Had carpal tunnel release surgery in Dec 2016 - still have pain/cold feeling affected my work - any advice?
Hi all -- I'm a 29 y/o male who was diagnosed with CTS in my right wrist, likely due to repetitive work stress and regular home computer use. After going through multiple diagnostic tests with my surgeon (MRI, nerve conduction study, cortisone injections), he performed the release surgery on me in December of 2016. I returned to work in mid February of 2017 and my wrist/hand continued to experience very similar issues (mostly pain, discomfort, and a cool tingling sensation). I spent the next 6 - 7 months going back to my surgeon, having the nerve conduction study re-run, another cortisone shot, and another MRI. Here's some more info:
-The original and follow-up nerve conduction study showed very few abnormalities, which he said sometimes happens even when CTS is present. It doesn't always show issues.
-The post-op MRI showed mild/moderate compression of the median nerve "despite the release surgery", and a ganglion cyst in the join of my wrist which my surgeon double-checked and assured me isn't influencing the nerve at all.
-The third cortisone shot I receive (2 before, 1 after my surgery) helped, but not nearly as much or for as long as the first two did. My surgeon said that this isn't uncommon for the benefits to lessen with each use.
-I don't experience much numbness, but rather pain/discomfort in the area between my lower wrist up to my upper palm, and a cold tingling sensation (feels like someone put minty toothpaste inside of my wrist/hand).
So after going back and forth, my surgeon has basically told me that the only thing he can do for me at this point is a revision surgery, as sometimes the surgery isn't fully successful and scar tissue build-up can sometimes cause these issues to come back. He said he's hesitant to perform the revision, only because it requires a larger incision, and he was pushing toward the route of me just living with the issue and tolerating it. I understand the concern, but it really interferes with my work, since I sometimes do repetitive mouse movements for over 2 hours straight and it's awful. The issue has also affected my ability to write with a pen/pencil (it's uncomfortable and slightly more difficult). To top it all, he has also mentioned that he can't be entirely sure it's even carpal tunnel, but that all signs point to that.
So my questions is.... has anyone experienced similar issues? Did you go through with the revision surgery? Does anyone have advice? Therapy/care of the issue with anti inflammatory medications and a brace hasn't helped at all. I toyed with the idea of getting a second opinion, but based on what my surgeon has told me, it sounds pretty straightforward (in terms of what could possibly be going on in my wrist). I'm concerned that, what if the issue isn't carpal tunnel syndrome but something unique and unrelated? If the revision surgery would help me, I'd be 100% opting for that, but I can't be sure...
Difficult! I think this is not necessarily CTS. CTS is not the only wrist condition that will improve with steroid injection, so although I sometimes use injection as an aid to diagnosis I always keep in mind that many inflammatory conditions can improve with steroids. Your symptoms do not immediately sound like 'barn door' CTS. I'm wary of MRI interpretations showing 'evidence of CTS' especially after surgery, and much prefer ultrasound imaging - with the caveat that there are currently only a handful of people who have much experience of assessing the ultrasound images after unsuccessful surgery. To start with I would love to see your NCS results if you have them, so that I can see what 'not much evidence of CTS' actually means. JB
Thanks for your response- I wasn't expecting a specialist to chime in at all; it's a very nice surprise. Unfortunately, the NCS was done at the office, so I don't have a copy of the results since it's all housed in their system. I do know that everything looked normal (textbook normal) EXCEPT for a slight irregularity in my neck, which is why he sent me to a neurosurgeon. I had an MRI of my neck and they said that there's nothing wrong, and the second NCS they gave me showed that the neck issue was no more (they explained it to me in the past but I forget the detail, something about temporary muscle knots that can cause issues on the NCS like that?).
I'm going to go through my records to make sure I don't have a copy of the report. Like you said, I really don't think it's CTS because I don't get the numbness/tingling in my fingers much... just a cold buzz like feeling up my hand, and a weird pain in my wrist/forearm/hand. Almost like its cramping, in my carpal tunnel... something else to add is that he ruled out tendonitis entirely, as the MRI (pre-op and post-op) showed nothing of the sort.
I tend to do a lot of research on things that affect me and I did find studies which concluded that in situations like the one I'm experiencing, wrist issues located in a single wrist as opposed to both for younger patience (in terms of the average age of CTS onset) should be treated more skeptically than if the patient were older and if the issue existed in both wrists. It concluded that symptoms that seem to be CTS related, or even if CTS is present, can be caused by a different issue spurring the early onset in a single wrist. I think I came across that study when searching for ganglion cyst presence in conjunction with CTS (when I was speculating whether or not the cyst that showed up on the MRI could be influencing the pressure on my nerve, which my surgeon ultimately said wasn't the case). The fact that I'm 30 and experiencing these CTS-esque symptoms in a single wrist leads me to believe, based on what I read, that the cause is likely more than can just be explained by "CTS"... I'm probably one of those patients that doctors loathe, since I go about reading up on things and getting ideas on my head.
Something I'm just now remembering is that I had hurt my wrist a few times through my teens and early 20's, usually by falling on it (3 or 4 times). May have been sprained? Maybe that's why the ganglion cyst is there.
Also ANOTHER thing I forgot to add is that when I workout and lift weights (which I haven't done in a while... I need to stop being lazy), my wrist sort of... pulls apart and cracks a lot. Like the bones separate and then snap back together? It's not painful, but a weird uncomfortable feeling and usually only in that wrist. It's like how you can pull your knuckles apart by slowly and firmly pulling your finger directly away from your hand, but it's my entire wrist.
Anyway, I know you probably can't make sense from any of this rambling, and all of this typing is making my wrist yell at me. I do appreciate your reply though. I'm guessing the next logical step for me would be to probably see a new specialist for a second opinion.
Thank you!
I think you are spot on there. Rather than embark on further surgery with normal NCS results I would be inclined to consult a neurologist who can look at the whole problem again with completely fresh eyes. If the NCS results do come to light then I'm happy to take a look. JB
(can't figure out how to edit my post)
Addition: Also forgot to mention that this pain/discomfort only seems to flair up to noticeable levels during use of my wrist. My surgeon explored the potential of the issue being in my neck/arm, or elsewhere, but I has an MRI of my neck and shoulders and saw a specialist for that and they said they couldn't find a single issue. It seems, through multiple tests, that the issue is isolated to my wrist (cortisone shots helped, no issues showed up elsewhere, etc).