Need advice

I hardly know what to say. The surgeon has performed a procedure for a condition which you did not have (you cannot be said to have carpal tunnel syndrome if you had no symptoms as it is a clinically defined syndrome) and left you with more of a problem than you had before surgery. Was the surgery performed under local anaesthetic and did the surgeon concerned obtain your informed consent to the additional procedure - ie did they warn you about the possible adverse effects of cutting the transverse carpal ligament? The new symptoms of numbness and tingling might indicate actual trauma to the median nerve and you should certainly have some nerve conduction studies and probably ultrasound imaging done now. Are there any symptoms in the other hand? Are you in the UK or elsewhere in the world? JB

I have never been to the doctor for carpal tunnel syndrome and I've never had symptoms in either hand. I was under general anesthesia so I was not given the chance to hear about adverse effects.I didn't even know he had cut the ligament until I went for the first appt after the surgery. They took the bandage off and I had stitches from my palm to about four inches up. I'm in the US.

Well in the UK, and assuming of course that the details as reported are correct, I think it is quite clear that that would have counted as operating without adequate informed consent from the patient. I don't think we currently use consent forms here which give the surgeon carte blanche to do anything he sees fit once the patient is under anaesthetic. Obviously US practice may not be the same. More importantly however you need some investigations to try to get some idea if anything can be done for your problem now. Find yourself a neurologist or physiatrist certified by the AANEM (American Association of Neuromuscular and Electrodiagnostic Medicine) and get them to assess the current state of your median nerves on both sides. If there is evidence of CTS on the unoperated side that might at least be presumptive evidence that there may have been early CTS in the operated one so it's worth finding out if the other side is absolutely normal or not. The findings in the operated side will be be useful both for prognosis and as a guide to further management. JB

I signed a consent but from what I understand the dr has to be specific about what procedures he could do. It's done now so im just ready for it to be normal. He scheduled an MRI Friday. He wanted to do a nerve conduction test but I want to do the MRI first. He put me on another round of prednisone for the swelling. Thank you very much for the advice. My dr hasn't been helpful so far and I needed to know where to start looking for help. I teach gymnastics so I have to walk on my hands!

The nerve conduction studies are likely to be more informative than MRI, though both are worth doing. Ultrasound imaging can be better than MRI in some circumstances for nerve problems but it depends on the local expertise available. I would be curious to know what is found. JB

I really appreciate your help. I will let you know.

The MRI results: fluid in prestyloid recess, tendinosis of the ECU tendon with increased signal in it and a splint in the center, dorsal scapholunate ligament is torn, median nerve is prominent no hyperintensity or enhancement, ulnar nerve is enlarged no hyperintensity or enhancement. There are two more cysts. Tear of the palmar aspect of the scapholunate ligament. I see the doctor Tuesday. I am also making an appointment with another surgeon to get a second opinion.

Sounds like lots of minor problems in and around the wrist joint - perhaps some of them related to your occupation, did I see mention of walking on your hands? - Those comments on the nerves are of limited use and they don't seem to have made any comment on the transverse carpal ligament which your surgeon says he divided. You still need some nerve conduction studies doing I think. JB

I teach gymnastics so I'm sure there are problems in my wrist. I saw my doctor Tuesday and he told me the two cysts that are still there are inside the wrist joint and he said that's why I can't move my wrist. He told me he didn't do the kind of surgery for that and I needed to go somewhere else. I'm really upset. I'm in pain and I can't work efficiently and the doctor that did this has told me to go somewhere else.

You did mention seeing another surgeon for a second opinion so it will be interesting to see what comes of that,. If you are still getting lots of pins and needles and numbness in the fingers then get some nerve conduction studies done - they aren't all that traumatic. JB

I have a new doctor! The first thing he said was the incision is in the wrong place. He said the swelling and scar tissue could have caused carpal tunnel. I'm having the nerve testing next week. So, we will see what's going on.

Thanks for the update, really. It is a little frustrating when I get to see half a story on here and then silence but so far quite a few people have followed things through to a conclusion and I have found some of these stories very informative, if sometimes a little startling. If your nerve conduction studies are abnormal now that will potentially have several different interpretations which, in the absence of studies from before the original operation, will be quite difficult to sort out. How are the symptoms doing? - any improvement? JB

The nerves all look good- so that's good news! There is mild carpal tunnel. I still have pain and I can't move my wrist very much. I've stopped wearing the splint so I can try to do things I would be doing. It has been very difficult and frustrating. I'm going for a consultation with a pain management doctor this week and maybe schedule a nerve block in my neck. My new surgeon thinks it may be regional pain syndrome and he is trying to move quickly so I can regain some movement in my wrist. I really appreciate all of your advice so far. I'm trying to stay positive.

I'm assuming the 'nerves all look good' and 'mild CTS' comments are referring to nerve conduction study results? If they really are fairly mild abnormalities then we still cannot really tell whether you did have some degree of CTS before surgery or whether the surgery has in fact caused a problem which you did not have in the first place. A pain clinic consultation sounds like a good idea. JB

Yes, I had the nerve conduction tests last week. You're right! There is no way to tell if there are any changes because I went in to have a ganglion cyst removed not carpal tunnel and no tests were ever done before the surgery. My hand is starting to have red blotchy spots all over. I am seeing the pain management doctor tomorrow and I am supposed to schedule a nerve block and then start occupational therapy. Hopefully, I will regain some movement in my wrist. I will keep you posted.

Thankyou, I would love to hear how it turns out. I'm not much of a useful opinion on complex regional pain syndrome so it will be interesting to see what the pain team say. If the hand is looking visibly different then a (suitably anonymous) photograph would be fascinating but don't feel obliged. JB

The color changes have been coming and going. It almost looks like windburn and that's actually what I thought it was at first. My fingernails are getting harder and very groovy. I'm not sure if the color would show up in a picture but I will see. I would like your opinion on the incision from the surgery. I will upload some pictures.

I can't figure out how to upload a picture.

Best thing to do is to email to me at Jeremy [dot] Bland [at] nhs [dot] net and I will add them to a forum message for you - unless you would rather keep them away from the public. JB

Thanks for the emailed photograph. It's certainly a big incision but presumably it was a large ganglion cyst to begin with. We'll keep the image off the public forum. JB

I had the nerve block yesterday. I am still having pain and still little movement in my wrist.

I guess that might be a little early for a full effect but it's not a treatment that I have any real experience of myself so I would be guided by the people doing it in terms of what to expect. JB

Still no improvement. I think I'm being referred to a hand specialist at a sports medicine clinic. My insurance deductible for therapy is $2000 so I've been discouraged about that. I've been trying to stretch and move my arm on my own.

Typically, how long does the numbness and pain last in the palm and the scar after carpal tunnel release. Also, I'm still having sensory (touch- I don't know what it's called) differences in my palm. My surgery was September 19, 2013. I'm sure there's no definite answer and each person is different. I'm getting anxious to tumble and get back to work.

So this is now about 7 months since the original operation and you are still worse off than you were before surgery in terms of symptoms, and faced with a significant cash cost for further treatment too. That's a pretty terrible outcome for someone who had no symptoms of CTS to start off with and I'm sorry there's nothing I can do remotely to help. Trying to keep it mobile is probably a good move though. The scar from carpal tunnel decompression does sometimes cause local symptoms for many months - occasionally permanently. JB

I still can't move my hand back and I can't afford a $2000 deductible for occupational therapy (thank you US Healthcare). I am determined to get better! I'm searching exercises to try. It feels like that's all I have left and try to manage the pain. Your thoughts have been very helpful. Thank you, again.

Still no good news about my hand. My doctor told me he thinks my last option is spinal stimulation therapy but I don't think I can do that. I'm trying Lyrica again and the side effects are pretty rough so far. I've been trying to move my hand back more and it's causing a lot of pain. I've been going to a chiropractor. I don't know if it's helping but I've got to keep trying. There is a circulation problem. My fingers have been turning purple off and on.

The colour changes and persistent pain do have some features of complex regional pain syndrome. I'm sorry it's not improving. I presume the original surgeon has washed his hands of you now too and that you are still not back working? I'm afraid I don't have any other very helpful suggestions but as ever I remain interested in the outcome. JB

The original surgeon dropped me a few months ago. I am working- I own the gym so I have to work. It's getting really tough. I wanted to let you know the latest news. Thanks again.

I wonder if having to use the hand is helping or hampering recovery - I'm not sure that anyone knows in this situation but if I come across any decent evidence I'll post it on here. JB

I've taken this discussion to email - JB

I wasn't implying you were trolling for clients and you may not see this but my own medicolegal position in running the site is somewhat precarious. Whatever I may think about this particular case I have to keep my own advice strictly limited to my area of medical competence and I feel a responsibility for everything that I allow to be posted on the forums. JB

It's been a long three years. My doctors have been telling me my only option was SCS and I've been too scared to try it. A week ago I did it -I had a spinal cord stimulator implanted. The trial was a success. I did things with my hand that I haven't been able to do in three years. It isn't helping as much yet but I just think it needs to be programmed a little better. I pretty much feel like death right now. I had to give up my gymnastics gym. I'm ready to feel better and find a new job to keep myself busy. I haven't been able to work since May so I'm restlesss. I'm ready for the pain relief to pick up from the stimulator so I can move on.
Catherine

Thankyou so much for coming back to me with an update. It's so rare to get really long term outcomes in my speciality but several kind people have now come back with messages like this so the website is proving surprisingly informative. I'm glad that an avenue of treatment has opened up which offers some prospect of improvement but still very disappointed that all this proved necessary following a procedure that you probably did not need. JB

The surgeon was very pleased with the contact of the leads to my spinal cord and he said the leads are anchored very well. He said I should be able to twist and turn my body any way I want to without causing the leads to migrate. He said over time I might be able to get the range of motion back in my hand. It will take time to get used to the tingly shocks in my arm but it's better than feeling the constant nerve pain. I also have to get used to keeping the remote control with me and I have to keep the implanted device charged. So I agree with you- this is a lot to deal with for a procedure I didn't need. I appreciate your advice and you listening to me. This site is extremely valuable.