6 weeks post op - still in pain
Report from my surgery was that the median nerve was severely compressed by the flexor retinaculum, pale and ischemic. It had been compressed (undiagnosed by Newcastle Australia's 3rd world medical system) for more than a year. The operation was done in Sydney by a neurosurgery department. I'm 6 weeks post of, and yet to see any improvement. Still sore at the wound site. Follow up next week. Worried by the lack of progress.
Not sure. First test done in May last year said that there was no sign of carpal tunnel syndrome. 2nd one, at a different lab, doctor said you "may" have a touch of carpal syndrome. I knew they were wrong. I can't stress enough just how bad the medical system is in this area. I'd be surprised if a doctor here could reliably diagnose a stubbed toe.
Should add that for several months I was treated on the assumption that I was suffering from pronator syndrome - which I wasn't. Condition was deteriorating all through that time
Well if it was CTS that was hard to detect on NCS that would suggest relatively mild physiological impairment and such cases should respond very quickly to surgery - ie overnight! A lack of any change in the symptoms 6 weeks after surgery in those circumstances suggests either incomplete division of the transverse carpal ligament or else an incorrect diagnosis. I presume you have found the page on the site here discussing how to analyse the outcome of surgery when it is not all one would wish?
On another topic, do you mind if we edit your original post so that it is not possible to identify your particular surgeon as I try to keep the forums helpful rather than critical? I know your comments are not currently directed at the surgeon but even so it's probably better to keep identities out of it unless people join the conversation themselves. The comments on your local healthcare system are interesting - it's curious that many patients around the world seem dissatisfied with their own system and are convinced that some other country has a better solution. I've quite often been told that the Australian system is wonderful. JB
There's nothing wrong with the Australian health care system. It's the particular region I live in. Regarding severity, the symptoms were not mild. They were severe. I was in a lot of pain, sometimes extending to the shoulder (cervical exams were fine). What I don't have any faith in is the standard of the studies I had done. I had an appointment to leave the region for another exam before I was stupid enough to believe both the GP and therapist who claimed pronator syndrome. Also, given the post operative pain is in the precise area of the pre-operative symptoms, that's a pretty clear indication of the final diagnosis.
PS. EDIT as you wish
Unfortunately there is only a very loose correlation between the subjective severity of symptoms and the degree of median nerve damage shown up by nerve conduction studies - ie some patients with no easily detectable abnormality on testing have severe symptoms and some with catastrophically bad nerve conduction results have no symptoms. What is important is that the nerve conduction results have some predictive value for how the condition will respond to treatment whereas the subjective severity of symptoms has almost no such predictive value. We do understand some of the reasons for this 'disconnect' between how the condition feels to the patient and what conventional nerve conduction studies measure and I might do a page of the website devoted to it at some point for those who are interested.
The pronator syndrome is a bit of a contentious entity but if it does exist it is undoubtedly much rarer than CTS. It is hardly ever demonstrable by nerve conduction studies and attempts to treat it surgically meet with rather mixed results.
I've just taken the precise identification of the Sydney hospital out of your original post. I hope it starts to improve shortly. JB
Pain seems to getting worse over the last couple of days. Especially in the thumb and at the incision site
It definitely shouldn't be getting worse at 6 weeks post surgery so someone (preferably the responsible surgeon) should take a look at that. JB
My nerve conduction tests don't have a "Grade"
It seems that the significant numbers which were in bold font and highlighted with an asterisk were
Motor Nerves
Site -Med Wrist
Onset (ms) 4.7
Normal Onset <4.2
Amp (mV) 4.1
Sensory Nerves
Site - Med Palm
Onset (ms) 1.7
Peak (ms) 2.2
Amp (uV) 47
Dist (cm) 8.0
Vel (ms)47
Normal Vel >48
Site Med Digit II
Onset (ms) 3.4
Peak (ms) 4.0
Amp (uV) 8
Dist (cm) 13.0
Vel (ms) 38
Normal Vel >48
Site Med Digit III
Onset (ms) 3.4
Peak (ms) 4.1
Amp (uV) 8
Dist (cm) 13.0
Vel (ms) 38
Normal Vel >48
Report
The median distal motor latency is delayed across the right wrist. There is no slowing of median nerve conduction in the forearm or across the elbow. The median sensory responses are delayed. The ulnar studies are within normal limits. Needle EMG shows fibrillation and positive sharp wave potentials in the right Triceps, with moderate chronic denervation changes present also. There are less pronounced chronic neurogenic changes in the EDC as well.
Interpretation
There is evidence of moderate slowing of median motor and sensory conduction across the right wrist. There is no slowing of median nerve conduction more proximally.
I saw the surgeon on Friday. He reiterated that median nerve was very badly compressed. The surgery went very well. There's some tenderness at the incision site which is unusual this far out. I've got some gentle exercises and massage to do and have been prescribed steroids. Follow up in 5 weeks.
Those are just NCS for one hand and they show a grade 3 CTS by my standards Are those pre or post surgery?. If they were the pre-operative set then one would expect the CTS symptoms to respond promptly to surgery with that degree of NCS abnormality. It's rather odd that they described needle EMG abnormalities in triceps and extensor digitorum communis muscles but made no further comment on this in the interpretation section of the report. Those EMG abnormalities, if genuine, would not be seen in CTS but would be seen in a C7 radiculopathy. The use of steroids after surgery is interesting - what sort of dose? JB
Surgeons seem to say that about almost every carpal tunnel operation in my experience. A much better guide to how it should be doing post-operatively comes from the pre-operative nerve conduction studies if there were any? Cases in grades 5/6 can be slow to recover even after surgery. JB