Two suggestions for additions to existing website content


Firstly as a new forum member I must thank you for creating and maintaining this comprehensive website and support forum. Speaking as a patient I find that it provides a very substantial and valuable resource, and is very much appreciated. It will help patients who want to research and understand in some detail their medical condition, the treatment options, and some of the associated risks/merits. Particularly so for patients whose existing consultant surgeons may be unhelpful in responding to requests for more information and discussion during consultations.

I recently had release surgery for severe CTS. From my own experience of suffering from CTS, and after reading through the extensive information you have provided on this website, I think additional guidance on a couple of topics might prove of help to existing and future sufferers (prior knowledge would certainly have helped me in the suggested topics).

Provide an explanation of the “normal” process, and typical timescales, for the internal healing of the TCL, following the surgical cut procedure to fully section. Plus (if applicable) some notes on any recommendations or restrictions in use of hand during recovery period after surgery, so as not to compromise internal healing process.
a) Your notes make reference to the tunnel being converted into a trench following the surgery, but does it stay like this or eventually heal/re-join? I have read comments elsewhere the TCL reconnects with scar tissue resulting in a slightly larger circumference. I have also read some notes elsewhere indicating this internal healing process may typically occur 6 to 8 weeks after surgery. It would be nice to know what the true situation is from a source of authority and expertise like yourself.
b) The patient can see and understand how well the surface wound is healing, but has no idea what is happening at a deeper level inside the hand. I presume the healing and recovery process will vary across the patient population, even so, any qualified guidance that can be provided on general expectations about the recovery process and timings of the TCL would still be valuable.
c) Does the internal healing (or otherwise) of the TCL directly relate to the pillar pain topic you already comment on in the website? (I note that after more than 10 weeks post-surgery, I cannot put any real pressure on the base of my palm without feeling discomfort, and I am avoiding pushing up with the affected hand when getting up out of a chair in fear of affecting the internal healing process? Will I be left with permanent tenderness of palm heels that can’t support my body weight, or does the tenderness usually disappear (fully or largely) after a certain number of months?
d) Taking account of above comments, and my hospital experience where no guidance was given on use of hands during recovery regarding weight bearing on base of palms, I think any guidance you can provide to cover this area could only help interested patients with their recovery.

Provide an additional way of describing and illustrating the thumb abduction movement. I noted you provided a description on one of the forum topics [for user SallyAnnWalsh, Aug2012], based on picturing the hand on a flat horizontal table surface, palm side up, with thumb moving vertically upwards away from table.
I think another good way of illustrating and describing the abduction movement is as follows. Hold both hands vertically in front of your chest, palms facing inwards towards each other approximately 15 to 20cms apart, with fingers pointing straight ahead, and elbows tucked in to touch your sides. Now rotate both thumbs horizontally from the straight ahead position, so that both thumb tips are pointing inwards towards each other, new position now approximately 90 degrees (right angles) to fingers and palms.
Comments: By being able to look down and directly compare the full range of abduction movement achievable by both thumbs, it may then be possible to also notice the start of any loss of full articulation of a thumb due to onset of severe nerve compression and thumb muscle wasting. This is certainly the situation with my own case; severe wasting of the thumb muscle in my left hand gradually occurred without me noticing (whilst I was completely ignorant of CTS), and abduction movement of my left thumb has been severely compromised (I will email you an image of the maximum range of my thumb abduction movements). I’m not clear whether my suggestion would be a useful self-diagnosis tool “in real time” for a patient or not, because perhaps by the time a restriction in the range of thumb movement is noted, major muscle wasting has already occurred? But from my own experience, I can now only look at my restricted thumb movement with the benefit of hindsight “after the damage was done” and think I may have noticed something sooner regarding loss of articulation.

Do you have any immediate comments or thoughts on my suggestions. How soon (if at all) could I reasonably expect the heel of my palm to largely or fully recover its weight bearing capability (compared to before surgery)?



Thankyou for the suggestions. I'm not sure where to place the replies. I'm a bit obsessional so I try to keep the forums structured and this post includes two different typs of things. Firstly there are some suggestions on website content which I appreciate. I probably will add something on post-operative regimes and healing at some point but the problem is that there is almost no scientific evidence of any quality on which to make recommendations. Some surgeons do have very definite opinions about post-operative care and I don't want to start any arguments between patients and their surgeons so until there is some quality evidence to quote this is going on the back burner so to speak.

The second suggestion is about illustrating thenar wasting and weakness. I think we can do this much better. The best illustrations I have seen so far have been video and we may get around to doing our own at some point. In the meantime there are some fairly good ones on Youtube which I have referenced elsewhere in the fourms. Your photograph (via email) does quite strikingly illustrate the difference in mobility of your right and left thumbs but you are right that this clinical sign is too late a feature of CTS to be very useful as a warning sign for use by patients (or by doctors for that metter). By the time you have weakness and wasting it is too late to get the best results from treatment so CTS should be detected an treated before this develops if possible.

As well as those suggestions you have asked a set of very specific questions about your case in particular and I think these are better tackled in the general CTS forum so I will deal with those in a reply to your post there. JB

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