Post Operation Symptoms
Dear Dr Bland
Surgery carried out at QEQM last Thursday (16/08/12).
Three days after surgery and index finger is completely numb and stiff, but am able to move it. Thumb, middle and ring finger slight numbness in the tips but again am able to move them.
Felt shooting pain in the fingers twice during surgery and surgeon said this was where he I had touched the nerve.
I am carrying out finger exercises as advised, and there is some pain in the palm of the hand during the first session of the day, and after that OK except for occasional sharp shooting pain in the fingers.
No swelling, but taking pain killers as advised.
Are these these post op symptoms are to be expected?
Mr X carried out the surgery, and a follow up appoinment will be made to see him in four weeks although i have no details at the moment. I am concerned about the symptoms in my index finger, and would be more than happy to see you if possible.
It's a bit more difficult for me to butt in where Mr X is the surgeon (I have removed the name in your message as some surgeons may not like being identified in this forum, especially in connection with a possible problem) . I know Andrew Smith would not mind me looking at a patient for what might be termed 'research' purposes, though we are not talking about formal research trials - just trying to satisfy curiosity about the expected course of the change in symptoms after surgery. We know in one sense what to expect in that the majority of patients operated on for moderate to severe CTS report immediate relief of the CTS symptoms and that some degree of scar tenderness is common but we do not really know in great detail how far variations from that story are acceptable before being clues to a problem with the operation. One of many research projects I can think of would be to collect a series of patients who eventually proved to have had incomplete decompressions and try to find out by interviewing them how soon after surgery it was obvious that something was wrong. My guess is that it is something that can be spotted quite quickly.
I will email Mr X and ask if he minds me checking this out. If not then we will repeat your NCS about 2 weeks after surgery if the numbness persists - stay in touch please. JB
Thank you very much Dr Bland.
I did comment about my finger being numb when the sugeon came to see me after the op, and he asked me if I could move my fingers, which I could.
I have a reply from Mr X who is happy for me to re-test you if it seems appropriate so let me know how it is developing over the next few days if it is still very numb 2 weeks after surgery I will fit you in for a quick re-test somehow. JB
Dr Bland
Wednesday morning and no change to symptoms on index finger. The numbness in the thumb and middle finger seems slightly worse with what can only be desribed as a burnig feeling. Still continuing with exercises as much as possible.
I will messge you again on Friday.
I have an appoinment with my GP to remove the stitches on Thursday 30th Aug, and a now have a follow up appointment with the surgeon on Friday 14th Sept.
Again thanks very much for your prompt reply and support.
What time of day is the GP appointment for stitch removal - we might be able to see you that day also if the problem persists. JB
So if you are free we could take a look at that during the morning clinic sometime. Let me know how it feels on Tuesday/Wednesday and we'll reach a decision then.JB
Still have numb and stiff index finger with a burning tingling sensation. Thumb is slightly numb above knuckle and tender to touch with some tingling, as is middle finger. Ring finger slightly numb at the very tip.
Palm of hand below thumb, index and middle finger is numb.
Unable to use hand for eating and writing.
It sounds to me as though it would be worth taking a look at that then. Can you make it to my clinic on Thursday morning first thing. I usually get in about 8:45 and the first ordinary patients are booked at 9:00 so I should be able to check the NCS quickly and perhaps the ultrasound too. JB
Dr Bland
Attended post op outpatients appoinment Friday 12th Sept. Surgeon was not present so I was seen by his Registrar.
My symptoms have not changed that much since I last came to see you, although I am not woken up at night quite so frequently with tingling in my fingers. The area to the right of the scar in my palm is tender to touch. There is some feeling in the tip of my index finger but the rest is still numb. Thumb, middle and ring finger still have the same symptoms.
Unfortunately the Registrar was not aware of my symptoms and did not have any details of the last NCS or the ultrasound which you carried out, but I told him that the reading for my index finger showed a worse result than before the surgery, and that the ultrasound suggested that there was still compression in the wrist. I told him that this information was sent via email to the sugeon and he tried to track it down but was unable to do so at the time of my appoinment.
The Registrar suggested that my symptoms were all part of the healing process, and that he would see me again in six to eight weeks, and if there was no change he would then consider further surgery. He is also making an appoinment for me to see a hand therapist. He has supplied me with a straight wrist spint to wear at night, but as soon as I put it on I have tingling in my fingers including the index.
I have to disagree entirely with the registrar there I'm afraid. He could have called me to talk about it if he wanted to. I will email the consultant surgeon again and let you know what response I get. JB
Dr Bland
I explained to the registrar that I was unable to drive because of the burning and tenderness in my hand, resulting in me being unable to grip the steering wheel. He told me not to drive or lift heavy objects. The feeling in my palm and fingers is similar to having burnt them. My arm also feels weak when I lift it above my head.
I am suppost to be driving down to Cornwall on the 28th September for a family wedding and holiday so will have to make alternative arrangements as things look as though they are unlikley to improve before then. I am also seeing the occupational health nurse this Wednesday to discuss my situation as I have not been able to work since the operation.
I have discussed my symptoms with my employees occuptational health department today and thay are unwilling to allow me to return to work in my present condition. Do you think I should contact the surgeons secretary and try to get an appoinment ASAP?
It generally does no harm for the patient to nag the NHS a bit to keep things moving so getting a message to the consultant via the secretary that you and your employers are in a bit of a fix because of the current state of affairs would be reasonable. I have had no reply as yet from Mr X - I rather suspect that that, combined with you seeing the registrar last week, probably means he is on holiday.
Unfortunately, even if there was a sudden flurry of activity and we now decided to re-explore the wrist in the coming week, that would almost certainly not leave you able to drive to Cornwall on the 28th so you will have to make other arrangements for that trip in any case. JB
Have spoken to the surgeons secretary and explained the situation, and that I am away from 28th Sept to 13th Oct. She has brought forward my next appoinment from November to 19/10/12. The surgeon is away on holiday at the moment but returns to work next Monday.
I thought as much - just bad luck that his break coincided with your return visit to the clinic I'm afraid. JB
JB
Slight change in symptoms in that I no longer seem to be woken up with pins and needles.
When I run my ring finger across my palm, or bend my middle finger or thumb back I get tingling in my index finger.
Other wise my index finger is still numb apart from the bottom section and the tip, and it still has a burning feeling and is tender at the tip.
Thumb middle and ring fingers still have the same syptoms with a burning feeling.
My GP has prescribed 10mg Amitripyline at night for the burning feeling but it does not seem to have helped. I have also stopped taking asprin just in case I have more surgery this week.
Have been contacted by the Hand Therapist at K & C hospital that I have an appointment with them at 08.30 tomorrow (Tuesday)
Well at least that's someone attempting to do something about it. Still no email reply from the surgeon here. JB
Dr Bland
Thankyou very much for your support, email recieved and I have contacted the surgeons secretary. Because I am away from this Friday, she says it is difficult to make an appoinment, but has made one with the surgeon as soon as I return.
I will keep you informed of the outcome of my appoinment in a couple of weeks.
Session with hand therapist went well, and I have been given some hand exercises to do, including scar massage and a desensitising progamme, with another appointment on the 16th Oct.
It is in situation's like this that the patients forum is most valuable.
Well I hope it improves and that your travel plans for next week are not too disrupted. JB
Dr J Bland
I have emailed you with details of the outcome of my outpatints appointment on Friday 19th Oct.
Andrew Smith has asked me to see him tomorrow 13.45 at the QEQM so unfortunately I will have to cancel my appoinment with you.
Well at least that's pretty rapid action. If you are doing occupational health at the university early in the morning you can drop in and see me afterwards before going back to Margate if you like. We will manage to squeeze in a test somehow. JB
Occupational health appoinment is 08.30 and will probably last about an hour, so this will enable me to get across Canterbury to you sometime around 10.00.
Dr J Bland
Appointment with Andrew Smith was very helpful. He looked through the results of the tests which you kindly did for me yesterday, and asked me what my symptoms were. He told me that by doing nothing the problems would remain, so he suggested further surgery. He asked me if I wanted another op, and obviously I said yes. He said that another op would not guarantee 100% sucess rate, and asked me who I wanted to do it. I told him that I would prefer it if he carried out the surgery, and he was quite happy to do so.
Again thank you for all that you have done for me since since my first surgery.
Thankyou for the update. It will be interesting to see what is found at surgery and no doubt you will let me know the outcome. JB
I guess that's not too bad in terms of NHS wait times - are they doing this one under general anaesthetic? JB
Dr J Bland
My operation was carried out under general anesthetic on 24/11/2012, and pre op symptoms are slowly improving. I saw Mr Nicholas at my post op out patients appointment, and he said that any improvment of my symptoms was a good sign that the operation was a success. Mr Nicholas asked me through the forum to arrange for another NCS towards the end of February. If at all possible an afternoon appoinment would be more convenient for me.
Glad to hear it's beginning to improve - seems it was worth re-operating. I'm sure we can do an afternoon in February though Michael Nicholas is with me in the clinic on a Thursday morning and would probably like to see how you are doing too. JB
Dr J Bland
Since my appointment with you in February there has been no noticeable improvement in the symptoms in my right thumb and index finger. There is still some numbness in both and there is quite a bit of burning/stinging sensation. I am taking 30mg of Amitriptyline each day, prescibed by my GP, but they don't really help the symptoms.
I might expect this to take some time. We will test it again about August I think. In the meantime if an adequate dose of amitriptyline is not affecting it then one could try gabapentin or pregabalin or even lidocaine patches - all of these agents used for neurogenic pain work for some patients and not others so it's worth doing some experimenting. JB
Dr J Bland
My GP has changed my medication from amitriptyline to gabapentin (300mg per day) as suggested by you in our last communication, and it has helped the symptoms of stinging/burning. There has been no improvement in the numbness of my index finger and thumb on my right hand since my last visit to you.
I have recently had an appointment with the university of Kent Occupational Health nurse for a progress report and she seemed to think that there are signs of muscle loss to the base of my right thumb. If this is the case she suggested that maybe I should see a hand therapist in the physio department. MW
Starting from a grade 5 weakness of the muscles at the base of the thumb is pretty common so not too surprising. I have some doubts that hand therapy can do much more this than just using the hand as much as possible but I could be wrong of course. Let me take another look at it next time I get to see you and we will have a think about it. I'm hoping to find you a follow-up appointment sometime in August/September JB
Dr Bland
Since my steroid injection last Monday (14/10/13) there has been no change in my symptoms. Still some numbness, burning and stinging feeling my right thumb and index finger.
Well it was an interesting experiment. I would not give up on it until a few weeks have passed but I suspect that what we are seeing here is just a manifestation of how badly the nerve was damaged after the first operation. Hopefully it will gradually improve over time. JB
Dr Bland
Just to keep you informed, there has been no improvement in the symptoms i am experiencing in my right hand since February of last year, and the steroid injection had no effect at all. My GP has now increased my daily dose of Gabapentin from 3 x 100mg to 3 x 200mg as the symptoms seemed to be getting worse. Occasionally there seems to be some slight numbness in the tip of my right middle and ring fingers which I have not experienced since before my first operation.
We might measure that again in a month or two if it's OK with you just to see if there is any evidence of sliding back from the grade 2 it was last time. Does Gabapentin help? If it does then that might imply that there is some nerve irritation taking place and there are other surgical procedures which are sometimes used to try and alleviate this - but we would have to consult with Mr Smith. JB
Yes Gabapentin does help, but I have to take 200mg approximately every six hours.
OK we will definitely take a look at that sometime in the next few weeks. JB
I don't really like the 'completely numb and stiff' index finger - especially as it was not like this before surgery if my records are correct. You had a lot of night-time tingling and numbness - has that gone? Who was the surgeon - so far as I know Michael Nicholas and Andrew Smith are away on holiday so I wonder who did it? What arrangements have they made for follow-up? If neccessary I will see you myself but if they have it in hand anyway that may not be necessary. JB