Post carpal tunnel release surgery (9 years ago_
12 November 2013 - 1:45pm
I had surgery on my left hand 9 years ago and this has left me with a weakness which impacts on my daily life and my job in respect of grasping, holding and manipulating every day objects. I still occasionally get the old familiar tingling and pain in my right had (did not operate on my right hand). Does anyone else have the same problem?
Weakness of grip is a not uncommon complaint after carpal tunnel surgery. When people measure it formally with a grip strength meter it is usually only a slight reduction, not enough to bother most people, but the slight average reduction actually conceals quite a wide range and some people do have enough loss of power to affect their daily functioning. In some patients this will improve with time, but not in all cases, and after 9 years it sounds as though your problem is permanent. To illustrate how common it is, a 1996 study of 89 hands in 66 patients found grip strength was reduced in more than half ten months after surgery. It should be noted that this occurs when the operation is performed correctly and the weakness is probably just a direct consequence of dividing the transverse carpal ligament - which is exactly what the surgeon sets out to do in order to relieve the pressure on the nerve. Post operative grip weakness is therefore not usually a sign that there was anything wrong with the operation as such. I am afraid I have not seen any reliable reports of late interventions which are able to fix this - it is rare enough for it to be a significant clinical problem that it would be hard to find a decent size sample of patients like yourself to try something out on.
There are some studies of interesting variations of surgical technique. A French paper by Fissette J, Acta Orthop Belg 1981:47 p375 - which described 26 patients who had reconstruction of the transverse carpal ligament with a dacron reinforced silicone sheet at the time of surgery and compared these with 27 patients who just had the conventional operation found better grip strength in the reconstructed group. The study was not blinded. This seems to be something of a French speciality - a second paper from 1994 compared 77 simple open operations, 133 in which the ligament was repaired/lengthened and 99 endoscopic operations. Again the repair and endoscopic groups seemed to do somewhat better in terms of grip strength recovery. (Foucher G et al, Eur J Orthop Surg Traumatol 1996; 6; 185-189). However a more recent study (Larsen M, 2013 Carpal tunnel release: a randomized comparison of three surgical methods, J Hand Surg 38E; 646-651) found no real difference in grip strength at 24 weeks post op between the endoscopic and open operations - there was no ligament reconstruction group in this study.
So the bottom line is that yes - there are quite a few people who share the same problem with you but there is no satisfactory evidence base to tell us how best to deal with it. JB