Unexplained new symptoms after CTR

Manhand1
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Hi

I had open CTR about 3 years ago on my left hand and I am not sure it was a good idea as my symptoms for a long time were mild, however increasing whole-of-arm issues and full spine MRI which showed neck problems led my Neurologist to do Conductive studies which showed moderate CTS and they suggested getting it done even if the neck was part of the problem (sort of elimination treatment with "no risk"). Surgery supposedly went well but I am not convinced it has made an improvement to the usual fingers involved and I have a long lasting swelling issue inside that blood tests and wrist MRI have not given any real answers to.
The new symptom is one I reported immediately after surgery and is still the same now and involves the ulner side of my palm and ulner side fingers. I have no doubt that I probably have ulner issues both in the elbow and from the neck degenerative issues I have, but I am also sure that new symptoms of my palm and little finger/ring finger are new and follow directly from surgery.
Basically I have a permanent level of mild altered sensation to this part of my hand that feels like there is "tape stuck on it" or slightly dulled sensation, especially if I lightly brush it against a surface and those fingers have slightly less sensation than the other fingers and those on my other hand. It is not that I have lost all feeling but can the open CTR incision sever fine nerves or nick a nerve that affects this part of the hand? the wrist MRI suggests no such damage.
I got a second opinion from another hand surgeon who sent me back to the same Neurologist for second lot of comparative conduction tests and it is all good apparently, although the neurologist shoved me out the door pretty quick and bulk billed me instead of the large sum they charged the first time so I am almost a bit cynical about this result.
I have a slightly hypertophic scar on the Thenar side of the scar, the scar is well healed but a bit sensitive and very numb just above it. if I turn my wrist side to side I get a "catching" feeling inside that stays for a bit or goes if I push down on the area. No real pain - just odd sensations. Because the scans look OK, I feel like the doctors think I am making this up so I have given up asking them now but has anyone else had permanent affected sensation on the ulner side of their palm and fingers following what was supposed to be a successful Carpal Tunnel Release? I am one of those who thinks the surgery was not warranted (agreed by second hand surgeon opinion) and I feel like all it did was damage my hand.

jeremydpbland
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The idea of any surgery as a 'no risk' option is of course bonkers. However a conventional carpal tunnel incision in an anatomically normal hand is very unlikely to have damaged the nerves supplying the ulnar side of the palm and little/ring fingers. I have seen an incision so far out of place as to end up entering the canal of Guyon where the ulnar nerve lies rather than the carpal tunnel. There are also some interesting anatomical variations which may have some bearing on this though I can't think of a common one which would produce exactly these symptoms. MRI is not an ideal method for investigating post-operative nerve problems - inadequate resolution unless you have a 7T scanner and no facility to examine the structures dynamically as the hand moves - ultrasound imaging is much better if you can find someone who is good at it. If you have copies of the two sets of nerve conduction results we can take a look and see if there are any clues. Aggravation of an existing ulnar nerve lesion at the elbow is perhaps the most likely explanation - one would need to know details of the anaesthetic method used and post-operative care to explore that further I think. JB

Manhand1
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Thanks for your reply Jeremy and apologies for tardy response. I thought I had the forum set up to notify my email but I must have not done it correctly.

I don't have copies of the 2 x Conduction tests but I can ask my GP if he can access them for me. I have had the wrist looked at with ultrasound but no dynamic inspections but it really does seem that there is no sign of damage from the surgery from all the scans - just signal of some inflammation. Perhaps you are right about the elbow issue but it just seems so specifically on the palm skin surface and so immediately after surgery that I struggle to think the symptoms are not at least partly caused by the surgery - even though I know i have other nerve impingement issues in neck and likely shoulder and elbow.

You mention odd anatomical variations - whilst the surgery and scans gave no indications of anything odd I recall when the surgeon first tried a cortisone shot into my wrist and told me to expect numbness in the Thumb to middle finger I actually got numbness in all fingers (including little finger) except the ring finger which was less affected - so that didn't make much sense.

I believe the anaesthetic was "twilight"?? which means I was meant to be awake but I have zero recollection of the surgery. I went home the same day and back at work after a couple of days doing light work only (no manual labour). the surgeon suggested there was no need for any hand therapy at all. I did look up some gliding exercises and did them a bit.

I do have a lot of tendon and arthritis issues which I suspect may have been a big part of the problem all along (hence my doubt of the wisdom of getting the CTR done) so I wonder if the settling of the wrist components after release has just created new issue from something else that is amiss?

It is all probably a bit academic now but if I can get the comparative conduction studies I will let you know. Really appreciate the comments and feedback.

jeremydpbland
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Sounds as though they injected a local anaesthetic along with cortisone, something that always strikes me as pointless. What happened to the hand symptoms in the weeks immediately following injection? As you can't remember anything about tthe surgery we can only guess at what might have gone on during it I'm afraid. Happy to look at the NCS if you can get them. JB

Manhand1
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Thanks Jeremy

I have booked to see my GP in a fortnight so will try to get those NCS then. The symptoms after the injection of cortisone was not really any different to before - seemed like it made no difference. I feel like I get symptoms now more easily under heavy use of the hand now than before surgery but less nightime issues. I still think half of the symptoms were due to issues further up the arm/neck but the neurologist said the NCS post op showed an improvement.... Just doesn't feel like that is the case from my first hand experience. Hopefully I will have those results soon. Thanks again for your thoughts.

Manhand1
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Just to add - as an example of how it feels like it is worse now than before surgery, in the past I would have to use vibrating machine like a strimmer for while to get numbness in my fingers but it would subside after a while. I find now it takes a bit less time to do this although it varies - sometimes it is not so bad. Then today for example I was walking around with a document folder in my left hand, not heavy and my wrist is pretty straight holding it but after a while i have tingling in my thumb and first 2 fingers so i swap to my other hand and no problems. I realise there are so many things at play and but it is these kinds of things that make me think the problem has not really been sorted wherever that problem is - and the fact that I have this permanent altered sensation on my ulner side of my palm straight after surgery leaves me rather disappointed with the treatment, especially considering it has been so long since surgery that I don't think I can expect any further improvement.

jeremydpbland
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Lets see if we can get the NCS results so that we at least know what sort of CTS we were talking about to begin with. JB

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