strange development after CTS surgeries
I was a hairstylist for 15 years, mostly doing haircuts.
My profession led me to bilateral CTS surgeries in early 2011. Since then an EMG test shows that my CTS is back in both hands after only one year.
My orthopedic surgeon wants to perform a second CTS surgery on my right hand first and then on the left one. He says that this time it will be a longer surgery about 40 minutes, and he’s going to build some space in the wrist so that the CTS does not return. Of course he is not making any guaranties. And I have not decided that I want to have this surgery.
Anyway, a couple of months after my first surgeries I went back to cutting hair, but the strangest thing developed on both of my hands. I have a swelling between my index finger and the middle finger, in the knuckle area.
The more I use my hands the more it swells and hurts. Sometimes it feels as if I was hit by a bat on both hands and the pain radiates across my knuckles on both, top and palm area of my hands. There is also a sharp pain on the side of my index finger; the side that the tip of my thumb can touch. It gets very sore and it feels like the muscle on that area is wasting away.
I was wondering if anyone has ever heard of this. I can’t find any info on this condition. My Doctor called intrinsic inflammation, and he said CTS surgery will not help it.
Hi JB, thanks for responding.
I live in South Florida, USA. My orthopedic surgeon is a hand specialist with a good reputation. So I feel he has done a good job concerning the surgeries, but he has pretty much ignored the knuckle swelling condition that developed after, and has offered no remedy for it.
I’ve had three EMG test performed, using the same equipment, because my doctor says it the only way to get accurate results.
The first test was done before the CTS surgeries, showing that I had severe CTS on my right hand and moderate on the left.
The second test was performed a few months after the bilateral surgeries and they showed great improvement. So I went back to work but that’s when the knuckles swelling started to happened.
Shortly after my surgeries, I started to feel the nerve shooting pain that feels like there’s a machine gun inside the forearm shooting bullets to the finger tips. This does not wake me up anymore but it still happens during the day, on either hand, if I lean on them the wrong way.
So a year and a half after my surgeries I had a third EMG performed and it shows the CTS has returned. My doctor wants to perform a second surgery that is more complicated than the first one.
I wish I could post a picture of my knuckles. The doctor said it was swollen muscle, although it looks like its liquid under the swelling but he says it’s not.
The two first knuckles on my right hand are twice as large as the ring finger and pinky knuckle. You can see the swelling really well when I make a fist. My index finger and middle finger are also much larger than the rest.
I had three surgeries on my left hand. One on my thumb, which was the first sign of trouble, then the CTS and then my ring finger which got trigger finger after CTS surgery.
My right hand only had the CTS surgery, but it is the hand that hurts most in the evening because it feels heavy with radiating pain in wrists and the pain in knuckles.
Thank you JB
Well that sequence of NCS results, as reported, would certainly support a genuine recurrence of CTS. I'm slightly surprised that an orthopedic surgeon would have nothing to say about whatever is going on in your knuckles - it sounds like an interesting problem from a medical point of view but I doubt if I can contribute much more to it online. Trigger finger is certainly commoner in people who get CTS as you have already found, and I suspect that some other hand disorders such as Dupuytrens comtracture are too.
I think you can upload a photograph into the forum - check out the icon near the left end of the toolbar when typing a message in. It has a tooltip that pops up - 'image' - click this and you get a file selector which lets you choose a jpg file from your hard-drive in the 'upload' tab and send it to the server. The 'image info' tab allows you to set the size at which it appears in your message like this:
'
... just testing to check that it works with a random photo of mine!
Curiously we are all coming to Florida in October - the American Association for Neuromuscular and Electrodiagnostic Medicine is holding its annual congress in Orlando, but that's a bit late to see your hand. JB
The photos I could not upload here are photos of my hands at their worse. At this time the pain was so intense, it felt like I was wearing a vise grip between my knuckles all the time.
I also had sharp burning intermittent pain on the side of the index proximal phalanx area where the thumb can touch.
I feel the muscle in that area (side of the index proximal phalanx) is weak and wasting away.
When the orthopedic surgeon released my trigger (ring) finger, he also injected cortisone in the knuckle area of both hands while I was under anesthesia. My right hand was in so much pain the next day, that I used the left hand that had had surgery, to feed myself.
The slightest movement sent intense pain to the nerves of my right hand making it unbearable to move at all. I remember telling myself I would NEVER get a cortisone shot in that area again.
Since then (Jan. 2012) I have stopped cutting hair and the inflammation has gone down, but I still have it and it acts up mostly when I use my hands in a gripping or pulling motion.
The diagnostic name he gave this condition is, IF MCP extensor tenosynovitis/capsulitis.
He says x-rays show no pre-existing arthritis.
I wonder why this would show up after my CTS surgeries.
Unfortunately I do not see the tool tip that allows me to upload an image here, but I would be happy to post them online. As soon as post them I'll let you know.
Do enjoy your time here in Florida, you must visit our lovely Mouse. I live four hours south of Orlando.
There's certainly some swelling between the second and third metacarpophalangeal joints isn't there. It doesn't look to be quite in line with the extensor tendons and you can see the extensor tendon to the middle finger as a very well defined linear structure in the second picture so if it is an area of inflammation related to extensor tenosynovitis it seems to be spreading to the side of the tendon rather than surrounding it. I presume these pictures were taken after the steroid injections to the MCP joints?.... and I guess they must have been somewhat painful beforehand or he wouldn't have been injecting them? If I have the sequence of events right it was:
1) Surgery to the right thumb (for?)
2) Bilateral CTS confirmed by NCS - worse on the right side (you are right handed?)
3) Bilateral carpal tunnel decompression (both done on the same day?)
4) Repeat NCS show bilateral improvement in the CTS (Symptoms improved too)
5) Return to work - MCP joints become swollen and painful, R trigger finger develops
6) Trigger finger release and injections to right MCP joints
7) Immediate flare up of pain in the right hand
8) these pictures some time after
I'm assuming that, as well as the plain x-rays and the NCS, some routine bloods have been checked. 7) sounds like the phenomenon described as 'steroid flare' - there is a discussion of what I have been able to find out about it (not much) in the section here on steroid injections for CTS. Given a history of several different problems all developing in the hands over a relatively short period I would probably consult a rheumatologist before re-opening the carpal tunnel and I would certainly want to look at that swelling with the ultrasound scanner to see if I could get any further clues to what it is, as well as scanning the carpal tunnel to try and get an idea of how it is that the CTS is deteriorating again. I have no idea how easy/difficult it would be to get that done in Florida though - I have the luxury here in East Kent of a team of helpful colleagues in various specialities who I can easily get opinions from. Is there any sign of problems developing in any other joints elsewhere in the body?
Incidentally I've edited your last post to make it an active link the pictures - hope that's OK - JB
Thanks for activating the link for me JB! I posted new photos on the blog.
By May of 2010, thumb on my left hand was stiff and very painful.
July, 2010, first EMG, I was diagnosed with bi-lateral CTS.
Wearing splints on both hands and physical therapy did not help condition.
November, 2010, CTS surgery on left hand and trigger finger release of left thumb.
January, 2011, CTS surgery of right hand.
March, 2011, I returned to work as a hairstylist. First signs of swelling in knuckle area appear after cutting and blow drying hair.
June, 2011, second EMG, results show no CTS, but I’m feeling pain and locking in my left ring finger.
August, 2011, cortisone shot in left ring finger. It helped but the locking came back after three months
December, 2011, Doctor prescribes a Medrol Dose Pack, to help with severe inflammation of knuckle area in both hands.
January, 2012, left ring finger surgery. Also, cortisone shots on both hands in the knuckle area.
I worked as a stylist for 10 months after my CTS surgeries. My work load was only 1/3 of what it was before. The consequences for returning to my job of cutting hair, was to injure my hands with knuckle swelling.
March of 2012, Doctor suggests that I make a career change because of knuckle inflammation.
May, 2012, third EMG test shows that CTS has returned. My hands are weak and in pain with the slightest tasks.
June 30, 2012, CTS surgery scheduled for right hand.
I have no other developing problems in other joints or parts of my body.
Thank you JB, I greatly appreciate your feedback.
Well I almost got the sequence of events right! Personally I would go with a rheumatology opinion and some further imaging before repeat surgery as long as that did not introduce major delay - it depends a little on exactly how bad the latest NCS look too, I guess, and also whether you actually have symptoms that sound like CTS at present. Hope it works out OK for you in the end and, as usual with conversations on here, I would be delighted to hear the end result. JB
It is of course very hard to judge a lump without seeing it. You could photograph it I suppose and if you were my patient the first thing I would do with that is take a look at it with the ultrasound scanner. You should certainly not get lumps in that area directly as a result of CTS or surgery for it, but there are other conditions which are common in people with CTS which might account for it.
Genuine recurrence of CTS after surgery is very rare, but does happen sometimes. Abnormal nerve conduction studies after surgery are not necessarily an indicator of recurrence - it depends how they compare with the pre-operative tests (if any were done?) What part of the country do you live in? JB