2 operations and still not right
Just found this forum and am hoping I can get some impartial advice here.
I had an initial carpal tunnel release operation done on my right wrist in July 2015. After 2 weeks I returned to work and although it was better than before the operation, it slowly started going back to how it was before (tingling fingers, aching hand). I had a 2nd operation on the same wrist in July this year (5 weeks ago) which found some scarring and this was tended too. This time I have had 4 weeks off work and returned on the Monday just gone. After a couple of hours typing (I work in IT) my hand feels as bad, if not worse than before the operation. Am I expecting too much ? Will it take a few more weeks / months to feel ok ? People I have talked to who have had the same op, say they were instantly better, with all previous symptoms cured. I also have hypothyroidism, which apparently has CTS as a side effect, although I am on tablets for that, so I assume would no longer be an issue ?
Basically, I am confused / annoyed / worried all in one. If I am to continue with these symptoms, I will have to find a new job as I cannot work for more than an hour or so before the pain / discomfort becomes unbearable. Any help or advice would be much appreciated.
Thanks for the quick reply Jeremy. I have read that page and done the test - Chances of CTS were 47%, Severity was Left 1, Right 3.6, Functional was Left 1, Right 2.4
The symptoms at the start were pins and needles / tingling / numbness in my right hand. Mainly when working with a mouse and keyboard or driving, but often at night when asleep and in the morning when waking too.
The only investigations done were various pulling and prodding of my hand and lots of questions. Physiotherapy was tried but had no effect other than getting rid of some other aches and pains I had. This was when my GP referred me to a specialist.
After the first operation proved unsuccessful, no other tests apart from more pulling and prodding were done. A steroid injection was tried, but had no effect. This was when it was decided to try another operation.
I have regular blood tests for the hypothyroidism and have recently had my dosage increased, but that has had no effect on my CTS.
OK The lack of investigations makes life a lot harder but at least the original clinical diagnosis of CTS was fairly probable. At this point you really need some nerve conduction studies and ideally ultrasound imaging done. It's hard to find people in the UK who are used to interpreting the ultrasound in this situation but there are one or two now so it depends to some extent where you are. It should be possible to get NCS done anywhere and in most areas your GP can refer direct if the surgeon is being unhelpful.
Out of curiosity - did the surgeon give you any actual figures for the succcess rate of surgery before operating? JB
I am in Bristol. I have a GP appointment next week, just to get a 2nd opinion really, but I will probably book another appointment with the consultant too. I will ask them about the ultrasound and NCS, thanks.
I was given an idea, but he was confident it would be sorted out with the first operation.
There's a very good neurophysiology department in Bristol including someone who knows a fair amount about nerve ultrasound - though I doubt if she has seen many cases after two attempts at surgery. Hopefully this can be looked at and we can get an idea what is going on. JB
Thanks again Jeremy. I will book an appointment with the consultant and let you know how I get on.
Just a quick update. I had an appointment with my GP last Friday for a 2nd opinion, but after waiting for over an hour, I gave up and went home. Over the weekend my hand was fine, with just the occasional twinge, so I thought it must be getting better.
Come Monday morning and after a couple of hours of working on the keyboard / mouse my finger was numb and my wrist was aching again.I had a busy day, so couldn't take many rests and by the evening it was pretty unbearable. I have now booked an appointment with my consultant for Thursday afternoon to see what is going on.
I am concerned that working on a keyboard / mouse is aggravating the condition and I may have to look for alternative employment if this can't be sorted out. My finger is going numb typing this and I have only been in work for 45 mins.
I'm increasingly finding myself having to apologise for the health service I'm afraid - how on earth does one end up waiting for an hour in GP for a non-urgent appointment. I know my GP colleagues are under a lot of pressure at the moment but that sounds either disorganised or very unlucky if you were bumped aside by a string of very urgent problems. I hope either your GP or consultant are willing to refer you for some neurophysiology - the Bristol department is ready and waiting for you! JB
I believe they had a difficult patient in. Rather than add to the delay, I thought I may as well cancel my appointment and just see the consultant instead. I can sympathise as my Mother used to be a dental receptionist. Although if any of her dentists were running an hour late, she would have had words with them !
Quick update - I saw my consultant on Thursday and I am booked in for an x-ray and MRI tomorrow morning. More tests to follow, depending on what they find.
One wonders why they aren't doing the obvious test and getting some NCS done instead of messing about with expensive imaging. If the MRI is of your neck it will probably be mildly abnormal - almost everyone's is. If its of the wrist it will need expert interpretation after two attempts at carpal tunnel surgery. JB
I had the MRi and an x-ray of my wrist and they showed some inflammation. I am booked in to have a cortisone injection again on Thursday, which I'm not too pleased about as it hurt like hell last time (I am a wimp though !) and didn't seem to do anything last time. I did mention the tests, but as he could see the inflammation on the scans, injection is the next step. Another operation was mentioned if the injection didn't work, but I will insist on the tests before that, as 3 operations will be a bit much in my opinion.
I wonder what they thought was 'inflamed' on the MRI - I don't suppose they gave you the MRI report either did they? JB
I think it was between the ligaments and the bone ? I was shown the scans and had the inflamed area pointed out and when the consultant pushed that part of my wrist I could definitely feel it.
The cortisone injection seems to have taken away the aching from my wrist, but I still have a numb fore finger. In fact as I type this I am not actually using that finger any more.
OK, so they are assuming that there is some inflammatory process in the wrist itself. Interestingly the neurophysiologists from Bristol are with me at present but none of us can do anything to investigate this if they will not refer you :-( JB
Just been to the follow up after the cortisone injection and I am now being referred for tests ! My fingers are still very uncomfortable after typing for any length of time, so hopefully we will find out what is going on.
At last! It's going to be hard to interpret the results in the absence of any previous tests but at least we will get some objective data on the state of the median nerves. Ideally you need to see Dr Kane or Dr Klepsch I think. JB
Just had the follow up after the tests and it seems the carpal tunnel is ok now and no more operations are needed on that. Some tests were done on my elbows and there are a few issues there, but only what is expected of a regular keyboard user. Next plan is to do an MRI on my neck and see what is going on there.
Sounds as though we are now looking for alternative explanations to CTS. Do you mind me discussing the case with Bristol? This is a rather intriguing exercise in how the rules on medical confidentiality apply in the modern world. You and I are conducting this discussion in public, even though a third party observer should not be able to work out who you are. Conventional rules would say that Bristol cannot share their findings directly with me without your written permission, unless you were actually referred to me for a second opinion. On the other hand they could give you a copy of the results and you would be at liberty to pass the to me. JB
Have you read through the page here on failed surgery? The starting point in anylysing this has to be the original diagnosis - what were the symptoms like before surgery? (if you can remember pretty well you can run through the symptoms questionnaire here giving answers for the situation as it was before surgery). Were any confirmatory investigations done before the operation - NCS or ultrasound imaging - and was anything else tried before the operation, such as splinting or steroid injection. All that information will allow us to have a guess at what should have been expected from the first operation.
When it became apparent that it was unsatisfactory after the first operation did they repeat the NCS (assuming some were done to begin with), or carry out an ultrasound examination then?
The hypothyroidism is probably not relevant if your TFTs have been checked recently and are OK. JB