Carpel tunnel surgery, yes/no

[scottmandue]

We have chatted about this before but tomorrow is decision day for me, seeing a surgeon for a consultation.
Been to a neurologist, did the tests (ouch) and X-rays and the constant pain and numbness confirm I have carpel tunnel.
over the past couple months have done a lot of research and as usual I get everything from "Best thing I have ever done!" to "No way! Don't do the surgery!!!"

So what does PPOT say, anyone had this done and/or know someone who has and what was your experience?

TIA

[matt f]

Confirmed diagnosis of CTS involves both physical signs and symptoms as well as positive diagnostic testing.
It appears you have both the pain and inflammation as well as positive EMG/NCV results.
Further confirmation would involve wasting of the median N. innervated muscles, primarily,but not limited to the thenar eminence. To appreciate this, on the effected hand(s), bring your thumb and pinkie together, you may see a crease in the muscle at the base of your thumb.
Also, waking at night to "shake out" your hands to relieve symptoms is a subjective sign of CTS.
If you decide on surgical intervention, you will need to change change the habits that brought this on initially. Change of work habits and/activities of daily living that brought this on or exacerbated it is essentiall so that it doesn't return.

Noah930 is an orthopaedic surgeon who does a lot of hand surgeries.
Hopefully he will chime in and provide information on the "release" surgery and the post surgical protocol.

Best of luck,
Matt

[Rick V]

I thought carpel tunnel was a thruway between north and south Dakota. Ya learn something new every day.

[AFC-911]

My co-worker had it done a few months ago, he couldn't do jack for a several days.

[recycled sixtie]

Originally Posted by AFC-911

My co-worker had it done a few months ago, he couldn't do jack for a several days.

Maybe he could do jill then....

[patz]

Don't quit your day jobs.

[NY65912]

I had a really bad 6 month period of CTS. The pain felt like my hand was gonna explode, to my elbow and at worst to the shoulder. I went to one of the best hand surgeons in NYC, had the electric zap time test and scheduled my surgery.

I did my due diligence and decided to wait until the inflamation subsided.

I did not have the surgery and I am glad I did not. It took about six months but I recovered by 99.5%. I heard of too many stories of unhappy people who had the surgery. My own family member being one.

So, I wore a brace which I wore 24 hrs a day, got a special mouse pad and took Advil, it gradually subsided. You must wear the brace at night when you sleep. You would be suprised of the crazy positions you put your hands in while one sleeps.

Good Luck

I figure that if it ever really gets bad again I could have the surgery.

[scottmandue]

Originally Posted by matt f

Confirmed diagnosis of CTS involves both physical signs and symptoms as well as positive diagnostic testing.
It appears you have both the pain and inflammation as well as positive EMG/NCV results.

Yes and yes

Further confirmation would involve wasting of the median N. innervated muscles, primarily,but not limited to the thenar eminence. To appreciate this, on the effected hand(s), bring your thumb and pinkie together, you may see a crease in the muscle at the base of your thumb.

Neurologist looked at that, said he doesn't see it

Also, waking at night to "shake out" your hands to relieve symptoms is a subjective sign of CTS.

Yes, the waking in the middle of the night is what pushed me to the point of seeking surgery

If you decide on surgical intervention, you will need to change change the habits that brought this on initially. Change of work habits and/activities of daily living that brought this on or exacerbated it is essentiall so that it doesn't return.

I believe this was brought on by over a decade of installing HVAC, working a sawzall, swinging a hammer, a lot of working with tin snips, etc. I am now a tech but I don't do data entry, I do mostly light repair work on electronic equipment.

Noah930 is an orthopaedic surgeon who does a lot of hand surgeries.
Hopefully he will chime in and provide information on the "release" surgery and the post surgical protocol.

I believe I got some input from Noah when I first asked questions about the procedure, he was a great help

Best of luck,
Matt

Thank you everyone, I have also heard everything from "back to work in two weeks" to "it took six months the recover"

[Scott Douglas]

Back when I was working I ended up with a lot of the symptoms described above. Got a brace, new 'bent' keyboard, had to switch hands for mousing. I purposely changed my activity to lesson the effects of work. After 6 months, the symptoms went away.
If it was me, I'd avoid the surgery if at all possible.
I now mouse left handed (I'm a righty) and can tell when I've been on the keyboard too long.
Good luck, I hope it all works out for you.

[p911dad]

I suffered from this condition for several years after a bunch of building projects. My right hand had a severe burning sensation and pain at night, and also numbness that was very annoying. A surgeon friend of mine did the procedure about 10 years ago, and after a short recuperation period, I was as good as new. He said that in my case the surgery was the only cure, as I had already tried the brace and all that. He basically opened up the tunnel a bit to relieve the irritation of the nerve. The pain, burning and numbness never reappeared. I have a small scar that he matched up with my lifeline, you have to really look for it to see it.

[Laneco]

Steve had carpal tunnel surgery in both hands (one at a time) around 9 months ago. Each hand took about 4 weeks for him to feel fully healed but only about two weeks to feel HUGELY better.

If there was a non-surgical alternative that would have worked for him, he would have probably given it a try but more than one doctor was convinced that surgery was the answer for him. Indeed it was.

angela

[scottmandue]

Originally Posted by p911dad

I suffered from this condition for several years after a bunch of building projects. My right hand had a severe burning sensation and pain at night, and also numbness that was very annoying. A surgeon friend of mine did the procedure about 10 years ago, and after a short recuperation period, I was as good as new. He said that in my case the surgery was the only cure, as I had already tried the brace and all that. He basically opened up the tunnel a bit to relieve the irritation of the nerve. The pain, burning and numbness never reappeared. I have a small scar that he matched up with my lifeline, you have to really look for it to see it.

RE: The cause of my CTS, I was HVAC/sheet metal guy, imagine using tin snips every day, making rectangular duct and banging it together with a hammer, cutting holes in walls with a sawzall almost daily. I'm a righty but (when I changed careers two decades ago) switched to left hand mouse.
After ten years of that I decided at 30 years old my body would not fair well under those conditions and went to tech school.

Thanks again for your replies.

[Tobra]

Sometimes, the way to heal is with cold steel.

[Rednine11]

I had surgery on both hands years ago. I'm starting to see the symptoms again.

[rick-l]

Don't want to hi jack just a couple quick questions (free medical advice). I spent two weekends (12 hours a day) installing bowed and twisted hardwood flooring with an air nailer (you press the flooring down and then hit it with a hammer). Probably about 6000 nails. The second weekend when I quit Sunday my hands were swollen.

Now two months later I feel occasional numbness in my thumb and index finger and wake at night with pain in my hands, sometimes one sometimes both sometimes severe. Is this carpal tunnel syndrome? Why both hands? Did this cause it? Is this how yours started? Will it get better on its own?

When I run a long distance (> 1 hour) I sometimes feel a numbness in my hands similar to what I feel frequently now. I read this was due to lack of blood flow to extremities. Was this really CTS?

Originally Posted by matt f

Further confirmation would involve wasting of the median N. innervated muscles, primarily,but not limited to the thenar eminence.

This has me worried especially the word wasting. Would this show up if you moved your thumb and it feels like something catches in the meaty part at the base of your thumb?

[J P Stein]

I know several folks (including my wife) who have the surgery done, about half are still bothered by it. I spent 25 ish years working with my hands and was not immune. I never had it "fixed".

My hands/ wrists are shot......& prolly would be regardless.
CT surgery is optional in my book. It is just pain. The only big deal was when it kept me from going to sleep. Pain is Gods way of letting you know you're alive.

I treated sciatica the same way.....Just cut out "optional" sporting activities.
Calcification of my back vertebra took care of that.

I've been cut on for 3 bowel resections and that made me swear off any surgery that wasn't absolutely necessary.

[Noah930]

If you've got the proper symptoms, they're waking you up at night/interfering with your life, you've got the confirmatory nerve test, and you've tried reasonable non-operative managment, then a carpal tunnel release surgery is the next step to take in getting better.

Carpal tunnel syndrome is the median nerve getting pinched at the wrist. The median nerve supplies sensation to the thumb, index finger, middle finger, and half of the ring finger. Probably 80% of people with symptoms have numbness or tingling in that distribution. Maybe 40% have pain (and obviously some have both). Symptoms should be on the palm side of the wrist/hand, not on the dorsum or "back." Often people will say it's worse at night and wakes them up, or they'll feel it while driving, talking on the phone, doing their hair (women), etc.

Non-operative treatment centers around reducing inflammation of flexor tendons and the median nerve at the wrist. Nocturnal splinting, oral anti-inflammatories, behavioral modification, stretching exercises, physical therapy, or a cortisone injection into the wrist area. Some people believe in acupuncture or chiropractic deep tissue massage. I'm not a big believer in laser therapy or pneumatic stretching devices; the only people who seem to tout those are the ones marketing them. The cortisone injection also can serve as a diagnostic test; it's a very directed form of treatment so if you get better (even temporarily) then it confirms that that's what you've got and that you'll likely improve if you go through with surgery.

If you need surgery one day, go with a surgeon you trust, as opposed to finding a technique on the internet or through an airline in flight magazine ad and then picking a doctor based upon that. No matter the technique, in the end the underlying surgery is the same. The surgery takes about 15-30 minutes and is often done without general anesthesia; your arm is numbed and you're given a little sedation to take the edge off of things.

Not that anyone wants elective surgery, but it's one procedure that has about a 98-99% success rate, in my experience. I do about 80 of them per year. It's the most common surgery I do. And the majority of my patient population is a very tough-to-please demographic: the workman's comp patient.

The pain that you have in the middle of the night usually goes away within the first week. The numbness and tingling may take a few weeks to a few months to get better. But overall, if the diagnosis is correct, it's a procedure with a very high success rate. Having it done endoscopically (as opposed to open) can reduce initial return to activity by a few weeks' difference, but if you fast forward a year then all patients are the same regardless of the technique used. My partner had the surgery, and he returned to work (operating) a week later. That may be a bit aggressive, but return to most activity should be possible by about 6 weeks post-op, though you may feel some nagging pain/discomfort (like when pushing out of a chair or off a mattress) for about 8 months post-op. Recurrence is possible but uncommon as the released tunnel scars back together, but with about 20% more cross-sectional space than prior to surgery.

Best of luck.

[Noah930]

One other thing: people on this thread have mentioned avoiding surgery at all costs. If your symptoms are mild and not worsening, that's not unreasonable. But if you have severe carpal tunnel for long enough, permanent nerve damage can occur. So that even with surgery, your hands may never feel normal again. That's not meant to scare anyone, but it's the flip side to waiting. If you're getting atrophy (muscle wasting) of the fleshy muscle in the palm at the base of your thumb (thenar eminence), then you've waited too long.

[scottmandue]

Just an update, I went ahead with the surgery... two weeks later stitches are out and I'm back at work. Still a little sore and trying to touch thumb to pinky is a little painful but use of my hand is about a 85% and getting better every day. The numbness and tingling in my fingertips is gone much to my relief.

As has been said there is a lot of pro/con to this surgery, every human body is different and will react differently plus every surgeon is a fallible human so lots of things can go wrong..

However for me I think the surgery was a good idea, I still have some healing to do before I will be 100% but I think it was a success.

Just to be fair my wife's CP surgery did not go so well (different surgeon) it was a month before she had the mobility I now have and she and to return for a few surgeries to "fix" a few things. She is now mad at me for healing so quickly

[Tobra]

Do what they tell you post op, ice is a good thing

Originally Posted by Noah930

One other thing: people on this thread have mentioned avoiding surgery at all costs. If your symptoms are mild and not worsening, that's not unreasonable. But if you have severe carpal tunnel for long enough, permanent nerve damage can occur. So that even with surgery, your hands may never feel normal again. That's not meant to scare anyone, but it's the flip side to waiting. If you're getting atrophy (muscle wasting) of the fleshy muscle in the palm at the base of your thumb (thenar eminence), then you've waited too long.

This bears repeating

I damaged my ulnar nerve in a car wreck a few years ago. Sporadic numbness, no muscle atrophy/loss of strength=watchful waiting.

Nerves heal almost as poorly as cardiac tissue, which doesn't really heal well at all. Break your ankle, we can screw that baby back together almost as good as new. Badly damage a nerve and you are pretty much screwed. If you are lucky it is just numb.