numbness three weeks PO endoscopic carpal tunnel release

That could be a description of injury to one of the palmar branches of the median nerve - or of the fascicles within the median nerve at the carpal tunnel which are to become that branch in the palm. It's very hard to be certain however. If there are good pre-operative nerve conduction studies available it might be possible to get some way towards an accurate diagnosis with careful post-operative studies and maybe high resolution ultrasound. However I would probably wait until at least 6 weeks post-op as there is a possibility that this is only a neuropraxia which may recover spontaneously. JB

Dr. Bland,

Thank you for your response. I had a nerve study and EMG test and will see my surgeon in a week for follow up and results. The neurologist who performed the test only said there seemed to be some "slowing" in the wrist area and that could be from swelling.

Unfortunately there are no prior tests to compare with. Because my surgeon needed to make several passes to remove adhesions and scar tissue scraping the tendon (in his words) and was close to opening up my wrist, would that have made nerve damage or irritation more probable?

I'm now 5 weeks PO and have absolutely no change in numbness of 1/2 of my middle finger and 1/2 of the ring finger. I can't feel anything particularly between the fingers. I have tingling on the tips of both fingers and I have some sensation on the palm side of both fingers but it feels uncomfortable and a burning feeling when I touch the palm side of both fingers. Two days ago I started getting a sporadic burning feeling in the center of my palm.

If after six weeks I have no improvement what would you recommend? Also what is the benefit of an ultrasound ... will it show nerve damage? If there is injury to the palmar branch, what is the treatment? I'm extremely uncomfortable and frustrated because my fingers were not numb before the surgery and I'm unable to work. I had an open CT release on my opposite hand along with a ulner nerve transposition 3 years ago and had immediate relief after the surgery so I'm a bit concerned with this outcome.

Once again thank you for your answers - this site has been extremely helpful.

Have a good day.

It's a pity there are no pre-operative NCS for comparison. Did the person who did the new set try to test particularly the area affected by the new numbness (this is difficult but it can be done to some extent)? Ultrasound examination can do a few things. It is possible to check that the transverse carpal ligament has been satisfactorily divided and if you have a skilled operator with a high quality scanner it is possible to follow each branch of the median nerve all the way to the finger ends. Injury to the palmar branch which eventually supplies the adjacent sides of the ring and middle fingers will show up as a swelling of the nerve (a neuroma). However, there are very few people who are competent to do this. Endoscopic surgery probably does carry an increased risk of temporary neuropraxia. What to do beyond 6 weeks probably relies on a very careful examination of sensation in the affected area and on the exact findings of the NCS - not something one can do on the internet unfortunately. My guess is that this is in the USA? JB

I am hopeful the neurologist specifically did test the area - my referal noted the numb fingers. I was wondering if you can explain a little further about a neuroma. Does the entire palmar branch become swollen? Is there any treatment aside from waiting for it to heal and does it heal? At this point I'm so uncomfortable - in my perfect world we could surgically go back and open up my wrist to see what is going on but I'm assuming thats not practical nor would be of value?

As far as temporary neuropraxia, is there some sort of timeline as far as when feeling could come back or could this be longterm? My worry is that this will not resolve.

Your guess is correct - I am in the USA. I am set to see my surgeon in two days to discuss my EMG test results and hoping to get some kind of idea of what to expect going forward. Is there anything I should be specifically asking at that appointment?

I am grateful for your help and the info on this site has been the most comprehensive CTR advice on the internet, particularly when it comes to complications. Thank you again for your help!

The whole point of the ultrasound exam is to try and get a look at what is going on without having to 'open it up' again! You can get surprisingly detailed images. Neuropraxia can last anything from a few hours to about 3 months and can be thought of as the nerve stopping working for a while, but retaining it's structural integrity. Nerves are like any other tissue - when you injure them you see swelling at the site of injury. An injury that does not break the nerve will produce a fusiform swelling in continuity but if you cut right through a nerve you see a swelling at the cut end. With endoscopic CTD, lesions in continuity are much commoner than nerve lacerations - though both have been reported. Which it is has implications for treatment - lesions in continuity are much more likely to recover and are usually left alone to heal. There is no concrete evidence for this but I suspect that an injury which is too mild to produce swelling visible on ultrasound probably has a better outlook.

You should be able to tell what the neurologist tested if you were paying attention during the test. NCS to test the sensory nerves in the USA are usually done 'antidromically' which means placing ring electrodes around the fingers and giving a shock at the wrist to stimulate the nerve (usually 14cm up the arm from the ring nearest the base of the finger - you may remember them measuring this). Doing this using the middle finger in your case might have given a relatively normal response however because they are recording from both the affected and unaffected sides of the finger - which are supplied by two different branches of the median nerve. To selectively test each branch you have to record at the wrist and carefully stimulate each individual digital branch - so in that case the shocks are to the fingers, not the wrist, and usually need to be given with a small handheld stimulator. Even then it is difficult to stop the stimulus spreading to the 'normal' side of the finger but it can be done with care. JB

So I met with my doctor to go over my EMG/Nerve tests. My surgeon said because the test showed the right median distal motor latency was minimally prolonged and the right median sensory conductions were mildly slowed - he was of the opinion the nerve is just "irritated" and should recover although it could be up to 5 months to obtain complete healing and the feeling back in my fingers.

He felt because the radial nerve readings were normal there was no severe nerve damage such as a laceration. He is also of the opinion that I still have quite a bit of swelling in my wrist area and was going to do a cortisone shot to reduce the wrist inflammation but decided to wait on it. I asked him about doing an ultrasound but he didn't think it was of value at this time because of the test results. He also stressed that I should continue to "use" my hand even though my fingers become extremely sore and painful particularly after using the computer for a while. My hand "aches" at the end of the day and i continue to have trouble sleeping because of the finger numbness.
My test results were as follows:

Motor Nerve Conductions

Nerve Latency Amplitude Velocity Distance

Median 4.3 2.1 10
79 2.1 56 20

Ulner 3.4 5.4 10
7.1 5.4 62 23

Radial 4.3 2.1 20

Sensory Nerve Conductions

Nerve Latency Amplitude Velocity Distance (cm)

Median
(thumb) 2.1 44 38 8

Median
(ring) 4 12 40 16

Ulnar 1.5 39 53 8

Radial 1.6 38 56 9

The impression was the findings are consistent with mild to moderate residual Carpal Tunnel Syndrome

I'd appreciate your input and opinion on these test results and the wait and see approach my surgeon has suggested.

Thanks for your time ..

It looks as though they did not make any special effort to test the territory in which you have the new numbness. It is quite striking in those results that the median sensory nerve potential ampitude for the ring finger seems to be 12 microV, compared to 44 microV for the median potential using the thumb and 39 for the ulnar (presumably little finger but this would be more significant if the ulnar one was also recorded using the ring finger). It therefore looks as though the median/ring recording is unusually small compared to the others but we don't know what the normal values are for that lab. Comparing with the other hand would be useful. At this point, whatever the diagnosis, there is probably little you can do in terms of treatment other than sitting tight and waiting I'm afraid. As you know I would do somewhat more extensive NCS and u/s examination here to try and figure out what the problem is but I have to admit that whatever I found it would be quite unlikely to lead to specific treatment. Let me know how it evolves though please. JB

One question I forgot to ask if I may ... because of my diagnosis of "residual carpal tunnel" is it worthwhile to wear my splint or is it better to keep moving and using my hand through the discomfort? Does it benefit nerve healing to splint my wrist?

Thank you !

I don't think anyone really knows the answer to that one. In practical terms, if you think the splint helps control symptoms then use it - they are pretty harmless. It is unlikely to inflluence the process of nerve recovery either for better or worse after surgery I think. Nerves either regenerate or they don't and there are very few things that we have control over that make much difference to the process. The issue of whether to try and 'work through pain' in rehabilitation is a dificult one and not my speciality. I would suspect that there is a lot of individual variation in this from one patient to the next and that only someone very closely familiar with both the patient and the particular injury should really advise. JB

Thank you for all of your quick responses, Your advice has been extremely helpful as I go through this process. Hopefully this will resolve at some point and the feeling in my fingers will return .. I'll keep you posted !

Hi there,

Just a follow up @ about 15 weeks post op. I've had no change in symptoms that occurred after my surgery with the exception of my middle and ring finger get "cold" when the rest of my fingers and hand are warm - I also have constant burning sensation on the palm side of both fingers which wasn't there in the early weeks after my surgery. I continue to have no sensation particularly at the web space between my middle and ring finger as previously mentioned.

At todays appt. with my surgeon, It was his opinion that I have a compression at the carpal tunnel area resulting from scar tissue and swelling from the surgery and he doesn't recommend anything other than nuerontin for pain and waiting 6 mos. to see if feeling comes back. He told me nerve irritation is one of the risks that can occur with CTR surgery and with the results of my last EMG nerve study the nerve was not severed. He did a Tinel test and I felt the zapping feeling on the palm side between my ring and middle finger - he said that was a good sign. My concern since I continue to have zero change is that if there was some kind of nerve damage and I wait too long (6 months) if something could be done do I run the risk of not being able to repair or address an injury that could be repaired.

I've scheduled an appointment with a hand specialist for a second opinion and was wondering if you could suggest questions I should be asking also I have another Nerve study scheduled and would love some feedback on what I should look for or ask at this second test.

I am so uncomfortable all the time with my fingers its hard not too think or focus on anything else. They are a constant source of discomfort even holding the steering wheel when I drive. I guess I'm hoping for answers that may not be out there but I will feel better with a second opinion at this point. If you can offer any other suggestions I'd appreciate it.

Thanks again for your time and expertise.

I guess the key question is "could this be an intra-operative injury to the palmar branch of the median nerve which supplies the middle and ring fingers?". The other thing is to enquire whether you have anyone in the immediate area who is really good at nerve ultrasound imaging. There are several people in the US who are very good but it's a big country and they are scattered around. In the nerve test ask them to try and do sensory tests on all the fingers and compare with the other side. They could also try to stimulate just the individual digital nerves of the affected fingers and record at the wrist, again comparing with the other side. This is difficult because of spread of the stimulus to the opposite side of the finger but with careful comparisons with the other side it is possible to make something of the results. JB

Hello Dr. Bland,

Just wanted to check in with an update from my endoscopic CTR done 3/3/17. Unfortunately I have had no improvement in the continued tingling and numbness on 1/2 of my middle finger and ring finger and have a burning sensation in my palm almost in the center below the two fingers. I have seen two hand specialists who both say there is nothing to be done.

I can tap at the wrist area and illicit a slight tingling sensation at the point between the middle and ring fingers on my palm side. Pressing down on my palm about one inch from where the release was done - not the actual scar which is above on my wrist, is tender and burns. I was just checking to see if you had any new input regarding my continued symptoms or if this is something that may or may not resolve. I'm still hoping for answer.

Appreciate your time!

I'm sorry to hear that but not entirely surprised I'm afraid. On the assumption that this is a relatively minor nerve injury that is leading to persistent irritative symptoms then the hand therapists will offer a variety of massage, exercise, desenstisation and odd techniques such laser or ultrasound application but I have to say that there is no concrete evidence that any of these things help. They do at least allow you to feel that something is being tried though. Surgically there are procedures such as interposition of a fat pad between the nerve and the skin which have been attempted for problems after carpal tunnel surgery but again evidence of efficacy is thin on the ground and some surgeons who used to do these have given them up. A further set of NCS to check that the nerve is not deteriorating since the first post-operative set can sometimes be useful, but not often with this particular pattern of symptoms. In my own clinic I would still be trying to identify the exact site of the injury but that's not something I can do via the net I'm afraid. The point at which you can elicit tenderness in the palm is the obvious site to look as post-traumatic neuromas are often painful on pressure. JB

I initially met with a hand therapist a few times and then stopped. It hurt too much and my feeling at the time was I didn't want to further irritate the nerve. I am scheduled to see my surgeon again in a few weeks and will request a new NCS to compare with the post op NCS. Can you give me more info on a neuroma? In regard to the palm tenderness to pressure and burning sensation what are other symptoms of post - traumatic neuromas? You mention that you would try to identify the exact site of injury - how would you do that?

Lastly are there any questions you would suggest to ask specifically when meeting with my surgeon at this point?

Thank you for your time and expertise!

A neuroma is simpy the swelling formed at a site of nerve injury - they are often pressure sensitive. I would be using a mixture of detailed nerve conduction studies and ultrasound imaging to try and identify the site of any such problem but that's pretty much a research level application of the techniques at present and not necessarily something that you would expect the average jobbing neurophysiologist or musculoskeltal ultrasonographer to have in their repertoire. There are a few people in the USA who would probably take it on but the odds of you being near to one of them are slim and even if you do identify a small post-traumatic neuroma that doesn't necessarily tell you what to do about it - treating them is not that easy. I would definitely ask your surgeon what he thinks the cause of the persisting symptoms is and you might enquire what he thinks about fat pads and similar interventions for post-carpal tunnel decompression symptoms of this type. JB

One more question ....

One more question if I may - when I tap on the area right below my wrist, where I assume the release was done I get an electric shock feeling at the exact spot between the middle and ring fingers inside palm area. Is this a good sign ? There is no shock feeling throughout my palm just at the base of my two numb fingers. It may be nothing but I thought it might be worth mentioning.

That is technically known as Tinel's sign and indicates the mechanical sensitivity of nerve fibres either at a site of injury or where new nerve fibres are regenerating. Tapping causes the nerve fibres to fire off action potentials which are interpreted by the brain as that tingling/shock like sensation (The word originally used by TInel, who was french, was 'fourmillement' - the sensation of ants crawling on the skin, which is very vivid). Exactly where you feel this depends on which nerve fibres are sending the signal. The brain has no way of knowing where a signal comes from other than past experience - you feel a pin stuck in your finger in the finger because the brain has learnt that that particular set of nerve fibres are connected to the finger so they have become mapped onto the bit of sensory cortex for the finger. When you then generate a spurious set of impulses, halfway along the route from finger to brain, the brain still interprets that as originating in the finger, so that is where you feel it, even though the signals may have started out at the elbow. Mis-interpretations of incoming signals like this are quite common. They underlie the phenomenon of 'phantom limb pain' when someone can still 'feel' an amputated limb and I've recently seen a man who had the nerves cut at the shoulder and re-connected to the wrong stumps so that now when you touch the little finger he feels that in the thumb. In your case I wouldn't interpret it as either good or bad. JB

Hi Dr. Bland - I'm hoping to get your opinion once again as I had a second NCS study last week and am now nine months post op from my surgery and continue to have no change in symptoms.
My second nerve study shows no improvement and my surgeon has proposed surgically opening up my wrist to for a second look to see if there is any scar tissue etc. and to look a the nerve branches? He also wants to do a fat transfer. Is it possible to send you my current NCS studies as well as the study done in March following my surgery? I would appreciate you taking a look at them and letting me know what you think about the recommended surgery. I'm not opposed to another surgery if there is a chance I can get some feeling back and some relief from the constant discomfort but would also like to hear what you think. Let me know how you prefer to get my NCS studies. Again thank you for your expertise and knowledge.

Happy to look at them - probably best sent by email (my nhs email address is in the contacts section of the site) - JB

Thanks for the NCS. I've replied in detail by email but essentially not much change compared with the previous set. JB

Finally a diagnosis ... cautiously optimistic

Hi Dr. Bland

Just wanted to give an update with findings after I went for a third opinion on my hand ... I had an MRI and I finally have a diagnosis !!

The hand specialists impression from the MRI :

1. Median nerve edema and enlargement in the carpal tunnel with short segment sigmoid-shaped partial herniation through a carpal tunnel defect related to prior release.

2. 4x4 by 2 mm septated ganglion cyst at the dorsal margin of the scapholunate ligament. Occult ligamentous tear/degeneration. Moderate dorsal capsulitis.

Once again any input on these findings are appreciated. After going over the results with the doctor I’m scheduled for surgery in 2 weeks to complete the release and a fat pad transfer over the nerve. I’m cautiously optimistic and hopeful I’ll that I’ll get feeling Back ... fingers crossed !!

I'm not a great fan of MRI of the wrist for CTS and certainly not expert in interpeting it. Finding 1) sounds like what you would expect after carpal tunnel release but you would really need to see the images to see what they are talking about. Finding 2) - ganglion cysts are very common in the wrist and usually cause no problems, though they can sometimes result in nerve compression. Again you would need to see the images to fully understand that report. As usual I would love to see this on the ultrasound scanner, which provides higher resolution than MRI - one of the frustrations of runnig this site, so many people turn up with interesting stories where I would love to know the definitive answer. At the moment I would think further surgery offers some prospect of relief but I would not immediately assume that those MRI findings are the definitive answer. As usual, please let me know how you get on. JB

The diagnosis was an incomplete release ...I don’t think I mentioned that previously.

I’m curious since you mention, in finding 1 - “sounds like what you would expect after a carpal tunnel release”. Is an incomplete release what you surmise from the MRI information ?

One other comment from the MRI :

Focal rettincular defect with thickening of the residual retinculum on the radial side - adjacent edema and irregular enlargement of the median nerve.

What exactly does that mean and is it info of any value towards a diagnosis? May mean nothing but just curious - thanks!

Well the 'median nerve hernation through a defect' is pretty much what you see after surgery in a sense. The intention is to cut the transverse carpal ligament and let the carpal arch open up so that the cut ends of the ligament separate, leaving a gap - in which you would then expect to find the nerve and tendons closer to the surface than they used to be. The MRI report doesn't explicitly say whether they thought there is any residual ligament left which has been missed - at least in those bits you quoted. Thickening of the residual ligament either side of the cut is just a normal phenomenon I think - you have deliberately injured this structure by surgery and as after any injury the subsequent inflammation and scarring can produce some thickening. Enlargement of the median nerve is a feature of carpal tunnel syndrome, both before and after surgery, so doesn't mean a lot. If you compare pre and post operative measurements the post operative one is usually smaller, but that doesn't mean it necessarily goes back to normal. JB

Hi Dr. Bland,

Wanted to give an update on my hand. Went in for surgery 24 days ago with a hand specialist. She found that the median nerve was indeed cut in two places. She explained the cuts by using the analogy of String Cheese, She said that as the Endoscopic instrument from my previous CTR came down the median nerve it actually made a divet (so to speak), and then peeled back a piece of the nerve in two places . One section of nerve was tangled over the other so she straightened them out, cleaned up the ends of the nerves and sutured them back from where they were cut then placed a fat pad over the nerve repair. Apparently it was a mess of scar tissue and she did her best to do what she could to clean it up and said after repairing the nerve it looked like there was good blood flow. The surgery was supposed to be about an hour and ended up taking almost three hours.

At this point my symptoms remain the same ... burning numbness and thick tight feeling in both the middle and ring finger with the middle finger the most painful. It was such a relief for me emotionally after surgery just to have the confirmation I wasn’t crazy and that indeed there was a cut nerve after a year of pain and seeing three different doctors who could only tell me “nerves are tricky” and not do anything. My surgeon is hopeful but I’m not naive to the fact recovery will take time and how much feeling I get back, if any is unknown at this time. Still just knowing the nerve has been repaired gives me some solice. I’m in a splint which I am to wear for about 3 weeks And then hand therapy. it’s been a long year and a half ☹️

It's a little depressing to see that my original guess of a nerve injury during surgery was close to the mark. I thought they might have injured one of the terminal branches of the nerve but it sounds as though the problem was further up, in the region of the carpal tunnel, but only a partial laceration, presumably involving the fascicles of the nerve which were destined to become the relevant palmar branch a bit further down in the hand. That's a very delicate piece of microsurgical repair and I'm not surprised it took several hours working around a previous operation site, presumaby with a fair amount of scar tissue to contend with too. I really have very little idea what the chances of improvement in symptoms are at this point so I would be very grateful if you would let me know in due course whether things get better at all. JB

I will definitely keep you updated if it gets better. I can’t thank you enough for your time and expertise on this subject. I got most of my information from you and this site and with that I was persistence in going to several doctors with that info until I found one who would do an MRI. In the end I’m realistic but cautiously optimistic with the recovery of the nerve and like I said before if I don’t get any kind of relief, the fact that there was a real reason for my pain and numbness is validation I needed. The constant pain I have without a diagnosis was difficult and at times it was all consuming for me because I knew something was wrong. It was such a relief for me when finally I had a reason why. I am curious to know though if this type of injury is a common complication with ECTR and also do you think the outcome of the nerve repair, if it was discovered and surgically repaired sooner than a year after the original injury would have a better success rate?

For others on this site ... do your research before endoscopic CTR. If things do not feel right after any surgery be persistent. My original doctor made it seem like a “slam dunk” easy operation with very little down time. Knowing what I know now I would NOT recommend it.

This type of injury is a very rare complication. We have two correspondents here on the site with complete or near complete nerve lacerations and now you, a third patient with partial nerve injury. Injury to two small median nerve branches is commoner - the palmar cutaneous branch and the recurrent motor branch - I've seen about half a dozen of the latter.

I think it's important to try and keep a balanced view of the operation - it is mostly very successful of course. What I do not understand myself is our failure, as a profession, to correctly convey a reaslistic impression of the risks and benefits to patients before surgery. Far too many patients seem to enter the operating room with no understanding that there can be poor outcomes, even though the risk of these is relatively small.

As regards endoscopic vs open CTR I don't think there is any concrete evidence that one is better than the other in any respect except for a trivial shortening of the return to work time for the endoscopic procedure - but there may be an interesting paper on nerve lacerations coming out shortly. JB

On one final note I was reading through the operative report from the original surgery. There is a paragraph that says "the endoscopic camera was placed in, significant tenosynovitis was noted with adhesions present. At this point persistent scraping and dilation was done. Ligament was "Partially visualized" and release was done stepwise with several passes"

My question is should there have been "complete visualization" of the ligament before it was cut? I know its neither here or there at this point but its got me wondering.

Me too I think! I'm not a surgeon of course, far less an endoscopic surgeon and I have no practical understanding of the difficuties of the technique and the variations one might encounter in individual patients. I do know that a certain number of attempted endoscopic procedures are converted to open operations because difficulties are encountered. My colleague Michael Nicholas watches the forum too and does have considerable experience of surgery, but of the open operation. I would like to see a few surgeons keep an eye on these forums and add to the debate but so far we have seen only one or two contributing. JB

I hope Dr. Nicholas will see this and weighs in with an opinion with my particular case too. I'm bothered by what I read in my report about the partial visualization. I have trouble wrapping my head around the fact that the original surgeon went ahead and cut the ligament without fully seeing it ... most likely causing the laceration to my nerve? I wonder if that is within the scope of "standard procedure" or if it is along the lines of negligence as opposed to a complication from the surgery?
The surgeon who performed the nerve repair said my case was something she had not seen before and, like you isn't sure her repair will result in any recovery. After some discussion she recommended that she would like me to see another hand doctor who specializes in nerve reconstruction/microsurgery, for his opinion and to go over her repair of my nerve and to see if he has anymore input with the whole situation. I'll let you know if I get anymore info. Again I cant thank you enough for your quick response to my questions as well as your thoughts and opinions on all of this.

Totally confused now ...

Today I went to a microsurgeon who specializes in CT at the request of the surgeon who repaired the lacerated nerve from my previous CT surgery. She wanted his advice if a nerve graft would give a more predictable recovery of the nerve. The microsurgeon was of the opinion that there was probably NO laceration and what the surgeon may have done was repaired scar tissue as it’s sometimes difficult to differentiate between nerves and scar tissue especially if there is a large amount of scar tissue. He determined this by the fact that I have feeling on the palm side of my fingers by pricking my fingers with an Instrument he used. It had one prong and another area with two prongs. When he used it on me with my eyes closed I was able to distinguish whether he had used two pricks or one prick. He only tested the palm side of my fingers. I explained to him that I could feel the palm side of my fingers somewhat - the palm side of my fingers are definitely less numb than the top side. I have stinging sensations like when they fall asleep and are just waking up when I touch them. Its been like that since the original surgery. The numbness and burning area that is most painful is on the top side of my fingers, the web space between the ring and middle fingers and in between the two fingers. The numbness is so bad that I cannot feel anything on my middle finger (top of hand) and I have no feeling between both middle and ring fingers as well as the ring side of my finger next to the middle finger. He said because of the feeling I do have he feels there is no incontinuity (?) of the nerve and I should get feeling back. He suggested Lyrica and hand therapy consisting of desensitivity.

Just for your info this is what was in the surgeons operation notes from her repair were :
“The nerve was followed and it did appear that the branches that had split into the fascia had been transected as there was a defect noted along the ulner side of the median nerve”. The small fascicles were carefully freed as much as possible until a healthy end could be reached, at which point, it was transected out of scar tissue. The root of the nerve was then also debrided at which point the small fascicles were reattached to transected distal ends that were identified. These were attached with 8-0 nylon interrupted sutures”

I apologize for the long winded explanation and would appreciate any of your thoughts on all of this.

I suspect the first surgeon is right and the second wrong about the injury - after all the first one has had a chance to inspect the nerve directly while the second is guessing from the clinical signs. I would not rely on two point discrimination (which is what he was testing) 3 months after a partial injury. The nerve conduction studies are a much better indicator overall. The second one is right about one thing though - because there is clearly partial function in the nerve it is obvious that the main median nerve trunk is in continuity and it would therefore be foolish to put in a full median nerve graft - you would have to sacrifice the working nerve fibres to do that. He is therefore quite right to say sit tight and await recovery. I have seen numbness dues to injuries to small nerves eventually resolve even after several years so don't give up hope for it. JB

Question about EMG studies

I received an email today from the microsurgeon I saw at the request of the surgeon who repaired my nerve. He changed his tune a bit from when I saw him last week. He reviewed the MRI taken before the nerve repair surgery and said it definitely was abnormal at the median nerve, and surgical revision was appropriate.

I was curious though because he also said that the previous nerve conduction studies from last year (3/2017 and 11/2017) show no axonal (nerve fiber) injury. Are nerve studies accurate enough to determine this. He is still of the opinion the feeling will come back and he wants me to take Lyrica for the pain. At this point Im not going to take the Lyrica but am still on board to start desensitizing therapy in a few days. I'm going with the wait and see approach along with the surgeon who performed the repair.

I would have to look back at the NCS report again which I've kept somewhere but I suspect he is relying on the lack of needle EMG abnormality for that comment. American electrophysiologists tend to rely on needle EMG as an indicator of axonal loss but it's not the only factor and loss of amplitude of the NCS signals also results, in part, from axonal loss. The bottom line is that sometimes you can say there is clearly axonal damage from the tests, but you can have axonal loss without it being obvious on the tests too.JB

Hello, I'm not sure if its ok for me to respond in your thread (forgive me Dr. Bland) but I am very curious as to how your hand is doing now, as I have almost identical symptoms to you. I am now almost 4 months post surgery and have the numbness between middle and ring finger and on half of each finger ever since the surgery. If theres a way I could pm you or email you I would be very grateful. Thank you.

I wonder if ohboy is likely to see this - it's a long time since 2018. If he left the notification system active for the thread however he might get a prompt to come back and reply. Lets see. JB

Hello again Dr. Bland

I check in periodically to see if there are any updates to my particular issue and just came across johnno1970’s post. I can definitely sympathize with the disconcerting feelings that your fingers/hand are still numb once anesthesia wears off after surgery.

Unfortunately 2+ years out from my nerve repair I’ve had no improvement whatsoever. Still deal with numbness, pressure and pain in my fingers and burning in my palm. It’s constant for me every day. My hand is never comfortable, I’ve just learned to live with it ☹️

Best of luck to you @johnno1970. I hope you find some resolution with your hand, and if you do please share !

Thank you for the reply ohboy3x, sorry to hear things haven't improved for you. I'm just the same as well, 7 months post op now. Nerve study got cancelled in March due to pandemic, so still waiting for a call on that. I'll let you know how it goes. Thanks again.

Sorry it's taken me so long to come back and reply to this but I had to familiarise myself with the ohboy3x story again before I thought I could comment:

ohboy3x - sorry to hear that there has been no progress. I think the persistence of the symptoms after this long probably supports the idea that this was a nerve injury, quite probably the partial laceration identified by surgeon number two. Unfortunately I know of no approach to treating this which has not already been tried and failed in your case. Way back in 2017 you had significant functional impairment in the right hand after surgery. it would be be interesting to see if your scores have changed in all that time - you can add another one for comparison from the 'My CTS' pages. What was the eventual verdict from the surgeon who did the original endoscopic operation - was there ever any acknowledgement that something might have gone wrong?

johnno1970 - yours is indeed a remarkably similar story and I hope the long-term outcome is not the same. It does seem that, in at least some patients, the nerve fibres within the median nerve at the wrist which are on their way to the middle and ring fingers are the most susceptible to damage, perhaps because of their exact situation within the nerve. This shows up as patients who have not been treated telling me that they are the worst affected fingers in clinic, and also in cases like these two where thre brunt of intra-operative nerve damage seems to fall on this group of fibres.

Despite the extraordinary ingenuity of surgeons in devising variations on how to perform carpal tunnel surgery over the last 50 years or so it does not look to me as though the overall success rate/complication rate has changed significantly since George Phalen popularised the operation in the 1950s and 60s. It remains the case that something in the region of 5% of operated patients are very unhappy with the results and also, strikingly, that most surgical sources of patient information on the web tend to downplay this risk. Personally I like the operation and if a case of CTS is not responding to non-surgical measures then I'm happy to send people to have it done but I do think that, as a profession, we should be more honest about the complication rate. JB

A few times I've thought about obtaining a new set of nerve studies. One of the things holding me back though is that the hand surgeon who did my nerve repair has moved away so I'm not able to follow up with her. I've seen most of the CT surgeons in my area a few years ago on my quest to find out what went wrong with my original surgery and I'm a bit jaded to put it mildly, about getting their opinions once again. I realize my situation was not the norm but three different surgeons and a hand specialists basically told me nerves are tricky and the feeling would come back. They wouldn't entertain the idea of a possible nerve laceration.

I did follow up with the original surgeon several times after my original CT surgery. If you recall he wanted to do a "second look" surgery and possible fat transfer. He was of the opinion the nerve was irritated and that's one of the risks that occur with CTR surgery. It was at that point I declined the surgery and looked for a second opinion. Little did I know then how difficult it was to get someone to actually follow through with my concerns. I'm certainly glad I prevailed and at least got a resolution albeit not a great one.

I wasn't thinking of another set of nerve studies - I was just curious as to whether your symptom score here on website had changed. If you go to 'My CTS' then 'My CTS Record", and finally 'Take a new severity score test' you can compare how the symptoms feel to you now with how they were back in 2017 as a numerical score.

It sounds as though you have more or less learnt to live with it anyway, which is fortunate because I don't think there are going to be any miracles now, sadly. JB