Post-Surgery Concerns for Carpal Tunnel Syndrome: Pain and Muscle Atrophy

Q: Post-Surgery Concerns for Carpal Tunnel Syndrome: Pain and Muscle Atrophy

Hello： Your condition may indicate that the nerves have not yet recovered. <br>It is recommended that you visit a neurology outpatient clinic for a detailed evaluation. <br>Sincerely, Dr. <br>Ding Hsien-Wei, Neurosurgery.

Carpal Tunnel Syndrome - Postoperative Questions

Dear Dr.
Ding,
Due to my work, I have been using the computer for a long time, which has caused numbness and pain in both of my hands.
It has affected my daily life to the point where I have difficulty even eating.
After undergoing an electromyography (EMG) test, the results indicated a score of over 7, leading to the diagnosis of carpal tunnel syndrome.
I received a corticosteroid injection, which temporarily alleviated the numbness and pain, but the relief lasted only about a month before it became ineffective.
Additionally, I have noticed muscle atrophy in the area beneath my thumbs, resulting in a noticeable indentation, approximately one-third of the muscle mass is gone.

I underwent surgery at the end of November last year, and it has been about 3.5 months since then.
My recovery has been slow; while the numbness has subsided, I still frequently experience unexplained pain that feels like deep soreness, which sometimes lasts for extended periods.
I have been following the doctor's advice and have not engaged in any activities that could harm my hands.

Recently, I have become concerned because I have noticed continued muscle atrophy in the same area.
The remaining two-thirds of the muscle that was previously intact has developed multiple areas of unevenness.
Shouldn't the muscle not continue to atrophy after surgery? I am genuinely worried and would greatly appreciate your clarification on this matter.
Thank you very much!
With infinite gratitude,
Candy
March 12

candy, 30~39 year old female. Ask Date: 2007/03/12

Dr. Ding Xianwei reply Neurosurgery

Hello: Your condition may indicate that the nerves have not yet recovered.
It is recommended that you visit a neurology outpatient clinic for a detailed evaluation.
Sincerely, Dr.
Ding Hsien-Wei, Neurosurgery.

Reply Date: 2007/03/12

More Info

Post-surgery concerns regarding carpal tunnel syndrome (CTS) can be quite complex, especially when symptoms persist or worsen after surgical intervention. Your situation, characterized by ongoing pain, muscle atrophy, and the sensation of "unexplained" pain, raises several important considerations.

Firstly, it is essential to understand that carpal tunnel syndrome is caused by compression of the median nerve as it passes through the wrist. Symptoms typically include numbness, tingling, and pain in the hand and fingers, particularly affecting the thumb, index, middle, and part of the ring finger. The surgical procedure, often a carpal tunnel release, aims to relieve this pressure by cutting the transverse carpal ligament.

In your case, while the initial steroid injections provided temporary relief, the recurrence of symptoms and the development of muscle atrophy are concerning. Muscle atrophy in the thenar eminence (the fleshy part of the palm near the thumb) indicates that the median nerve may have been compromised for an extended period before surgery, leading to muscle weakness and wasting. This can happen if the nerve has been compressed for a long time, resulting in irreversible damage to the muscle fibers.

Post-operative pain that is described as "unexplained" or "aching" can be attributed to several factors. One possibility is that the nerve may still be recovering from the compression it experienced prior to surgery. Nerve healing can be a slow process, and while some patients experience immediate relief, others may take several months to notice significant improvement. The timeline for nerve recovery can vary widely, and it is not uncommon for patients to experience pain or discomfort during this period.

Another factor to consider is the possibility of scar tissue formation. After surgery, scar tissue can develop around the surgical site, which may lead to additional pressure on the median nerve or surrounding structures, potentially causing pain or discomfort. This is often referred to as "post-surgical pain syndrome" and can be managed through physical therapy, stretching exercises, and sometimes additional interventions.

Regarding your concern about continued muscle atrophy, it is crucial to engage in rehabilitation exercises as recommended by your healthcare provider. Physical therapy can help strengthen the affected muscles and improve function. If muscle atrophy persists despite rehabilitation efforts, further evaluation may be necessary to rule out other underlying conditions, such as complex regional pain syndrome (CRPS) or other neuropathies.

In summary, while some post-operative pain and muscle atrophy can be expected after carpal tunnel surgery, persistent symptoms warrant further investigation. It is advisable to follow up with your surgeon or a specialist in hand therapy to assess your recovery and explore additional treatment options. They may recommend imaging studies or nerve conduction studies to evaluate the status of the median nerve and surrounding structures. Additionally, a tailored rehabilitation program focusing on strengthening and range of motion can be beneficial.

Lastly, maintaining open communication with your healthcare team is vital. If you feel that your concerns are not being adequately addressed, seeking a second opinion from a hand specialist or a neurologist may provide further insights into your condition and recovery process. Your well-being is paramount, and proactive management of your symptoms is essential for a successful recovery.

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