Persisting symptoms
Hello. I am two weeks post op for carpal tunnel surgery and 5 weeks post op for Colles fracture in my right wrist. I have had severe cts since i broke my wrist (on 5/30/15). The doctor pretty much ignored my symptoms until i finally convinced him.... he said me median nerve, when he operated, had red streaks on it. However, most symptoms remain. The shooting pains have decreased but i still have constant pins/needles and numbness in my thumb and fingers (middle and fourth mostly--index not as bad) and the site of incision still hurts because it was in the thumb cts area. I have been instructed to do desensitization exercises--tapping my fingers, holding things, etc. Do you think this will work? Is there anything else I can do? Or is the nerve damage, even if cts lasted only 3 weeks, likely permanent? Thanks.
Thanks for your prompt reply! There were no nerve conduction studies done or even discussed at any time. I kept telling the doctor about my tingling and he did a reduction before surgery but it didn;t help the tingling. It was the weekend--i broke my wrist Friday night. (I live in the US, in Montana.) Then after surgery i told him about it again but he told me it would go away and gave me a prescription for gabbapentin, which only made me sleepy. Three weeks later I saw the hand surgeon in the practice (the surgeon I had was the one on call and specializes in shoulder injuries) and at first he dismissed my pain but when he tapped on the median nerve it sent pain into my fingers. So he did a release surgery two days later. Would it make sense to have nerve conduction studies done at this point? How could they help? I have not seen a neurologist. (The wrist itself is healing quite nicely and I do exercises six times a day and go to a therapist two times a week.) Thanks.
I should also say that I still have considerable swelling in my fingers and hand, so much that i am unable to make a fist. And it throbs when it is lower than my heart. Oh, and unfortunately I am right-handed.....
It would have helped a lot in analysing what is going on now if there had been some nerve conduction studies before the carpal tunnel release but even without the pre-operative studies, doing another set now will provide some useful information. The other thing which sometimes helps in this situation is high resolution ultrasound imaging as that can show evidence of continuing compression of the nerve. JB
Thank you so much. No one around here does ultrasound imaging, but maybe I should at least consult a neurologist. It's great that you are there..... my orthopedic surgeon is pretty much done with me!!
I've no idea what facilities are like in Montana but it should be possible to get some nerve conductions done and see how severely affected the median nerve is. Usually in the USA it's possible to get a copy of the results so that we can see just what has been recorded. JB
If my tingling/numb symptoms don't abate in the next few days (you'd think after 2 weeks I'd have SOME relief, wouldn't you, or is this in the normal range?....) I'll try to get some nerve conductions, though what if the nerve is compromised? Will it eventually return to normal over time? I just cannot imagine living with this tingling..... it will be like the middle and fourth finger don't exist, it is so excruciating to touch them--and the thumb nearly so.
I am also getting some acupuncture tomorrow to see if we can get the swelling down and he said it could also help with the scar tissue.
Pat
In straightforward CTS, outside the context of a fracture, tingling usually goes away immediately after surgery so your story is unusual. Numbness and weakness can be much more persistent/slower to recover but with peristent tingling I would worry about something still directly irritating the nerve. Fairly good nerve conduction results would be reassuring, very severely abnormal ones would make me want to investigate further. JB
Hello again. I've been silent, hoping that time will provide relief. But it hasn't. I did learn that I cannot see a neurologist as the sole practice here is taking no new patients. So nerve conduction studies seem out of the question. I have been making progress in using my hand and in gaining more movement. But the cts symptoms remain. What's odd about my symptoms is that I have no tingling/numbness/pain at all in my index finger and in the half of the thumb facing the index finger. The middle finger is the worst, but half of the 4th finger also tingles, as does part of the thumb and thumb pad. The top part of my palm is fine. Can you think of a reason why this should be so? (My therapist can find no evidence of obstruction in my shoulder and neck. She has diagnosed complex regional pain syndrome.) I am otherwise a healthy 62 year-old female, but I do have mild Reynaud's. Many thanks. Your website is the most thorough I've found. Thanks for that, too!!
The interesting distribution of the symptoms suggests problems with individual branches of the median nerve, or the bundles of fibres within the nerve a little further up which then go on to form those branches. Essentially you have one nerve branch heading towards each gap between two digits, which then splits to send a branch to the adjacent sides of those two digits, hence the 'half finger' effects. Surely there must be some way of getting nerve conduction studies done in Montana. It's not good enough to accept a physiotherapist's diagnosis of CRPS in a situation like this without looking into the state of the nerve that has been operated on. JB
Hello again. I'm back. Just to let you know that my diagnosis of complex regional pain syndrome seems to be true. I still have edema and somewhat glassy fingers, paresthesis in all but the index finger and half of my thumb, slight temperature differences in my hands, and I've recently noticed strange hair growth on the back of my right hand. The pain is also worsening somewhat. I'm still a bit in denial, still having hand therapy, and I still hope to get better. And still no talk of nerve conduction studies. Is this an American thing, I wonder? I've made appointments to discuss a stellate ganglion nerve block (though I am leaning away from this procedure), and also to get a second opinion about the CRPS. I just got the records from the doctors who did my surgeries, which I had to do before making an appointment with another doctor for a second opinion. I noticed that the doctor who did the first surgery--plate and pin wrist surgery--apparently edited the records to say he "certainly" discussed carpal tunnel release with me at length immediately following that surgery. He did not. In fact he dismissed my symptoms and only mentioned carpal release in passing, recommending against it. At the time, despite my complaints, he did not even ask me to explain my symptoms. Because I later complained about this, I think he went back in and adjusted his memory!! I keep thinking that had he done the release early--rather than my waiting three weeks for someone to listen to me--perhaps the median nerve would not be so damaged and I would not have developed CRPS. It hardly seems ethical, and I am disappointed. But there is no way of knowing. Anyway, thanks, again, for your responses. It helped to have someone listen to me out there...... Hopefully I can convince someone to do nerve conduction studies so we can tell a bit more about the nerve damage. If so, I'll let you know.
The shiny skin, swelling and pain would fit with CRPS but the tingling fingers are odd and suggest there is still a median nerve problem. CRPS can follow any injury, even apparently quite trivial ones, so it might have followed the fracture even if there had been no median nerve compromise. I still want to know what your nerve conduction studies look like but it's not proving easy to get any done is it. I don't think it's a general American thing - many of the people who come on the forum here seem to have little trouble getting electrodiagnostics done - so just your local patch I think. JB
Hello again Dr. Bland. I went for a second opinion with another hand surgeon and he said since no nerve conduction studies were done at the outset it makes no sense to do them now--that the median nerve is obviously damaged and it will take many months to regenerate. I went to another doctor who performed an ultrasound and he said the median nerve is swollen at the wrist--compared to the same nerve in the forearm. (He wanted to give me a cortisone shot as a diagnostic to see if the pain was coming from the nerve or the CRPS, but that made no sense to me so I declined; I know it's the nerve.) It's now been about 2 months since my CT release surgery and 11 weeks since I broke my wrist. The pain in my affected fingers is quite bad in the evening but calms down at night so I can handle it. (I assume there is pain and swelling associated with nerve regrowth.) The doctor says it is likely that the CRPS will also resolve with the regeneration of the nerve. So I wait. Thanks for listening. I'll let you know the end of this story in a few months......
I would have to disagree with the hand surgeon there about the NCS but as a neurophysiologist I would wouldn't I! The ultrasound is interesting and consistent with CTS. I think steroid injection might have been interesting though I prefer to do these before carpal tunnel surgery not after. There can certainly be pain asociated with nerve re-growth but not usually visible swelling - just a sensation that it feels swollen. I would indeed love to hear how it turns out. JB
Hello! I am back, to report on the nerve regeneration in my hand. It's been about six months since CT surgery (and nearly 7 since I broke my wrist). My hand isn't as angry as it was (it doesn't turn purple when I lower it below my heart) and my thumb is nearly better though it;s still numb and a bit sensitive at the tip. So, hooray, there's nerve regrowth going on. But the third and fourth fingers haven;t improved. My doctor says it will take more time--at least a year. Meanwhile, the tendon in my wrist is still swollen and it sometimes hurts, and my hand remains stiff. The CT incision often stings and burns still. I remain hopeful but my expectations for full recovery have fallen considerably. Thanks so much for being there and listening to me when I needed an ear. You made a difference. I hope you have a lovely holiday. Pat
It's a long slow process isn't it - but there does seem to be some progress. Nerve recovery after a simple traumatic injury can often take two years to complete the process so in those terms this is still fairly early days. This is not the usual story for a simple carpal tunnel decompression though - they usually recover quite quickly. It's a pity you can't nip over the border to the north to my colleagues in Alberta! JB
Wait... what do your colleagues in Alberta do? How could they help? Being an American I could;n' very well access the Canadian system, but I've been wondering what you meant.
I have a close collaborator in Edmonton who shares my interest in carpal tunnel syndrome, but as you say, it's a different country, and probably still quite a long way away given North American distances. JB
I've taken the liberty of separating this question from the thread it as attached to as that one needed moving to the Canterbury patient's forum anyway.
In the context of an acute injury like a Colle's fracture severe nerve damage can develop very rapidly. If we are to have an informed guess at what we can expect your symptoms to do we ideally need to know what the nerve conduction studies looked like before the carpal tunnel operation - were any done?
Pain in the incision area at 2 weeks is not uncommon and there is a good chance that this will settle. The desensitisation exercises and massage of the scar are worth trying. JB