a bad CTS before surgery then one expects a rather different post-operative course compared with a nerve which was only mildly impaired to begin with. The other thing one needs to do is make a detailed comparison of the symptoms before and after surgery to try and work out what has improved/deteriorated/is new - in this case for example we would want to know whether the numbness of thumb was there at all before surgery and whether it is worse or better now, or whether it is a completely new feature. You would carry out a similar analysis for each symptom. Were any nerve conduction tests done before surgery? (not everyone bothers to do them) JB
Thank you very much for your speedy reply, in answer to your questions yes nerve conduction tests were done and showed medium results in both hands. But I have to say due to pain and numbness in both hands she more or less had got to the stage of not being able to hold things without dropping them or using her walking stick prior to surgery. Another point worth making, is when her surgeon made an assessment at her appointment, she concluded within minutes that she needed surgery asap to elevate the pain, tingling sensation and numbness in both hands. Getting back to the numbness in the thumb this was there prior to surgery but not constant as it is now. To try and explain it better regarding the thumb, apart from the numbness on the left side of her thumb, my wife experiences a burning pain sensation within the thumb pad when touched which unfortunately is a new symptom. She still has quite severe pain in her wrist when she tries to bend her hand which was an existing issue which we had thought would stop after surgery plus her hand is also weaker than before. Our conclusion rightly or wrongly is she is worse off after surgery. Sorry to be so negative about this but I guess all we can do is go back and see the consultant surgeon.
It sounds as though this was probably fairly severe before surgery, albeit perhaps with other problems affecting hand function too, and one might therefore expect it to be a while before one can fairly evaluate the outcome of surgery - a first assessment at 6 weeks to 3 months would probably be reasonable. If it feels no better then I would be inclined to repeat the nerve conduction studies. These should be done by the same lab that did the pre-operative ones and the results assessed by a consultant neurophysiologist as interpreting the findings after surgery is relatively complicated. The burning sensation in the thumb is hard to evaluate - it might indicate either worse or better nerve function. Weakness after surgery is common but is not usually a major long-term problem. JB
A few patients do recount tales of quite severe pain during surgery. There are probably a variety of reasons for this. In some cases the anaesthetic may have been incorrectly placed or not given enough time to work. There may be a few rare patients who are resistant to the effect of local anaesthetics (see the discussion with the twins early in this forum). Some patients seem to find the sensations which are experienced as the surgeon is manipulating the tissues unpleasant, and finally many surgeons use a pneumatic tourniquet on the upper arm to obtain a bloodless field during the operation and some patients find that unpleasant. The aim of course is always to achive pretty much painless surgery and in theory the most painful bit should be the injection of local anaesthetic to begin with. JB