Strange post surgery symptoms
I wonder if you can give your opinion on a complete mystery.
I had carpal tunnel surgery on right hand 11 weeks ago. The pre op symptoms were numbness and pain. Need for surgery confirm ed by nerve studies. The recovery was initially very good. Numbness cleared by four weeks. Function returned. Scar healed and not sore.
At six week post op I started with some aching in finger joints of middle, ring and little finger.
Then gradually early morning stiffness set in and some minor swelling of middle and ring finger ( makes flexion and extension of these fingers painful ). There is all day stiffness of middle and ring finger with pain centred around top part of palm ( there is slight lump there below mcp middle finger ) and mcp joints. It is getting slowly worse and now difficult to lay hand flat on a table. Index finger and thumb are no problem. I can stretch it out after ibuprofen and ice and stretching but after any flexion activity it's tricky and painful to stretch out again. This is not stuck in flexion like a trigger finger but in about 30 degrees flexion at MCP joint. It literally feels like half my hand is frozen solid unless I work hard to release it.
My surgeon ( had left CT done last week ) couldn't really say what it was. He had two suggestions
1. Trigger finger but it's not triggering at all. And pain centred on MCP joint.
2. Dupreytrens ( my father has it ) but I'm not sure it would be this painful.
I see him again for post surgery follow up of left hand next week. I'm terrified the same will happen to the left which is going well at present.
I have searched the Internet for ideas but found little. I'm a physio myself so have some knowledge. Have you any ideas please? Or investigations that would throw any light on it. I did see my GP to get blood tests for anything obvious ( thyroid, diabetes, rheumatoid , full counts all normal). I'm a fit and healthy 58 year old.
Many thanks for your website and advice you offer.
I'm paying privately for treatment as the NHS in Bucks doesn't offer this surgery without a long wait and a big fight to get it.
Thank you for your time and opinion. Maybe I played down the fact that there is definate lump below the MCP joint in the upper palm below the middle finger. There's no resistance to passive or active flexion of the finger ( except slight restriction due to some swelling of the finger). There is painful resistance to passive and active extension of the middle and ring finger with pain in palm and fingers. Most pain from middle finger.
I'm pretty sure my original CT was due to tendinitis. I do think the current problem fits with tendinopathy. The lump seems to move when I flex the tendon.
I think the daytime stiffness is due to the slightly swollen fingers and the whole thing is helped by movement and stretching and ibuprofen.
Would you think a cortisone injection into the lump or area of it would help or am I facing more surgery ?
Would an MRI be worth having ?
If it's a 'non-triggering' trigger digit then they do sometimes respond to steroid injection. I think you need to be able to see the hand to get any further with it. JB
You may be interested to know what happened for me ( or maybe not !?)
I had an ultrasound scan which showed tenosynovitis with fluid in middle and ring finger flexor tendons. Thankfully no sign of dupreytrens. HAt the same appointment last Tuesday I had ultrasound guided cortisone injections into those two flexor tendons. So far so good, the ring and middle finger almost immediately able to extend more normally ( may be due to local anaesthetic too ). The hand is no longer stiff and painful early morning. It's all settling down. The lump is still present but not painful and seems to be reducing.
The left hand now three weeks post op from CT release is currently doing well and I'm hoping tendinitis/ tenosynovitis doesn't set in like it did in the other one at six weeks.
I'm always interested to hear outcomes, thankyou. Sounds as though that's probably a case of a 'non-triggering' stenosing tenosynvitis. Hopefully it will all continue to settle in response to steroids. JB
I'm sure you are aware that morning stiffness, especially if prolonged, is usually rheumatological in origin. Trigger digit, interestingly, doesn't have to 'trigger'. Dupuytrens seems quite unlikely if there isn't much to see/feel and I would expect your surgeon to recognise that anyway. I would primarily suspect some form of tendinopathy, rarer possibilities might include ulnar nerve or radicular neurological problems or a dystonia. If it's progressively worsening and routine bloods in primary care have revealed no evidence of systemic inflammation then it might be worth seeking a neurological opinon.
Sorry about the NHS in Bucks. There are a few other CCGs around which have taken a pretty aggressive line on carpal tunnel surgery too. JB