Pain From Nerve Injury
Another uncommon complication of hand surgery ismedian nerve damage.It occurs more often with endoscopic carpal tunnel release surgery. Most times this pain goes away in 1-3 months. However, feelings like numbness, itching or burning may take its place. And those feelings can last years- or be permanent.
The typical nerve injury occurs to one of two smaller nerve branches in the hand. One controls the thumb muscles. The other carries sensations from the palm of the hand. Accidentally cutting or nicking a branch of the nerve causes a disturbance in the area that nerve controls.
The Effect Of An Open Carpal Tunnel Release On Thumb Cmc Biomechanics
Thomas W. Wright
1Department of Orthopaedics and Rehabilitation, Orthopaedics and Sports Medicine Institute, University of Florida, Gainesville, FL 32608, USA
Academic Editor:
Abstract
Purpose. We have observed worsening thumb pain following carpal tunnel release in some patients. Our purpose was to determine the effect of open CTR on thumb carpometacarpal biomechanics. Methods. Five fresh-frozen cadaver arms with intact soft tissues were used. Each specimen was secured to a jig which fixed the forearm at 45° supination, and the wrist at 20° dorsiflexion, with thumb pointing up. The thumb was axially loaded with a force of 130N. We measured 3D translation and rotation of the trapezium, radius, and first metacarpal, before and after open CTR. Motion between radius and first metacarpal, radius and trapezium, and first metacarpal and trapezium during loading was calculated using rigid body mechanics. Overall stiffness of each specimen was determined. Results. Total construct stiffness following CTR was reduced in all specimens but not significantly. No significant changes were found in adduction, pronation, or dorsiflexion of the trapezium with respect to radius after open CTR. Motion between radius and first metacarpal, between radius and trapezium, or between first metacarpal and trapezium after open CTR was not decreased significantly. . From this data, we cannot determine if releasing the transverse carpal ligament alters kinematics of the CMC joint.
1. Introduction
What To Expect After Carpal Tunnel Surgery
Immediately after surgery, you may feel some numbness in your hand and fingers. This is due to the lasting effects of local anaesthesia. As it wears off, you may feel some stiffness and soreness.
You may need to keep your hand elevated and apply ice packs to reduce swelling. This is not the case for all patients. Dr McLean will explain his findings at the time of surgery and recommend whether this is appropriate for you.
If you have open release surgery, you may need a bulky dressing for 2-3 days afterwards. This is normally removed and the non-absorbable stitches will be covered by a dressing that will be removed at your 2-week follow-up after your operation.
- Elevate the hand above heart level to reduce swelling.
- A splint may be worn.
- Ice packs to the surgical area to reduce swelling.
- Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering.
- Physical therapy may be ordered to restore wrist strength.
- Eating a healthy diet and not smoking will promote healing.
You will need to restrict the use of your arm, especially for strenuous activities so that it has a chance to recover without additional damage. Dr McLean will advise you about these restrictions.
Also Check: Can You Run With A Broken Wrist
Why Do Fingers Still Have Tingling After A Carpal Tunnel Release
- Details
- Category: Blog
Carpal Tunnel Syndrome is the most common nerve entrapment in the arm. It is caused by a compression of the median nerve in the carpal tunnel at the wrist. Sometimes treatment might involve surgery to release pressure on the median nerve. Following this, however, the fingers may still tingle, feel numb or be painful, and there is a simple reason for this.
Symptoms include numbness and tingling in the palm, thumb, index and middle fingers, especially overnight. The symptoms may also extend into forearm or elbow. Other symptoms may include weakness or clumsiness of the hand.
Carpal Tunnel Syndrome can usually be diagnosed by thorough assessment by your therapist, but nerve conduction and EMG studies can also help with a diagnosis. ;Treatment for Carpal Tunnel Syndrome can be conservative or surgical. Longstanding Carpal Tunnel Syndrome or Carpal Tunnel Syndrome that has proximal radiation of symptoms is less likely to respond to conservative treatment.
In the treatment of Carpal Tunnel Syndrome, recovery periods are extremely variable. This is because damaged nerves have slow and variable rates of regeneration. While the recovering nerve regenerates, you may still feel symptoms in your fingers, even after surgery. Most patients notice an improvement in their symptoms within the first few days, but some patients have ongoing symptoms for up to 3 months following surgery.
What Happens After Surgery
Pain after surgery is minimized with oral or intravenous analgesics. Elevation and an ice pack for the bandaged hand can help reduce bleeding and swelling. You will be monitored for a short time. When the doctor believes you are stable, you can leave the surgery center. Be sure to bring someone to drive you home. If you have any complications, you may be required to stay longer.
Mild pain, discomfort, and swelling are common after surgery. Your doctor may recommend icing, elevation of the hand, over-the-counter pain medications or a splint to be worn at night or during various activities. Your doctor also may limit the amount of weight you can lift.
Stitches are removed 7â10 days after surgery in the doctors office.
Follow the surgeonâs home care instructions for 2 weeks after surgery or until your follow-up appointment. In general, you can expect:
Restrictions
- Keep the arm elevated above your heart for 48 hours.
- Avoid pushing down on your palm . Donât lift anything heavier than 5 pounds on the involved arm for one month after surgery.
- No strenuous activity including yard work, housework, and sex.
- You may drive 2 days after surgery if the pain and swelling in your arm is controlled.
- Donât drink alcohol. It thins the blood and increases the risk of bleeding. Also, donât mix alcohol with pain medicines.
Incision Care
Medications
Activity
When to Call Your Doctor
You May Like: Sciatica Heat Or Ice
Tendonitis Pain In Wrist After Carpal Tunnel Surgery Workers Comp Hassle
I had carpal tunnel surgery over a year ago and it took care of the pain I was having. Now I have pain in my wrist. It limits range of motion as far as turning my wrist or picking or carrying anything too heavy.
———————-Please reply using the comment link below. Do not submit a new submission to answer/reply, it’s too hard for me to find where it’s supposed to go.And, comments have a 3,000 character limit so you may have to comment twice.———————–
How To Relieve Carpal Tunnel Pain
For most people, it doesn’t matter where carpal tunnel pain is as long as they can treat it. But it may surprise you that treating the pain symptoms is only slightly helpful. But treating thecauseof the pain is far more effective and lasting. In other words:
If you treatonly the painit will come back. But if you treat thecause of the painit will eliminate symptoms forever.;
Therefore, where carpal tunnelpainis your main symptom, there are 2 approaches to treating it:
- temporary pain treatmentswhich just treat pain for the time being
- permanent pain treatmentswhich treat & eliminate the source of the pain
I highly recommendyou use thepermanent pain treatmentsfor obvious reasons. I list the temporary ones below because you’ve probably tried them – with no long-term effects.
You May Like: How Do You Tell If Your Wrist Is Broken
How Is Carpal Tunnel Syndrome Diagnosed
First, your doctor will discuss your symptoms, medical history and examine you. Next, tests are performed, which may include:
- Tinels sign: In this test, the physician taps over the median nerve at the wrist to see if it produces a tingling sensation in the fingers.
- Wrist flexion test : In this test, the patient rests his or her elbows on a table and allows the wrist to fall forward freely. Individuals with carpal tunnel syndrome will experience numbness and tingling in the fingers within 60 seconds. The more quickly symptoms appear, the more severe the carpal tunnel syndrome.
- X-rays: X-rays of the wrist may be ordered if there is limited wrist motion, or evidence of arthritis or trauma.
- Electromyography and nerve conduction studies: These studies determine how well the median nerve itself is working and how well it controls muscle movement.
Endoscopic Carpal Tunnel Release Surgery
In this method, a small cut is made in the wrist, and a tiny camera is guided through a thin tube into the hand.; This allows Dr McLean to investigate the mechanics of the hand and cut the transverse carpal ligament with minimal scarring.; This relieves the pressure on the median nerve to alleviate symptoms of carpal tunnel syndrome.
Also Check: Does A Heating Pad Help Sciatic Nerve Pain
Carpal Tunnel Pain Worse After Carpal Tunnel Surgery What Treatment Can I Do Now
Based on patient Surveys, carpal tunnel surgery has the success rate of only 50 to 60%. As surgeries go, this tends to be lower than most patients would expect. Patient surveys reveal that patients expect surgical outcomes to be satisfactory at least 95% of the time before they will confidently submit to a surgical procedure.
So what can patients expect when carpal tunnel surgery is not successful? Well theres quite a range of possibilities. Many continue to have the same symptoms post-surgery as they had before the Carpal Tunnel Surgical Procedure. Some patients report persistent numbness and tingling post-surgery.
Others describe loss of grip strength and permanent tenderness at the point of incision even after a year of rehabilitation.
About 5 10% of people report that their Carpal Tunnel Symptoms get worse after surgery than they were before surgery.
So the question looms from concerned patients:
What can be done for the thousands of people who have carpal tunnel surgery and continue to have symptoms and carpal tunnel pain post-surgery?
Essentially this would be called a failed carpal tunnel surgery. So again, these questions are commonly posed by patients:
What can be done after a failed carpal tunnel surgery?
Where can a patient turn for help after a failed Carpal Tunnel Surgery?
The good news is there are natural treatments that can be done with high levels of success after a failed carpal tunnel surgical procedure.
Shelly
What Are The Results
During the healing process, the ligament gradually grows back together while allowing more room for the nerve than there was before. Some patients feel tenderness around the scar.
Most patients are helped by surgery and are able to return to their jobs. If there was nerve damage before surgery, a full recovery to a “normal hand” may not be possible. Loss of wrist strength affects 10 to 30% of patients. Residual numbness, loss of grip, or pain may be helped by physical therapy. Persistent symptoms are higher in those with diabetes.
The risk of recurrence is small. The most common reason for repeat surgery is incomplete cutting of the ligament during the first surgery or scarring.
Don’t Miss: How Do You Tell If Your Wrist Is Broken
Types Of Painful Feelings
As describe above, theplacewhere carpal tunnel pain hurts the most is easy to define. But describing the actualtypeof pain patients feel is more difficult.
The types of pain reported have a wide range. They can be anywhere fromannoying or bothersometocrushing or punishing. The specificqualitiesof pain sensations usually described are:
- shooting
Note that you can have only one or all of these pain sensations at the same time. Usually having more than one type of pain sensation is relative to the stage of carpal tunnel syndrome.More advanced stages produce additional types of pain sensations.
What Is Carpal Tunnel Surgery
Carpal Tunnel Surgery is an outpatient surgery where the transverse ligament is cut.; This ligament compromises the roof of the carpal tunnel which is intended to release the pressure and irritation of the median nerve. There are many different techniques with open surgery and endoscopic surgery being the most common.
Recommended Reading: Can Blueberries Cause Stomach Pain
When Will I Know The Results
Results may vary based on your individual condition. Talk to your doctor and surgeon to get a better understanding of when you can expect to see results.
- In most patients, pain, numbness, and tingling will be relieved shortly after surgery. Grip and pinch strength usually return by about 2 months after surgery.
- You may have some soreness and weakness in the hand for up to 6 months after surgery. If you still have pain or weakness after 2 months, your doctor may recommend that you work with a hand therapist.
- Complete recovery may take up to a year. If your carpal tunnel syndrome before surgery was severe, your recovery may take longer.
Causes Of Carpal Tunnel Syndrome
Increased pressure to the median nerve, as it crosses the wrist with the tendons of the fingers, is the main cause of carpal tunnel syndrome. This pressure can come from a number of influences. Work-related duties involving vibration or repetitive, forceful motion over a long period of time may lead to the development of this condition. Other factors that can cause undue pressure on the median nerve include:
- A history of fractures or arthritis
- Joint dislocations
- Thyroid conditions, diabetes, or obesity
Don’t Miss: Is Mobic Good For Sciatica Pain
Persistent Numbness And Tingling
There are two reasons why people have persistent symptoms of numbness and tingling after carpal tunnel surgery. One reason is the transverse carpal ligament is not completely released. The second reason is if there is long-standing compression to the median nerve in the carpal tunnel.
Incomplete release of the transverse carpal ligament can lead to persistent compression on the median nerve, and therefore persistent symptoms. This complication is more common with endoscopic carpal tunnel surgery.
Some people who have long-standing carpal tunnel syndrome may have persistent numbness and tingling even after carpal tunnel release surgery. This is thought to be the result of long-standing compression and therefore more significant nerve damage. In fact, some people have nerve damage so severe that sensation is never restored to normal.
A nerve test called an electromyography study can help give an indication of the severity of the nerve compression prior to surgery.
What To Expect After The Operation
Scar
Dressings
Rehabilitation
Not everyone needs to see a physiotherapist after surgery unless there is a problem with scar pain or stiffness. Some general rules that are useful for everyone are:
- Hand elevation is important to prevent swelling and stiffness of the fingers.
- Remember not to walk with your hand dangling, or to sit with your hand held in your lap.
- It is fine, however, to lower your hand for light use and you should get back to normal light activities as soon as possible as guided by common sense.
- It is safe to use the fingers for day-today activities such as eating, dressing, brushing your hair. These activities all help to prevent stiffness and swelling.
Symptoms
The pain and tingling you experienced at night before the operation should settle immediately. If you have established numbness, dryness, lost dexterity or wasting of the muscle at the base of the thumb, then recovery of these problems is uncertain, especially as you get older. Ideally, surgery should be performed before these problems develop.
Stitches
Your stitches will be removed at about 10 to 14 days after the operation.
Recovery
You will find that your grip is weaker than before the operation and slightly uncomfortable. This can be a bit frustrating but you should be back to full power by 6 to 12 weeks as healing occurs. Exercises such as squeezing balls will not speed up the process, and if overdone this can actually delay your recovery.;
Painkillers
Don’t Miss: Where Is Sciatic Nerve Pain Felt
How Often Is Hand Pain Caused By Carpal Tunnel Syndrome
While carpal tunnel syndrome is a common condition, it has a different set of symptoms from many other sources of hand pain. There are actually several similar conditions that cause hand pain. These include:
- De Quervains tendinosis: A condition where swelling affects the wrist and base of the thumb. In this condition, you will feel pain when you make a fist and simulate shaking someones hand.
- Trigger finger: This condition causes soreness at the base of the finger or thumb. Trigger finger also causes pain, locking and stiffness when bending the fingers and thumb.
- Arthritis: This is a general term for many conditions that cause stiffness and swelling in your joints. Arthritis can impact many joints in your body and ranges from causing small amounts of discomfort to breaking down the joint over time .
Numbness & Tingling After Carpal Tunnel Surgery
If the surgery was successful, thepainyou felt as asymptom of carpal tunnel syndromewill diminish. But numbness or tingling may persist. This is usually due to one of two reasons.;
- First, the surgeon did not fully cut the ligament. That means themedian nerveis still compressed. This happens mostly withendoscopic surgery.;
- Second, other tissues are pushing on the nerve, so cutting the ligament didnt matter. This can be a bigger problem, leading to nerve damage. That means numbness or tingling will never completely disappear.
Don’t Miss: Is Heat Or Ice Better For Sciatica Pain
What Can I Expect After Surgery
You will have a light bandage covering the incision that permits immediate wrist and hand motion. You will be encouraged to periodically move your fingers into a fist and straighten them out in order to prevent stiffness. It is important to ice and elevate the operated hand to limit swelling. Most patients will have the option of removing the surgical bandage 3 days after surgery and replacing it with a fabric bandaid. For the first 4 weeks after surgery, you should avoid forceful gripping, grasping, bearing weight, or lifting heavy items with your operated hand. Typing, operating a mouse or phone, and driving are permissible the day after surgery. The incision should be kept dry until healed, usually 1-2 weeks.;
https://kn-my-p-n.b-cdn.net/wp-content/uploads/99-best-images-about-thumb-pain-on-pinterest-arthritis.jpeg
https://www.knowmypain.com/why-does-my-thumb-hurt-after-carpal-tunnel-surgery/
https://kn-my-p-n.b-cdn.net/wp-content/uploads/99-best-images-about-thumb-pain-on-pinterest-arthritis.jpeg
https://knowmypain.weebly.com/know-my-pain/why-does-my-thumb-hurt-after-carpal-tunnel-surgery
No comments:
Post a Comment