carpel tunnel surgery

[Joe biebel]

I have had noticibly increasing problems (numbness, loss of feeling) in both hands but mostly my left (fencing) hand. It's been getting steadily worse for several years and the specialists I saw all indicated that left untreated (surgically) permanent damage would probably happen to the nerves. Tests show a marked decrease in nerve function and I am scheduled for surgery.

I am fortunate to have a very well regarded surgeon working on me, but I have a lot of trepidation (fear) since I know several people that have had less than wonderful outcomes. Granted their surgeries were some time ago and I've been told that procedures and outcomes have improved over time.

I'm hoping some of you might have had an experience, preferably "good" to share about the procedure.

[jeff]

I asked my wife the surgeon - so this isn't in the way of personal experience but general guidelines for expectation: you shouldn't expect to have the same hand you had at age of 25, but you can have reasonable expectation of decreased pain and other symptoms, and of the progressive worsening that you are experiencing. Carpal tunnel procedures are widely done now, and (as it sounds you've done) you want to make sure you have a board certified orthopedic surgeon who specializes in hand procedures.

[introspective]

Jeff, I've heard that sometimes the surgery isn't that great. I would be very very careful especially if you're a fencer!

[DonnaP]

I am a certified hand therapist and have been working with Hand Surgeons and treating hand diagnoses for 20+ years. First of all, if you have carpal tunnel and don't have it treated you can absolutely have permanent nerve damage of the median nerve which controls not only the sensation to the thumb, index, middle and half of the ring finger, but also muscle function in these areas.

Now there are three primary types of surgeries for carpal tunnel release. There is the open release which involves an incision along the palm of your hand about an inch long. This is the most common - the surgeons who prefer this technique usually state better visual access to the ligament which is being cut. The down side is a typically longer recovery due to scar pain and sensitivity in the palm of your hand - which touches everything when you are using your hand. The second surgery is a "mini" open. A smaller incision, but still over the palm of the hand and still has the same post-operative issues of scar tenderness. The third is the endoscopic release. The surgeon uses a scope lower on the wrist to enter the hand - a small half inch incision where the crease on your wrist is. The immediate recovery time is very fast - many times within days. Fencing will probably be a little longer due to the pressure in the palm area by the grip, but there is no comparing the immediate recovery rates. There are many surgeons who will denounce the scope surgery (it takes specialized training and specialized equipment to do this) saying that it doesn't fully release the ligament etc. I have seen literally thousands of carpal tunnel releases in my career and would professionally recommend the endoscopic - but only by a surgeon who is skilled in the technique. The research will show that any of the above techniques will have the same eventual outcome of functional improvement, however I have found that the endoscopic will get you there much faster.

A few things you should be sure of.... First, that your doctor is sure of the diagnosis. One of the reasons carpal tunnel surgeries "fail" is that the nerve may be impinged in other places further up your arm even in your neck which means that the surgery at your wrist isn't going to work. Another reason for "failure" is co-existing diagnoses such as diabetes or thyroid disorders which can limit the overall outcome. Scar pain is often a limiting factor in overall recover and patients who wait until there is permanent nerve damage may never have full recovery and the nerves may never heal or return to normal.

My final advice is to find a surgeon who has advanced qualifications in Hand Surgery. Surgeons (mostly orthopedic, some plastic and some neuro) can actually pursue advanced specialties in hand surgery. You wouldn't want a general surgeon doing your heart bypass, neither should you have a general orthopedic surgeon who does a knee in the morning, a shoulder at noon do your hand after lunch. Go to the surgeon who has done 500 carpal tunnel releases. Go to The American Society for Surgery of the Hand at www.assh.org There is a nice description of carpal tunnel syndrome on the home page as well as a link to finding certified hand surgeons.

Good Luck.

[Joe biebel]

DonnaP,
Thanks so much for your informative post. I had worried that I did not perhaps do all of the things I should have, to make sure that I needed the surgery and that I was in the best hands and was having the best possible procedure done. It was very nice to have a "check off" list and the information you provided has served to improve my confidence that all is as it should be.

Physician qualifications, procedure, testing/diagnoses. I'm pretty sure it will be as good a result as possible. While I am a fencer, it is not the only reason for the surgery. If I can make a really good recovery, I will of course continue to fence. The main thing is that I have good use of my dominant hand for the rest of my life. The carpal tunnel in my case is not so much pain related as for the scary symptoms of tingling, loss of sensation and weakness. Even now, after taking it easy for several months, the symptoms do not abate, so ignoring it will probably only cause additional irreversible nerve damage.

[MyrddinsPrecint]

Both my father and older sister had to have theirs done about 10 years ago. They had both tried a number of other treatments before that that hadn't worked, and they were both very anxious about surgury.

After, they were both very glad that they had done it, and were very happy with the results.

[fatfencer]

Joe,

There's this great stuff called KWAN LOONG OIL. When you feel this pain, go to your local Chinese store and buy like 10 or 15 bottles of this stuff. Dump it into a gallon kimchee jar and dunk your hand in it.

Helps my carpal tunnel immensely. I've never bothered to get diagnosed as such, but I'm pretty sure I have it or RSI or something like it from fencing/mousing.

This won't cure your problem, but it has a topical salicylic in it as well as menthol, camphor, etc. It's the best stuff out there. It's powerful enough on your hands where Ben Gay isn't.

Keep it in there as long as you can stand it. Oh, and before you immerse, immerse your hand in hot water to open the pores.

This is a great remedy; its also used as Stage One of several stages of hand immersions in arts like Seven Star Preying Mantis and Snake Styles. Both very tough on the hands, this liniment is the foundation of what we use to keep the hands supple.

I do this every night after fencing.

Fatfencer

PS: Good luck with your surgery.

[Joe biebel]

Fatfencer, thanks for your suggestion. This would be good and useful advice if pain were the only issue. My real concern is nerve death. If I keep ignoring the ever-worsening symptoms, tingling loss of sensation, pain, the nerve associated with carpal tunnel will wither and die. There is no going back from that. I have been able to relieve the symptoms, which has enabled me to continue fencing (at a lower level) but at the possible cost of permanent nerve damage.

I'm sure that your remedy would have the stated effect, unfortunately, I think this could be really harmfull, in the long run, to the medial nerve. Perhaps this remedy, after surgical recovery your suggestion might be most useful. Unless someone's Carpal tunnel is caused by a temporary condition such as swelling from injury or water retention or overuse, it will not get better. The available space in the "tunnel" for the medial nerve does not get bigger over time without surgical intervention.

[Peach]

Joe--hope you get a good surgeon. The procedures I've had over the last few years (tooth implant, lumpectomy, cataract surgery) (the second cataract surgery was last Tuesday) have all been very successful because I insisted on finding the best possible people who are on top of the latest developments. Many of my fencing friends are medical people and can be good sources of referrals.

Irrelevant note for others reading the thread: As Donna says, tingling in the hands can be caused by impingement elsewhere further up the arm. I've had the syndrome for 25 years--tingling and loss of sensation (but little pain) in the ring and little finger (possibly ulnar nerve, possibly a nerve in the shoulder). It hasn't gotten worse and it hasn't gone away. I've learned some habits and postures which alleviate the problem. I had carpal tunnel syndrome for a while following the birth of my daughter, probably just from general fluid retention, but that did go away eventually.

[Monash_Armourer]

Originally Posted by Peach

Irrelevant note for others reading the thread: As Donna says, tingling in the hands can be caused by impingement elsewhere further up the arm. I've had the syndrome for 25 years--tingling and loss of sensation (but little pain) in the ring and little finger (possibly ulnar nerve, possibly a nerve in the shoulder). It hasn't gotten worse and it hasn't gone away. I've learned some habits and postures which alleviate the problem. I had carpal tunnel syndrome for a while following the birth of my daughter, probably just from general fluid retention, but that did go away eventually.

I know this sounds odd, but what position do you sleep in? Do you sleep on your side or your back?

Reason is I managed to serisously pinch a nerve while sleeping in my left shoulder, because I was sleeping on my arm. Initially I had extreme pain all up my left arm, which subsided to tingling and loss of pressure and pain senesation in blade section, little finger and half the ringer finger in my hand. A year on it still does not feel right. When I was sent of for nerve conduction tests to check for permanent damaged, I was told this was actually alot more common than I would have hotught. A year later it still does not feel right, though am a lot more conscious of what postures I have while asleep (I don't move around in my sleep, I stay in the position I fall asleep in).

Incidentally that was actually about 2 months before I injured the same elbow, for which I had surgery on it to remove some bone fragments about 3 weeks ago. You're right when you recommened asking around about surgeons. I was recommended the surgeon by my physio who had his elbow reconstructed by the surgeon after shattering it in a rather nasty fall. Even this early I could not be happier with the results.

[Joe biebel]

Peach,
Thanks, I'm very lucky in the area of knowing "who's who" in the medical fields, locally. My wife is a RN that has served as "Head Nurse" in the emrgency room, and cardiac cath lab at a large local hospital. Her knowledge and her friends knowledge of various physicians and specialists is great. We've been fortunate in being able to find the "best and brightest" for our medical needs.

Once we decided on a specialist to see, we did the proper testing for nerve function to "map" and isolate the problem. It is clear that the main culprit is Carpal tunnel and not a neck injury as I had feared. Confidence is high that the symptoms and danger to the affected nerve will abate with the surgery.

[fencerbill]

Good luck Joe.

I still remember the finals at Limoges.

[Peach]

Originally Posted by Monash_Armourer

I know this sounds odd, but what position do you sleep in? Do you sleep on your side or your back?

There is some connection, but really not enough to change my habits--Sleeping on my side only sometimes produces the effect, and I suspect arm position and swelling from hormone fluctuations or exercise is more important than pressure on the shoulder, elbow, or wrist.

Driving is the worst offender. I'm always switching my hand position.

Now that I'm thinking about it (it's so much part of my life that I barely notice it any more), I don't have it as badly as I used to, probably because I don't have monthly spikes in my fluid retention any more.

[fatfencer]

Originally Posted by Joe biebel

Fatfencer, thanks for your suggestion. This would be good and useful advice if pain were the only issue. My real concern is nerve death. If I keep ignoring the ever-worsening symptoms, tingling loss of sensation, pain, the nerve associated with carpal tunnel will wither and die. There is no going back from that. I have been able to relieve the symptoms, which has enabled me to continue fencing (at a lower level) but at the possible cost of permanent nerve damage.

I'm sure that your remedy would have the stated effect, unfortunately, I think this could be really harmfull, in the long run, to the medial nerve. Perhaps this remedy, after surgical recovery your suggestion might be most useful. Unless someone's Carpal tunnel is caused by a temporary condition such as swelling from injury or water retention or overuse, it will not get better. The available space in the "tunnel" for the medial nerve does not get bigger over time without surgical intervention.

I doubt it would do anything more than alleviate pain. It's been used in one form or another since the dawn of Chinese MA. To be clear though, it is NOT a substitute for seiing a surgeon. Please SEE a surgeon. Get it over with; medical science has come lightyears in re carpal tunnel so it's probably not much more than outpatient suregery, healign time and therapy... during which time you can try the immersion method. It feels SOOOO good.

Be well, heal quick, fence soon...

Fatfencer

[Peach]

Originally Posted by Peach

I had carpal tunnel syndrome for a while following the birth of my daughter, probably just from general fluid retention, but that did go away eventually.

Hmmm . . . I take that back. I now find I apparently just don't notice it any more. I'm sitting here right now with numbness in the tips of my thumb, index, middle, and ring (inside) fingers.

[DonnaP]

Hey Peach!

You're probably right in that the tingling in the ring and small finger is likely relative to the ulnar nerve - in which case if the nerve is being stretched at the elbow it would be Cubital Tunnel Syndrome. (Very different from Carpal Tunnel for anyone reading this). IF that's the case, the positions of the elbow are what usually make this feel worse or better. The cubital tunnel is the soft groove on the inside of your elbow where the nerve travels. Severe positions of bending (like when people curl their arms in when sleeping, holding a phone to your ear for a long time, holding a hair dryer, leaning on the elbow like at a desk in front of a computer, etc.) are what will often aggrivate the symptoms. Such said, keeping the arm out straighter will typically alleviate the symptoms. If sleeping is ever a problem, I usually have people try taking a small towel, wrapping it around the elbow with tape so that it becomes a soft splint - this way it's comfortable for sleeping but doesn't let you bend your arm much. It's an easy way to see if the symptoms are managable through positioning. Again, not a good thing to let go - could eventually lead to permanent damage to the nerve which can/will cause wasting of the small muscles in the pinky side of the hand and can permanently lessen overall grip ability since a majority of the strength in hand grip comes from the ring and small fingers (contrary to common belief that it's the index finger side of your hand). One more comment - it's very common for women to develope "temporary" carpal tunnel syndrome during pregnancy due to fluid pressure changes which typically goes away after the birth of the baby. This obviously won't be the case with your possible cubital tunnel hon. PS. If I don't see you - good luck at nationals - I'm just going as a mom this year - but don't worry - I'm already planning on a strong comeback for 07-08!!! See you soon!!

[Peach]

Donna--I hope I'll see you at Nationals, but if not here's to meeting in competition next year!

Now that Joe raised the topic, I have been paying attention, and everything from sleeping on my side to riding a bicycle gives me numbness and tingling, either in the first three digits or in the last two. Faugh. Funny what you get accustomed to.

I suspect the shoulder rather than the elbow, actually.

[Fencingdriver]

Hi Joe:

I'm the mother of a fencer, an athlete and someone who has gone through neck surgery. I have been diagnosed with carpel tunnel as well as problems with the disks in my neck. I had lost sensation in multiple fingers, had a tingling from my elbow down to my fingers as well as a burning pain in my right shoulder blade (my dominent side). All three of those pain issues are characteristic of nerve impingement in the neck. The carpel tunnel is an add-on, if you will. Some of it came from years of active sports, but the final blow was a severe car accident.

Despite the searing pain, I was reluctant to do surgery, fearful that I would lose mobility and/or function. After speaking with surgeons from many hospitals (including Columbia Presbyterian, Mayo Clinic, Johns Hopkins), I decided on Dr. Zdeblick at the UW Hospital Orthopedic Clinic in Madison. He is considered one of the best surgeons around. He has numerous patents on procedures he has invented.

In the end, he advised against neck fusion and instead did a cervical laminoplasty, a less invasive procedure that opens up the passageway for the nerves using small titanium plates. The results have remarkable; I have had a dramatic reduction in pain. Prior to the surgery I have taking Oxycodone and Neurotin. Now I take an occasional Tylenol or Ibuprofin.

Prehaps you would want to consult with him.

Joe, I wish you all the best. You are a tremendous athlete. You have also been a gracious victor, offering pointers to my son after you've left him in the dust!