still having pain 4 month postop and after cortisone injection
I had surgery in April, the first of two planned. I had the type of surgery where they make the incision in the palm. I have never gone through with the second surgery because pain is still present when lifting, gripping or twisting the hand. My range of motion is fine, the tingling is gone, but the hand has pain with even minimal use. It is my non-dominant hand, and i have learned to pretty much not use it if i have to grip, twist or lift more than a few pounds. I have to constantly rub my palm (the fatty part of the thumb,mostly) due to pain and an itchy sensation (not triggered unless touched). I had a shot of cortisone about 10 days ago, to no benefit; in fact, the hand is still swollen from the trauma inflicted by the jabbing of the needle to inject the numbing meds, and then the cortisone. There was bruising in the hand as well. I wonder about whether i will ever be able to work again---i was a medical transcriptionist and now cannot type for longer than 30-minute increments, then I have to rest the hand, rub it a lot, and move on. It's been very frustrating, as I envisioned no more than a few weeks for recovery. I'm afraid to have the other hand done, and thankfully, it was the least affected of the two, and I can live with the occasional numbness and tingling. If i had had my dominant hand done first, and this happened, I would most certainly be disabled. Can anyone offer me any hope? I've had months of PT and it just makes my pain worse, so i'm foregoing any more of that. Should I have more cortisone if the first one hasn't helped? My hand surgeon, who i trust to be a competent doctor, seems to be out of suggestions. I can avoid having pain by doing nothing with the hand, but I can't live my life like that. It's scary because I don't know if it's ever going away.
the surgery i had was described to me as being easier to recover from. in the laymen's terms used to describe it to me, i was told that the small incision was made near the center of the palm, and a sheath was guided into the incision, covering the nerves, and then a hook-like instrument was inserted betweem the sheath and the band of tissue (again, protecting the nerves), into the forearm. the inside of the hook has a blade which is then pulled back out of the incision, cutting the band surrounding the carpal tunnel. if i could find my literature, i could tell you the procedure name. it took less than 10 minutes---more like five.
when i removed my bandage three days postop, i noted severe bruising in the forearm/wrist area under the thumb area, and most of the palm. when i went for suture removal, the physician's assistant noted the bruise on the arm and commented that it was strange. i don't know if that's relevant to anything....I also still have an area posterior to the incision that is completely numb and i cannot tell a sharp stimulus from a dull one---if i can feel it at all. the very bottom of the palm is sensitive to the touch all the time. I should also tell you that i rarely had pain pre-op; it was mainly numbness and tingling. Now i have pain. Had i known my outcome was going to be like this, i never would have had the surgery. friends who have had CTR surgery have given me their opinions, including the need for a nerve clipping.....just snip the nerve that's causing me pain. I'm not eager to undergo any further invasive treatment, let alone another procedure. but it's something to be discussed at my next appointment.
thanks for your reply.
The numb area near the incision sounds like an injury to a small cutaneous nerve branch - it's quite common for any cut to involve such branches. Did you have some nerve conduction studies done before surgery? JB
yes, two of them, about 18 months apart. there was little change between the two studies.
i have wondered if i'm just prone to nerve damage.....i had a thyroidectomy and had nerve damage, losing my voice for a few months......
There are genetic condictions which increase susceptibility to nerve damage but they are quite rare. Did you get any of the actual results of the nerve studies, and how close to surgery were the most recent set? JB
i had the last EMG/NCS on March 11, 2014, about six weeks prior to surgery. the findings state: "The bilateral median sensory nerves revealed prolonged distal latency and decreased amplitude. the bilateral median motor nerves revealed prolonged distal latency and decreased amplitude. All other nerves tested were within normal limits."
the page with the actual numbers show the following abnormal readings:
Left median motor (abd. pollicis brevis): wrist 8 cm: onset 4.5 ns (normal is <4.2) amplitude is 1.5 mV (normal is >5)
the EMG was normal. Right-sided values are not important (I haven't had surgery on that hand).
Does this help any?
Do you think a repeat nerve conduction study is necessary to see if there is nerve damage?
Thanks again.
By my standards that was a grade 3 CTS and should have done well with surgery really. It would be worth getting those repeated at this point to check whether there has been any improvement. If the nerve has been successfully released it should be showing some improvement by this stage. If you have someone available who is able to do the ultrasound imaging at the same visit the combination of both tests is even better for helping to sort out what the problem is now. JB
As usual in trying to analyse these post-operative problems I have to say that we need some pre-and post-operative investigations to start to make sense of what has happened. Surgery from thre palm only is relatively unusual - the well known endoscopic methods of carpal tunnel surgery are the 1-portal (Agee) method where the instruments are inserted in the forearm just above the wrist, and the two portal (Okutsu) method in which they are inserted above the wrist and emerge through a second incision in the palm but I have lost track of the number of minor surgical variants. There is a guide to how to set about analysing these problems on a page of this site so I would read that first and then see what investigation results you can obtain. JB