Post-Surgery Numbness in Hand: Causes and Solutions Explained

Q: Post-Surgery Numbness in Hand: Causes and Solutions Explained

Hello, Miss： Your symptoms may suggest compression of the median nerve in your right hand. <br>The median nerve passes through the wrist, traversing the "carpal tunnel" formed by the carpal bones and ligaments, and is subjected to pressure from the ligament located above the nerv

Numbness in the hand after removal of wrist internal fixation plate?

Hello Doctor: At the end of March, I dislocated my right wrist due to a fall.
The doctor initially said surgery wasn't necessary, but since I arrived too late and the dislocation was significant, I underwent surgery to place a steel plate and had a long steel screw inserted through the skin to stabilize the radius and ulna.
A month later, I had the screw removed in the outpatient clinic, but after another half month, I started experiencing numbness in my thumb, index finger, and middle finger.
After two months of numbness, I returned to the hospital, and the doctor suggested that the steel plate might be compressing a nerve.
I asked if removing it would resolve the issue, and the doctor said yes, but the plate could only be removed after a year.
I was concerned that a year of nerve compression might cause permanent damage, so I sought a second opinion.
The second doctor said the plate could be removed, but there was also a possibility that scar tissue inside was compressing the nerve.
After removing the plate, my hand only had slight numbness, but after 15 days, the numbness worsened again.
However, as long as I keep moving my hand, the numbness improves.

I have a few questions for you:
1.
Did I really need the steel plate from the beginning, since it was a dislocation and not a fracture? Would just the screw have sufficed?
2.
Is the numbness I experienced after the plate was removed due to scar tissue compressing the nerve? If so, I read online about using dextrose injections.
Is this covered by health insurance? Is it considered an outpatient procedure? Are there other methods to address this?
3.
If I wait for the scar tissue to soften, will the numbness resolve? However, if I wait too long, could the nerve sustain damage from prolonged compression?
4.
Should I see an orthopedic doctor for the numbness, or a neurosurgeon (or neurologist)?
Thank you, Doctor.
I appreciate your help.

Zhang S, 50~59 year old female. Ask Date: 2021/07/25

Dr. Jiang Junyi reply Neurology

Hello, Miss: Your symptoms may suggest compression of the median nerve in your right hand.
The median nerve passes through the wrist, traversing the "carpal tunnel" formed by the carpal bones and ligaments, and is subjected to pressure from the ligament located above the nerve, leading to clinical symptoms.
The median nerve is responsible for the movement of the thumb and provides sensation to the thumb, index finger, middle finger, and part of the ring finger.
The best method to diagnose carpal tunnel syndrome is through examination.
Nerve conduction studies involve using very small electrical currents to stimulate the median nerve to assess its response and the extent of any injury.
Based on your described symptoms, it appears to be mild compression, with intermittent symptoms and no muscle atrophy...
Mild carpal tunnel syndrome can be managed conservatively, with treatment options including avoiding excessive wrist movements, taking anti-inflammatory medications, and wearing a wrist brace.
Using a wrist brace can help reduce excessive wrist movements and should be worn continuously for 2-4 weeks.
For severe carpal tunnel syndrome or patients who do not respond well to conservative treatment, surgical intervention may be considered to release the ligament in the carpal tunnel to alleviate pressure on the median nerve.
I recommend consulting a neurologist for nerve conduction studies and a rehabilitation physician for muscle and nerve ultrasound and rehabilitation therapy.
Please ensure to practice self-protection, maintain cleanliness and disinfection, and adhere to new preventive measures before and after your medical visits.
Wishing you good health, safety, and happiness.
Dr.
Jiang Junyi, Neurology, Taoyuan Hospital, cares about you.

Reply Date: 2021/07/25

More Info

Post-surgery numbness in the hand can be a concerning issue, especially after a significant injury and surgical intervention like the one you've described. Let's break down your questions and concerns regarding your situation.

1. Need for the Steel Plate: In cases of wrist dislocation, surgical intervention is often necessary to realign the bones and stabilize the joint. While it may seem that a steel plate was not needed, the decision to use one is typically based on the degree of displacement and the surgeon's assessment of the stability required for proper healing. If the displacement was significant enough, a plate and screws may have been deemed essential to ensure that the bones heal correctly and maintain their alignment. The use of a steel plate is common in orthopedic surgeries to provide stability, especially when there is a risk of the bones shifting during the healing process.

2. Numbness After Plate Removal: The recurrence of numbness after the removal of the steel plate could indeed be due to scar tissue formation, which can compress nearby nerves. This is a common complication after surgery, especially in areas where there has been significant trauma and surgical intervention. The injection of glucose or other substances to help alleviate nerve compression is sometimes used, but it is essential to consult with a healthcare provider to determine the best course of action. This type of treatment may not be covered by insurance, depending on the specifics of your health plan and the nature of the procedure.

3. Waiting for Scar Tissue to Soften: Scar tissue can take time to mature and soften, and in some cases, this may alleviate symptoms of numbness. However, prolonged compression of nerves can lead to permanent damage, so it is crucial to monitor your symptoms closely. If numbness persists or worsens, it is advisable to seek further evaluation. Physical therapy may also be beneficial in promoting movement and reducing symptoms by improving circulation and nerve function.

4. Which Specialist to Consult: Given your symptoms, it would be appropriate to consult both an orthopedic surgeon and a neurologist. An orthopedic surgeon can assess the structural integrity of your wrist and determine if there are any mechanical issues contributing to your symptoms. A neurologist can evaluate the nerve function and determine if there is any nerve damage or compression that needs to be addressed.

In summary, your situation is not uncommon after wrist surgery, and the numbness you are experiencing could be due to a combination of factors, including nerve compression from scar tissue and the surgical hardware itself. It is essential to maintain open communication with your healthcare providers, follow their recommendations for rehabilitation, and report any changes in your symptoms. Early intervention can often lead to better outcomes, so do not hesitate to seek further evaluation if your symptoms persist.

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