numbness and 'zap' feeling

Hard to assess that without nerve conduction results from before surgery and a repeat now I'm afraid. Usually recovery from CTS is fairly uncomplicated so this is a slightly odd story. Quite a bit depends on just how bad it was before operation. JB

Since I'm only at 4 weeks out and haven't seen the dr yet (just the nurse for stitch removal), I don't have the option to get another nerve test yet. I see him in February but can call and get in earlier of you think it would be wise. Just typing this and my hand and fingers go tingly. Perhaps I used 'numb' in my original post when I should have said 'tingly' because I do have sensation when I prick the tingly areas. I will have to call them and see about the patient portal thing and see if I can access the nerve test from before the surgery and see exactly what it said; if not, I'll get them to mail it. I know that both hands go pins and needles when I type, drive or hold the phone for any length of time. The zap thing tends to be when I twist in certain ways with my wrist and is almost like something in there is passing over something else (like a line on a sailboat moving over another line). The twist of rolling a cereal bag down or fastening a wire twist tie, that sort of motion triggers it. Thank you for your time.

I have thought for a long time that you can perhaps get sudden median nerve symptoms when the nerve and tendons 're-arrange' themselves within the wrist on movement but I've never been able to prove it. On ultrasound imaging however you do see quite sudden movements of the nerve sometimes around the tendons and they do have more freedom to move around after surgery. Even so the pre-operative NCS would be a good starting point if they can be obtained. They would give us a chance to see what the expected speed of recovery would be like. JB

That makes a lot of sense to me. It does feel like something's moving in there and I get that jolt. I've got a call in the the Orthopedic Center where I had it done and they'll call me back, but it may be delayed due to the holiday. I just don't know if I'm at the point where I should push for another NCS or wait a bit more to see if it resolves. It's so vexing to not be able to use that hand. I'm not good at sitting still.

I wouldn't rush to repeat the NCS 4 weeks post op unless the symptoms were clearly completely unchanged or worse than before the operation. JB

Thanks. I don't think they would do it yet anyway. I spoke to the nurse earlier and she will have to mail me the ncs results, so it'll be a few days to get that. She said that it sometimes takes several months for everything to resolve and, since my was severe, that I should be patient. I'm willing to be patient if that is true but not if there's something wrong that needs to be addressed sooner. I asked her if, when I do a motion and the hand/fingers go numb, I should stop doing that motion. She said I can't 'undue' the procedure and there was no reason to not continue with the motion as long as I wouldn't drop a fragile object or something of that nature. The reason I asked is this: I recently started going to the gym to lose weight and get fit (only need to lose 10 pounds, as I'd like to be trimmer than I am, and I'm flabby). I had been making good progress doing upper body exercises on alternate days from lower body exercises, with cardio (rowing) for 30 minutes prior to the weights. Without this hand, and having to have the other hand done, the upper body is already losing tone (can't row or lift weights). So, should I just do the upper body weights with low or no weights (just go through the motions) or accept the numbness and lift to gain strength? I don't want to damage myself. I am 62 years old and really don't like to exercise, would rather starve to lose weight, but really need to get fit. Also, I can tell that sweets over the holidays make it more tingly and bothersome. Stopping the sweets and just over a day later, the numbness has receded and only comes back through certain motions. I am also drinking bone broth, quart per day homemade, as it can't hurt and I feel it gives me more of what I need nourishment-wise. I am willing to do what it takes to get better, I just need to know what that is.

The nurse is right that severe cases take longer to resolve... but the only reliable way to assess severity until it gets really bad is the NCS results so we really do need to see what they showed. Surgeons in particular throw around the word 'severe' with no precision of meaning whatsoever. It's possible to exercise without doing things that night cause trouble at the carpal tunnel. Avoid power grip and forced wrist flexion but all other muscles can be used normally, and even grip and wrist things should be ok by about 6 weeks post-op once the scar has knitted together fully. JB

Ok, I have received my ncs results. How do I send them to you once I scan them?

Easiest thing is just to email them - Jeremy [dot] Bland [at] nhs [dot] net. JB

Sorry I have not yet emailed my results. My husband went into the hospital and just got out. He's still very weak and needs much care and I have to get caught up at work. My hand has actually gotten worse since my last post. I called the the dr said we can do a steroid shot on 3 Feb, so I've got an appointment for that. He said that if, when the shot wears off, I still have pain and tingling, that he would redo the nerve test with an eye to possibly doing a re-release? How could it need to be released again if it was properly done the first time? From all my research, he is the best in this area and many people I know are very happy with their results. I wonder if some other damage could have occurred after the cts? I had one instance a week after in which I slipped and grabbed with that hand to catch myself. It hurt bad enough in that hand that I saw stars. Could I have done this to myself and it's not poor surgical outcome? If so, then what next? I guess I'll need to keep the appointment and tell him what happened, even though I did call the nurse after and was told it should be alright.

I tried to send the ncs but my email says your address is not valid. Do you have another we can try? Thanks.

Must be a mistyped address - Jeremy [dot] Bland [at] nhs [dot] net is definitely correct. The NHS mail system has a fairly strict limit on attachment size so you may need to make sure the file is relatively small but that shouldn't result in an invalid address message.

Steroid injection after surgery is an interesting but virtually unexplored topic. There is a bit about it here on the website. If it seems to be getting worse at this point then it's definitely time to be thinking about re-investigating it. All surgeons have cases in which they fail to fully divide the ligament at a first attempt at surgery and they need to have a second attempt - I saw two such cases on Wednesday. JB

OK I've got some NCS results now, unfortunately without the table of measurements for the motor studies (I have the sensory ones) and without any indicator of that lab's normal values, However, from what I can see it looks as though that was either grade 2 or grade 3 CTS in the left hand. (Your right hand incidentally is in no way 'severe' in a neurophysiological sense). Starting out from that point one would expect rapid and complete resolution of symptoms after surgery with most patients reporting the CTS symptoms gone the night after surgery and the scar pretty much healed by 2-4 weeks post-op - so that is what is 'normal' for CTS of that severity. Of course there are patients who get problems with the scar and side effects from cutting the ligament but the symptoms you are mostly complaining of sound like nerve related symptoms and they should have resolved. So it it does feel as though it is getting worse at present rather than better there is significant cause for concern. In my clinic we would examine this now with the ultrasound scanner to see if we could see an undivided band of transverse carpal ligament or any other object pressing on the nerve (stitch abscess, scar tissure etc) but you may not have anyone with the requisite expertise in imaging the median nerve nearby I'm afraid, not many sonographers are specifically trained in assessing CTS and only a handful have much experience of patients with post-operative problems.. Follow-up nerve conduction studies can also help but changes in the NCS results take longer to occur, except in exceptional circumstances such as the surgeon cutting the nerve by accident, and 6 weeks post-op is probably about the earliest it is worth repeating them. If they are worse at that point then usually it is advisable to re-open the wound and extend the release. JB