If you would like to come in sometime in the morning tomorrow I can give you an injection then. Just remember there is the small chance of a painful hand afterwards so bear this in mind when planning the rest of your day. EK
Thank you VERY much for getting back to me so soon - what an amazing service this is. I will have to catch the bus so will try to get to you by about 10.30ish. I assume I come to Dr Bland's normal outpatient clinic? Thank you again
Dr Bland,
Am sure you will have seen my reply above - but please can I pass on my sincere thanks to you for organising this so quickly. I cannot say how much I appreciate all your help. Thank you.
I suspect many of my colleagues would like to run their clinics like this if the systems supported them to do it. Hopefully injection tomorrow will bring the right hand under control. I will be doing a clinic in London so Emma will have the office to herself. JB
Dear Dr Bland,
Belated thank you for arranging for the steroid to be done on right hand in clinic - just to let you know that it worked instantly and now symptom free in both hands! Hurrah! Please pass on my thanks to Emma.
Post surgery update on left hand - still getting pain from scar at bottom by wrist and when stretching my hand backwards or putting strain on it in that position (i.e. lifting children!) I get pain running from bottom of palm (little finger side) upwards. Normal I guess? Do I simply keep on with the exercises or is there anything else I can do? Obviously the pain makes me avoid doing certain movements and I am afraid that this will hamper recovery in itself!
There are no hard and fast recommendations for dealing with the local pains around the wrist and scar after surgery. They seem to get better in most people whatever you do. it's probably not a good idea to do anything which obviously hurts and lots of people recommend massage of the scar with some form of cream or other. I, as always, am naturally sceptical about anything which does not come backed up by well designed randomised clinical trials. Glad to hear the other hand is OK at present. JB
Dear Dr Bland,
Quick update - having put up with pain getting far worse in left hand (scar) I went to Dr yesterday who said I have an infection in bottom of scar - it is very hard, swollen and scar line is yellow. Shame as it has been like this since stitches came out and I just thought it was the healing process as there was no oozing or puss like a normal skin infection. Guess the type 1 diabetes doesn't help with the healing though. I'm assuming this infection has been there a while and may possibly be reason for the pain around base of scar extending upwards towards little finger? Anyhow - am on a 7 day course of 4 x daily 500m penicillin and hope this sorts it out as pain is pretty bad.
I'm not an authority on wound infections so I'm not going to say anything about that. I'm sure Dr Rine would be interested though. JB
Dear Dr Bland,
Apologies for yet another post but wanted to just check something with you. I am now 4 days into a 7 day course of penicillin and although I think the almost concrete hardness around the lower wound area is lessening, the discomfort around the bottom one and a half centimetres of scar is still too tender to touch with the feeling off extreme pressure (almost to the point of something feeling as if it is trying to burst out of it). I am hoping that over the next 3 days this will feel much better, but am worried about lack of response so far to GP treatment. If (and I hope I am wrong with this) the symptoms are still present when the penicillin is finished what is my best course of action? Go back to GP or would it be better to contact surgery where op was carried out? Thank you for your patience.
I think it would be easiest for me to catch up with the situation if I saw you again - I can manage Monday morning at 9:30 if you are free? - of course if it stages a dramatic recovery over the weekend we can skip that. JB
Dear Dr Bland,
Thanks for your response - yes Monday morning 9.30 would be fantastic - although I do really hope by then that I will have seen some significant improvement. I do believe that the solid lump under bottom half of scar is slightly less today so am hoping that this is the start of that improvement. I will, of course, let you know if things improve dramatically over weekend. Thanks again.
Kind regards
Dear Dr Bland,
Thank you for your offer of seeing me tomorrow but things have improved much over the last 24 hours and I think I need to see how things go over the next week before I trouble you unnecessarily. The infection is clearly gone now as is the intense pain - pain and tenderness is still there in lower 1 and a half centimetres of scar but not to the awful extent it had been. The tissue under bottom bit of scar is still quite hard (but nowhere as bad as it had been) and when I extend the thumb outwards this area of scar looks very white (as if it's under pressure) and feels tender. Interestingly I went out for a long walk today and could only hold the walking pole for about 45 mins before discomfort was too bad over scar (unfortunately I'm left handed otherwise I would have held it in right hand!). Guess I just have to be more patient and let the healing process work now infection is gone.
Thank you for your time and patience and I will update you in a week or two to let you know how it's going.
As always - well done on your brilliant forum and aftercare service.
Kind regards
Dear Dr Bland,
Quick update! Have just made another Dr's appointment as I fear the wound infection is back again - skin really tender and very red at bottom of scar and area under bottom of scar feels quite hard again. Will there be any follow up following my surgery? Interested to see that people are usually contacted 6 weeks post op - not sure whether that will happen to me as it's now 7 weeks and haven't heard? Very interested to read the post op notes from another patient here - very different to information sheet I was given in terms of length of time for leaving dressing on/changing it. Such a shame about scar problem as the CTS in left hand is cured but scar feels so tender still. Will let you know outcome of Dr's apt next Wednesday.
Kind regards
The hospital hand surgeons follow people up at 6 weeks, we do the GP ones at 3 months. I'm a bit doubtful about the idea of relapsing/recurring infection unless there is a bit of retained stitch or some such acting as a focus. JOhn Rine should be operating this morning so we'll see if he has anything to add. JB
Dear Dr Bland,
Had to bring forward my Dr apt as scar was too painful and went after work today - another 7 day course of penicillin for what she thinks is another infection - although cannot be sure. She says there is clearly something wrong for the swelling, discomfort and redness but cannot be sure it is actually infected as scar is not hot. My blood sugars are all over the place again which is normally an indication of an infection. She did wonder if maybe a bit of the ligament was caught in the stitching? Could this explain the symptoms? If so - what is the best next step? I presume I should take this course of penicillin, but if there is something causing this problem how do I best get it sorted? Dr asked me to go and see her again next Monday as she said she would refer me back to you - but this seems rather a long winded process when I can contact you here? What do you suggest? Wait until this penicillin has finished?
Kind regards
I did discuss it with John Rine and we think infection is relatively unlikely though it's hard to be sure without seeing it and even then it can be difficult. My next chance to take a look at it will be on Thursday morning - any good? JB
Dear Dr Bland,
I can probably pop in on Thursday but it depends what time? Would first thing be at all possible as I can arrange cover at school from 8.30 - 9.30?
Kind regards
Come along in that slot sometime. That at least allows me to get a look at it and maybe a quick look with the ultrasound scanner. JB
Dear Dr Bland,
Thank you - will be there as close to 08.30 as I can. I really appreciate your help.
I made contact with John Rine with that photograph of the scar. Like me he thinks it's fairly unlikely to actually be infected - more likely just some excess inflammation around the stitch site. As it seems to be settling it's probably better not to interefere at present but, as we said on Thursday, having started a course of antibiotics it's probably better to finish it. If it relapses again we will think about it further. JB
Dear Dr Bland,
Many thanks for seeing me on Thursday. On day 5 of penicillin and, as last time, pain and redness is reducing but hard lump under scar is not. Will see how it progresses over next couple of weeks and if it reoccurs after several weeks off tablets I'll contact you again. Could the hard lump I am feeling under the bottom end of the scar be the enlarged nerve you were talking about when you did the ultrasound? Presumably we don't know whether it was that size prior to surgery (presumably it was) but maybe that is now putting pressure on the scar tissue? Hopefully this will decrease over time?
Many thanks again for all your time.
Kind regards
I doubt if you can feel the nerve. The lump will be a focus of scar tissue related to one of the stitches I think. JB
Dear Dr Bland,
Apologies (again) for needing to post you - but I think the same post op problem with left hand is starting again. Mid to lower end of scar is very tender and the majority of pain is to the right of scar. Should I go back to GP to see if they think infection is reoccurring? Not sure it is as it is not hot and not as red as last time, but it is certainly just as tender and getting slightly swollen (skin appears discoloured when slight pressure is put on it as it would with an infection). This has all happened over weekend where (interestingly) I have had a very lazy time - so definitely not hurt it in any way. Any advice on what to do would be gratefully received.
Many thanks
I don't think there are any easy answers. Some carpal tunnel decompression scars are tender for a long time, sometimes exquisitely so. This may or may not be more common in diabetes, no-one is quite sure, but you do seem to see complexes of multiple hand problems in diabetic patients sometimes. It's possible that the ministrations of the hand therapists might help but again there is no concrete evidence to guide us. Wait and see what happens to it over the next few days without starting any further new courses of antibiotics I think and then we'll review the situation again at the end of the week. JB
Many thanks for your swift (as ever) response. I had an awful feeling that that old sweet chestnut of being 'diabetic' may well crop its head up at some point. I had hoped that being a very well controlled type 1 would avoid any complications. Interestingly my blood sugars have started to rise again (which they have done each time I've had a suspected infection in the past 2 months) - may indicate same problem? Is it worth me trying regular 4 hourly ibuprofen? Don't want to but at this stage am clutching at straws and hoping this may help with swelling which is starting again. Will contact you again at end of week to let you know what is happening.
Many thanks
Your blood sugars will probably rise a bit in response to any kind of stress, not just infection, and as I said I really don't know whether the diabetes is relevant to your particular problem - it's just that you seem to see a lot of hand problems in general in diabetics. Ordinary analgesics in moderation should not be a problem, as long as your stomach tolerates them OK. JB
Dear Dr Bland,
Have got to the end of the week and bottom of scar on left hand still feeling very uncomfortable if any pressure is put on it and indeed very sensitive to anything touching it. I do think it is feeling slightly warm in that area and blood sugars still erratic (which is unusual for me) so am going to try and see my Dr at the beginning of next week to see what he says and whether its worth another week of penicillin (which has made a big improvement in the past). I'll let you know what he thinks. Hoping to rest hand for a few days as school has broken up - we'll see if that helps. Hope so!
Kind regards
Thanks for the update. Unfortunately I think this is going to be a troublesome scar for a while but hopefully it will settle down eventually. I can arrange for it to be seen by the hand therapists if necessary - their ministrations may or may not help but almost certainly do no harm. JB
Thanks for offer of help. Don't think hand therapy is the right option as I can move my hand perfectly - it just hurts a lot when scar is touched or any pressure put on it. If it is simply (!!) excess scar tissue then this will have to sort itself out over time I very much hope. Thanks anyway.
It is possible that their miscellaneous massages, creams, waves and exercises might have an effect on it, but I have to say that there is no very good evidence one way or the other. Let me know if you want to give it a try. JB
Dear Dr Bland and Emma,
Emma you left a message on Wednesday regarding my post op response and I think when you tried again later you spoke to my husband? It appears he has booked me in to come and see you again to have my scar checked with ultrasound. I think this may be a waste of your time as you checked it in March I think. It is clearly the same excess scar tissue problem that is causing the pain and unless I am mistaken there is nothing to be done for this? There is still a really hard patch on the base of my palm on the right of the scar and to the left of the scar it is pretty solid too. Presumably this is still the scar tissue as it is as it was when I last saw you.
I am coping although some things at school (particularly Forest School) I just can't do because it puts too much pressure on the scar which causes a lot of pain. It is uncomfortable pretty much all the time but I have learnt to put up with this and keeping my hand slightly cupped (rather than fully extended) stops the scar getting touched too much by kiddies at school! In view of the fact that nothing can be done about the scar (and there is clearly nothing in the scar to be causing the pain) then I think it unnecessary to waster your precious time in clinic rescanning it. Please can you cancel my appointment that was made for 08.30 on June 12th.
Thanks for your offer - I really appreciate it, but I also appreciate how stretched your services are!
Kind regards
If it's not showing any signs of improving over this long one might think about surgical revision of the scar - occasionally persistent local tenderness of a scar can be due to the formation of small neuroma within it where one of the very small nerves in the skin has been cut and sometimes there is merit in revising the incision but I am by no means saying we would definitely do that - it's just something worth considering, but not purely on the website - I would need to look at that again and discuss it I think. If all goes to plan I may have a much better ultrasound scanner available that week too. JB
Dear Dr Bland,
Thanks for your response and apologies for not having been able to reply earlier. I think it best to leave the scar at present and hope that it may in time get easier and less swollen at base as I have no wish to have any more surgery thank you being the coward I am! Anyhow - this week would not be good as we have several new parents visiting and a father's day breakfast to contend with at school!
If indeed it did appear that there was a small formation of neuroma presumably there is nothing to be done for this anyway? I assume that revisiting the site would be to simply look at what was going on? really - having had such a horrid time with the original scar I have no wish to have it reopened as I am coping with the pain and becoming slightly ambidextrous as a result!
Thanks anyway
There are case reports of improvement after excision of a neuroma but it is a rare enough complication that there is no good case series that I know of to give a realistic idea of the outlook. I don't think there is any rush for this so I'm quite happy for you to sit it out for a while and see how it changes. I would like you to stay in touch though please. JB
Hello again,
Thanks for quick response (as usual) - any chance of tomorrow - Friday 7th Feb in Canterbury? That would mean not missing any time from work when I'm back on Monday! If this is possible that would be simply amazing as I had another very disturbed night last night with the right arm and the splint does nothing to alleviate pain and numbness.
Thanks a million