Post Op - Still have symptoms

This is getting to be a bit of a recurring theme I'm afraid - surgeons who are confident that they know how severe CTS is before surgery and outcomes that are not as good as expected. It's hard to know what to make of the hot sensation and red and white streaks but CTS symptoms should definitely feel at least somewhat better a month after surgery unless it was catastrophically bad before operation. Perhaps the best starting point for this is to go back to how it felt before surgery and describe the original symptoms - or do the questionnaire on the site here for the symptoms as they were just before surgery - and then we can think about it - but the lack of pre-operative NCS will be a significant handicap in working out the nature of the problem. JB

Hi Jeremy

Thank you so much for your reply.

I awoke again this morning at 3.30am with stiffness again in my hands, I flicked my hands as it just seems the natural thing to do. I again awoke at 6.00am with my fingers on my left hand in a stiff crab like position which I gently opened with ease, both hands being very hot with my fingers having these white streaks as like blood is not flowing correctly. I have taken a severity test on the website on what my hands felt like before surgery results as follows:

Severity score: LH 3.09, RH 3.00
Functional impairment: LH 1.38, RH 1.25
Symptom score
ANN
LRP

I also have an underactive thyroid & currently take 225mcg thyroxine daily, not sure if this condition contributes to CPS as I have read somewhere that it may. It maybe worth mentioning that I took up a new hobby 'crocheting' in January this year and experienced CTS soon after prior to my new hobby I had no CTS whatsoever. I also stopped my new hobby!

Any advice on whats going on would be much appreciated

I've had a look through the questionnaire answers. If that was the picture before surgery then it was not wholly typical of CTS but there were a few suggestive features, particularly the timing of symptoms in the middle of the night. The other thing that one really wants to know is much harder to assess on the web - was there any weakness or wasting of the muscles at the base of the thumb? If you look at the photograph on the 'About CTS' page this is the sort of thing. This is the only easily visible indicator of severe CTS. In someone your age it would be quite unusual for CTS to progress to severe nerve damage in 5 months from symptom onset but it is not impossible

I presume your thyroid function was checked before surgery - undertreatment (too little thyroxine) can contribute to CTS, and the crochet may have been a contributor to triggering the problem... if it is CTS of course. 

You should have some nerve conduction studies done. Even without pre-operative studies the results might still give us a clue as to how to deal with the problem and the other side should cleary be checked out before surgery - you don't want to end up in the same situation with both hands. The other thing that can help in this situation is ultrasound imaging but there are very few people around with the interest in CTS, experience in looking at the nerves and a scanner available so that depends a lot on where you are. JB

Thank you so much for your quick reply. I've had a look at the photographs and the base of the thumb is where my CTS symptoms do stem from (most pain at the start of the symptoms). I live in North Kent but will do some research into where I can have ultrasound imaging whom have experience in looking at the nerves and have a scanner. But I need to be quick as my operation on my right hand is booked for next Wednesday. Hope you don't mind me asking but Is this something that you would do in your private clinic at Chatham as I feel at a lost as to what to do.

In North Kent your GP can arrange for nerve conduction tests. They are done at Medway hospital but administered through Kings College London. Getting them done before next Wednesday would be a challenge but if the neurophysiology department is told that surgery is planned for next Wednesday they might be able to fit something in on Monday or Tuesday if there is a clinic on then. You have a rheumatologist in Dartford I think who has published on ultrasound imaging of CTS but I don't know if he has taken any interest in post-operative problems.

I very explicitly do not want this website to act as a way of boosting my private practice income. I want it to remain as non-commercial as possible so I'm not going to make any offers of private appointments. You are near enough to my two bases in Canterbury and Kings College that you can be legitimately referred to see me on the NHS but it would be in London and my next clinic at Kings is not until Wednesday 10th July.

If you are unhappy with the state of the left hand at this point that could easily be used to justify deferring surgery on the right - we would usually want the first hand to be fully recovered, or almost so, before saddling the patient with the problems of managing for a couple of weeks with the second hand partly out of action as well. it is extremely unlikely that a few weeks delay would make any difference to the outcome of surgery. JB

Hi I have taken you advice onboard and have deferred my operation until more tests have been done, I'm due to see my GP on Thursday and will ask for a nerve conduction test be performed. Thanks again for all your advice. Kind Regards Bronte.

Is it feeling any better? If your GP is willing to make a referral for nerve conduction studies to Kings then ask him to mention my name in the request and I will try to make sure it ends up in the right clinic. JB