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DEAR MAYO CLINIC: Three months ago, I had surgery on my left wrist to treat carpal tunnel syndrome. Since then, I am in much more pain than before surgery, and two of my fingers are completely numb. I cannot even button a button, and tying my shoes is a chore. What would cause the pain to worsen after surgery? Could another surgery remedy the problem, or is this my new normal?
ANSWER: Your condition as it stands now shouldn’t be considered a new normal. It’s possible your symptoms are part of the recovery from surgery, and they may improve with time. It would be a good idea, however, to meet with your surgeon now, so he or she can reassess your condition and decide if you need additional tests or treatment.
Carpal tunnel syndrome is caused by compression of the median nerve within the carpal tunnel — a narrow passageway on the palm side of your wrist. The median nerve runs from your forearm through the carpal tunnel and into your hand. It controls the sensations you feel on the palm side of your thumb and fingers, except the little finger. Carpal tunnel syndrome often causes numbness and tingling in the hand and arm. Surgery to treat it involves relieving pressure on the median nerve by cutting the ligament that crosses over it.
Research shows that symptoms improve for more than 90% of patients following carpal tunnel surgery. However, the number who experience complete relief of symptoms after surgery may be only 50%. Patients whose symptoms are severe before surgery show the most improvement afterward, but this group also tends to have the most residual symptoms after the procedure.
At three months following carpal tunnel surgery, your numbness and pain still could be byproducts of the procedure. Many people find the incision causes pain and irritation as it heals. In addition, a condition called ‘pillar pain,’ which is a localized reaction to the surgery, can lead to discomfort. Both generally improve over several months.
Working with a hand therapist can be particularly useful during this uncomfortable period of recovery. The therapist can follow your progress by measuring the strength and sensation in your fingers, hand and arm, as well as provide advice about how to make your hand and arm more comfortable.
It’s helpful to note, too, that nerves typically improve after surgery at a rate of about 1 inch per month. When sensation returns, it happens gradually. In general, full recovery after carpal tunnel syndrome may take up to a year.
Whether your pain and numbness are part of the healing process or whether they signal the need for more intervention depends somewhat on how your current symptoms compare to the symptoms you had before surgery. For example, you mention that two of your fingers are completely numb. If the numbness is significantly worse than it was before surgery, or if it’s affecting different parts of your hand, then closer assessment is appropriate at this time.
It is a possibility that another problem is playing a role here. Various diseases, such as inflammatory arthritis, can first appear as carpal tunnel syndrome before it becomes evident that another process actually is triggering the condition. An ultrasound may reveal a new or additional diagnosis at the wrist. The scan also can help your surgeon determine if decompression of the median nerve is complete. If not, then another procedure may be useful.
In some cases, numbness following carpal tunnel surgery happens due to a problem farther up the arm, or in the shoulder, neck or brain. If your surgeon suspects that could be the case for you, you may be referred to another specialist, such as a neurologist, for further assessment. — Dr. Mary Jurisson, Physical Medicine and Rehabilitation, and Dr. Nicholas Pulos, Orthopedic Surgery — both of Mayo Clinic, Rochester, Minnesota