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Carpal
tunnel surgery complications? |
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I
was diagnosed with bilateral carpal tunnel and "trigger
thumb" and had surgery on right hand for the CT and TThumb
on 1/3/01. I thought I would wait a few weeks and then
have the carpal tunnel surgery on the left hand with the
hopes I would be as good as new. However, I am in worse
shape now than I was before I had the surgery on my right
hand, and I don't dare have the other surgery because
I am afraid it will turn out like this one. I am in more
pain now than I was before I had the surgery. The pain
is mostly in the wrist are and radiates up the arm almost
to the elbow. My thumb is practically useless as I have
very limited movement and cannot open doors, jars, or
write. I could do all these things before the surgery.
I have less strength in my hand than before. I have to
change the gear shift in my car with my left hand and
it is painful holding onto the steering wheel. I can barely
hold my coffee cup. The pain is so bad at night that it
wakes me up and I could cry. Needless to say, I am very
depressed over my condition. I am going back to my surgeon
this week and would like some advice on any tests I might
request to see what is wrong. I have also developed a
lump at the base of my thumb at the wrist area and a larger
area on my arm right above the wrist. I talked with other
people who have had this surgery and no one has had the
problems I am having. So you can see why I can't risk
having the CT surgery on the left hand at this time. Has
anybody ever heard of anything like this before? |
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Answer |
I can really
understand and share with you the pain. It is not however,
clear to me the exact cause. But the surgeon who did the
operation should be able to tell you more about it. Perhaps
repeat EMG to assess the position of the median nerve
post operative would help. I hope you get better soon.
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Possible
double crush to ulnar nerve |
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Two
years ago this May 17th 2001. I was rear ended by a drunk
driver to make a long story short I have had a long recovery
and am still going threw treatment, My question: After
the accident and to date I've had neck pain and numbness
in my little and ring fingers. I had very severe pain
in my neck so bad that just riding in a car was like having
no shocks, feeling jolts to my neck even gravel seamed
like boulders, and I would get pains in my collar bone
as if it was broken. I went in and had Ulnar nerve surgery
to help the numbness in my arm and fingers and in this
area has helped, the perplexing thing is as I awoke in
the recovery room I noticed a great improvement in my
neck pain? and the pain in my collar bone has not returned,
this is all on my left side. I have been told that the
Ulnar nerve should not effect the neck in this way, but,
I know the relief I have gotten to the neck area since!
I still have damage at the C6,7, and T1 nerve areas. that
I am going threw injections for at present but since the
operation have been able to drive fairly well though turning
of my neck becomes more painful the longer I do. A friend
of mine who has some knowledge in this area has suggested
a "double pinch" of the ulnar nerve that she had heard
of? But I've been unable to find any information in this
area of question. Are there any answers? There must be?
Is there any information I can be directed to? I thank
you sincerely for any help in this area. |
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Answer |
The
Double-Crush syndrome is well known and has been described
by Upton and McComas in their landmark paper in 1973
TITLE: The double crush in nerve entrapment syndromes.
AUTHORS: Upton AR, McComas AJ
SOURCE: Lancet. 1973 Aug 18;2(7825):359-62
The basic premise is that when a nerve is injured proximally
(or in this case close to the neck), it makes it more
susceptible to injury distally (away from the neck).
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What
exactly happens to give pins and needles sensation? |
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When
you experience the sensation of "pins and needles" what
exactly is taking place? Is it a result of the healing
process of the nerve or is it a result of damage to the
nerve. I know when your foot is "asleep", the pins and
needles come after the numbness but before normalcy, as
your foot recovers......so I am wondering if the sensation
might indicate a reactivation of proper nerve impulses?
I'm experiencing pins and needles in association with
lyme disease and am wondering if this could be the reawakening
of my damaged nerves and thus a good thing.....or does
it result as my nerves are damaged, and thus a bad thing?
Thanks. Ruth. |
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Answer |
This
is quite interesting question. Any or all of the sensory
symptoms (pins and needles) and signs are considered diagnostic
for a dysfunctional sensory nervous system or point that
some thing going on with sensory nervous system. It could
either occur at start or later in the process of nerve
affection. Although pins and needles may get less with
recovery. But does not basically or necessarily be a bad
sign.
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Time
lag before detection of positive sharp waves |
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In
your quite lucid explanation you make mention that fibrillations
cannot be picked up until about 2 months after injury.
I was wondering how long a lag exists till the EMG can
pick up positive sharp waves. Also, I've seen differing
opinions as to whether patients can actually feel the
fibrillations and the waves themselves. What is your opinion
on this? Thanks very much. |
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Answer |
Fibs
and positive waves are seen at about the same time. In
fact it's been argued that fibs are positive waves, which
are seen from a different vantage point by the needle.
People cannot feel either fibs or positive waves, what
you are referring to is fasciculations, which are much
larger contractions of muscle, and which patients can
usually feel.
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I
have Left elbow pain. Is it necessary to have EMG? |
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Do
I really need this test? I have been treating what the
doc thought was tennis elbow. But the cortisone shot I
had didn't help that much. So he wants an EMG. I don't
want it if it is not necessary! I have always had left
neck and upper arm pain (I have Fibromyalgia and injuries
from years ago) The main pain is in the elbow area and
runs down the arm...It is different form my usual pain.
Hurts to use the arm and hand...gripping and pulling mainly!
Any advice out there? Sometimes the hand gets cold and
tingles and turns bluish too. I still think it is a joint
problem. |
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Answer |
You
are right. It sounds like a joint problem. However, only
tingling suggests nerve problem. Therefore, EMG may be
of help.
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Comment |
Thanks
for the quick response. I am concerned that with the Fibro
pain I already have that the test will make my pain worse
so if I don't need it I don't want it. The arm is also
sensitive to touch. Like skin surface pain...all this
seems to lesson when I don't use it. That tells me it
is a joint problem but the doc said since the marcaine
took the pain away for 3 hours it could be nerve pain???????????
Any input here? It is set up for next Tuesday in the doctor’s
office. (A neurologist) Wouldn't the marcaine take any
pain away???????? |
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Answer |
Marcaine
should work as local or regional anesthesia and analgesia
for pain of any kind, as you said. However, The EMG study
should not worsen your pain, although it does cause little
pain by itself, which is quite tolerable. EMG is a diagnostic
test only.
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Rate
of false negative and false positive results of electrodiagnosis
in CTS |
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What
is the percentage of negative results on a positive finding?
Also, what is the percentage of a positive result of a
negative finding? I've gone through 5 nerve conduction
tests previously, and finally was diagnosed with carpel
tunnel. The neurologists said it was because of my small
boned structure that gave a negative result when it was
actually positive. When I received the tunnel releases,
it was very tight and surgeon was surprised that it didn't
show up earlier. I now have possible ulnar nerve problems,
but again my conduction test shows negative. Please give
me some information as why this happens. |
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Answer |
The pick
up of carpal tunnel or ulnar neuropathies by nerve conductions
is fairly easy so the false negatives there are very low.
For pinched nerves however (root lesions) the number of
false negatives is higher, sometimes up to 30 or 40%.
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Ulnar
nerve entrapment |
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One
month ago I had an EMG on my left arm. The results indicated
an ulnar nerve entrapment, and recommended elbow surgery.
I had continual pain in my arm and hand before the EMG.
The pain greatly increased immediately after the test,
and has persisted continuously to date. I understand this
is not normal. What could be the cause? Has anyone had
a similar experience? |
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Answer |
The nerve
stimulation itself does not cause any lasting damage and
usually the pain and discomfort resolve within 24 hours.
In some instances however, nerve irritation during the
test can cause an inflammation around it, especially if
the nerve is already irritated because of the damage to
it. In those instances, anti-inflammatory such as Aspirin
or Motrin might help by reducing the inflammation. If
they don't something else is going in and it is best to
seek a consultation for that.
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Comment
from another
Patient |
I
would suggest caution on this one. I had numbness/tingling
symptoms and a specialist (with good recommendations)
diagnosed Ulnar Nerve problems. I had a release &
transposition on one elbow and a year or so later on the
second. It turns out that more than likely the source
of the problem was c4-5-6 problems, not the nerve. I did
have an EMG to rule out the neck but my guess is the results
were inconclusive or false. This syndrome (from my research)
is not that common. Feel free to mail me for more specifics
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EMG
in CTS and double crush syndrome |
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Hi,
I have had an EMG results show carpal tunnel. I also have
cervical radiculopathy from disc bulge and spurs impinging
on nerve at C5-6 and C6-7.My neurologist does not believe
in the "double crush" theory and states that even if he
did, I did not have impingement of the C7 nerve. He obviously
did not even look at my MRI report, which clearly states
this. He also said that because he tested my median nerve
at the wrist and it showed compression this proved only
Ct. This is not my understanding of the process. My question
is; if it were indeed double crush would the testing of
the wrist median nerve still show entrapment? Thank you
very much |
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Answer
1 |
I
would say that neurologists are evenly split on the existence
(or lack thereof) of the double-crush syndrome. Let me
quickly explain it. The double-crush theory says that
if your nerve is compromised proximally (up high near
the neck) it is more likely than not to be also damaged
distally (below near the hand), meaning that the existence
of a proximal lesion makes the nerve more susceptible
to damage distally. So in answer to your question, if
you are a double-crush believer, the testing of the median
nerve at the wrist will show entrapment.
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Answer
2 |
The
concept of double crush syndrome is known for many years.
I think from seventies. It means, there are 2 lesions
along one nerve course, i.e. patients with one peripheral
nerve lesion did in fact have a second lesion elsewhere
and they implied that both lesions were contributing to
the symptoms or on another way, somewhat include symptoms
which result from a combination of two separate, local
lesions at different anatomical sites in the same nerve,
whether or not one actually contributes to the causation
of the other. Practically, a patient may have carpal tunnel
syndrome (distal) and another lesion (proximal) of plexus/root
in addition. So, yes, EMG could show a carpal tunnel syndrome
(to answer your question), which is fairly easy to diagnose
by such method. |
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CTS and EMG questions
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I
recently had and EMG done and was referred to an orthopedic
surgeon for surgery on both wrists. While having both
parts of the EMG done, the doctor tried to explain what
he was seeing to me. I guess what I am not clear about
is how bad this is. I mean, I know it's bad because he
insists on surgery and the pain; numbness and burning
are more than I can handle... He mentioned that when he
did the shock down by my wrist that it was a " 2 " and
a " 6 " up by my elbow on my right arm. And " 1 " and
" 8 " on my left arm. What does this all mean? Can you
refer me to any pages to help me understand this more?
What are bad results?? Semi bad??? What can you get by
on without having surgery? |
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Answer |
Me
too, I am not familiar with these numbers, perhaps further
information would help. Generally, a "bad" CTS
depends on the clinical picture and EMG findings. However,
the presence of muscle wasting and/or abnormal EMG spontaneous
discharges are bad signs. It is important to follow the
advice of the surgeon, as without surgery the symptoms
would persist. The wasting or atrophy will develop, if
it is not yet happened. At advanced stage the surgery
would not actually help to recover the nerve, but it would
anyway save what is left. |
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