Post-Surgery Nerve Issues After a Colles' Fracture

After fracture surgery

Dear Director Chen,
My mother underwent surgery for a right wrist fracture on February 7 (diagnosis: Colles' fracture of the right radius, initial encounter for closed fracture, open reduction for fracture of radius, ul).
After being discharged on February 12, she has experienced persistent numbness in her right hand.
Initially, we thought it might be due to the surgical wound not healing yet, but now, one and a half months later, the numbness has become more pronounced, particularly in the thumb, index finger, and middle finger (with the middle finger being the most affected, feeling very stiff).
On March 9, she returned for a follow-up and underwent an electromyography (EMG) test.
The report is as follows: The mixed nerve conduction velocity (NCV) study of the right median nerve showed no response.
The NCV study of other nerves showed normal responses.
The F wave analysis of the upper limbs showed normal responses.
Conclusion: Right median nerve lesion at the wrist, severe degree.
Does this report indicate symptoms consistent with carpal tunnel syndrome? However, prior to the surgery, her symptoms were not as severe.
Why has the numbness worsened significantly after the fracture surgery, and why does it seem that the sensory nerve is severely damaged? Could it be that during the surgery, the nerve was affected, or that the plates or screws are compressing the nerve, or could it be due to inflammation at the surgical site preventing the nerve from healing?
Would you recommend another surgery (if so, which specialty should we consult), or is it unnecessary? If surgery is performed, will it affect the current wound, or should we wait for the wound to heal a bit more to see if the numbness gradually resolves?
Thank you!

iris, 30~39 year old female. Ask Date: 2016/03/18

Dr. Chen Yongxue reply Orthopedics

Hello, the median nerve is often injured due to swelling, which can cause numbness and pain.
In severe cases, it may lead to muscle atrophy.
Based on your description, it is indeed carpal tunnel syndrome.
If the symptoms do not improve, you may consider decompression surgery as a treatment option.
Thank you.

Reply Date: 2016/03/18

More Info

After a Colles' fracture surgery, it is not uncommon for patients to experience nerve-related issues, particularly if the median nerve is involved. In your mother's case, the symptoms of numbness and tingling in the thumb, index, and middle fingers, along with the results from the electromyography (EMG) indicating a severe lesion of the right median nerve at the wrist, suggest that she may indeed be experiencing carpal tunnel syndrome (CTS) as a complication of her surgery.

Carpal tunnel syndrome occurs when the median nerve, which runs through the wrist, becomes compressed. This can happen for several reasons, particularly after a fracture and subsequent surgical intervention. Here are some potential factors that could contribute to the severity of her symptoms post-surgery:
1. Surgical Trauma: During the surgical procedure, there is a possibility that the median nerve was inadvertently injured or compressed by the surgical instruments, plates, or screws used to stabilize the fracture. This could lead to immediate or delayed nerve dysfunction.

2. Swelling and Inflammation: Post-operative swelling is common and can contribute to increased pressure within the carpal tunnel, exacerbating symptoms of nerve compression. If the swelling persists, it may prolong the recovery of nerve function.

3. Scar Tissue Formation: After surgery, scar tissue can form around the surgical site, which may lead to additional pressure on the median nerve. This can result in ongoing symptoms even after the initial healing period.

4. Pre-existing Conditions: If your mother had any pre-existing conditions that could affect nerve health, such as diabetes or thyroid issues, these could also contribute to the severity of her symptoms.

Given the findings from the EMG and the ongoing symptoms, it is crucial to address these issues promptly. Here are some recommendations:
- Consult a Specialist: It would be advisable to consult with a hand surgeon or an orthopedic surgeon who specializes in nerve injuries. They can evaluate the need for further intervention, such as a surgical release of the median nerve if carpal tunnel syndrome is confirmed.

- Physical Therapy: Engaging in physical therapy may help improve mobility and reduce symptoms. A therapist can provide exercises that promote nerve gliding and reduce compression.

- Monitoring Symptoms: If the symptoms are severe and affecting her quality of life, it may be necessary to consider surgical options sooner rather than later. Waiting too long could lead to permanent nerve damage.

- Pain Management: In the meantime, managing pain and discomfort with medications prescribed by her physician can help improve her overall comfort level.

- Follow-Up EMG: A follow-up EMG may be warranted to assess any changes in nerve function over time, especially if symptoms persist or worsen.

In conclusion, while it is possible that the symptoms may improve as the surgical site heals, the severity of the median nerve lesion indicated by the EMG suggests that further evaluation and possibly intervention may be necessary. It is essential to act promptly to prevent any long-term complications associated with nerve damage.

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