Fingers still numb 2 weeks after Carpal Tunnel

Just yesterday started having a slight burning sensation in the thumb, index and middle fingers and what I'd call kind of a "buzzing" feeling in the ring finger. Both sensations come and go. Any chance these are good signs of the beginning of recovery?

Certainly could be signs of progress but not wholly reliable as an indicator I'm afraid. One thing you can measure for yourself (with an assistant) is two point discrimination - the abilty to detect the difference between two sharp points distance 'x' apart and a single sharp point. All you need is a pair of compasses/dividers and a helper. It's not perfect but if serial testing reveals that you can detect smaller and smaller separations it's probably a good indicator of progress. In a normal fingertip it is possible to detect about 2mm separation between two points. Dr J Bland

Had a follow up at week 5. Doctor seemed a bit surprised there had been no real change. He doubled checked my nerve conduction test. He said my latency was 5.45ms through the wrist and that is considered moderate CTS. The rest of my results up the arm were all in the normal range and the only slow area was through the wrist. He said the next steps are: 1. Wait 4-5 more weeks and see if there is any sign of fingers waking up. 2. If not, try a cortisone shot. 3. If still no change, repeat EMG. 4. Last resort would a 2nd surgery this summer where he talked about wrapping the nerve in fat.

Right now I can produce extra tingling in the fingers if I stretch out my arm and flex the fingers up, palm out. There's really no change except for the occasional burning sensation in my fingertips I mentioned in my original postings. My question is two fold: 1. Does what he suggests sound within the standard approach if numbness remains after surgery? 2. Should I consider getting a 2nd opinion from another orthopedic surgeon or a neurologist?

I should mention I'm 40 years old and first felt off and on tingling in november which became constant numbness in mid December. So this is not a long term problem.

That figure is probably the distal motor latency and a figure of 5.4 msec is usually grade 3 CTS (out of 6). To be sure whether it is 3 or 4 you need a sensory nerve measurement too - was that done with a little handheld device? Ideally we want to know what the results looked like before surgery for comparison. By 5 weeks it should have shown at least a little measureable improvement on the NCS. As to whether the proposed course of action is 'standard' I think it's fair to say that there is no standard. The reasons for trouble after carpal tunnel decompression are too varied to allow a one-size fits all approach. Trying steroids after surgery is very rarely done but there has been a bit of interest in it in the last few years. You can read more on my own website. Dr J Bland

Yes, it was the distal motor latency.  And the 5.45ms was the measurement before the surgery.  Haven't had one done since.  

Should I get a 2nd opinion or just wait the next 4-5 weeks?  If so, do I see a different orthopedic hand specialist or a neurologist?  Part of me worries that if I wait and there is still compression on the nerve somehow, that will just keep adding to the damage already present.  Thanks so much for your replies.  

OK If that was before surgery then it should be making some progress by now and it could be checked anytime between 6-12 weeks to make sure that it is improving. If it is the same or worse one would start to wonder whether the ligament has been fully divided. Did they try anything else before surgery or was it a case of straight to the operation? Dr J Bland

The surgeon said we'd do a repeat test if there is no improvement by week 10 and if a cortisone shot at that point provides no relief.

Didn't try anything else. He said based on my symptoms, especially the constant numbness combined with the nerve test results, that surgery was the best option. He said if I had numbness and tingling that was intermittent and not constant, he would have started with non-surgical treatments.

Should I consider asking to have the conduction test repeated sooner than the timeline being suggested?

I would do it earlier myself but I work in an environment were that is easy to do. In many places nerve studies are not so freely available, for one reason or another. Personally I think a second set of nerve conduction studies are much more use than a trial of steroid injection after surgery - there is too little evidence available to tell us how to interpret the latter, though there is one interesting trial which you read about on the steroid treatent pags of my own site. Dr J Bland

it really depends on how bad it was before surgery. Numbness - ie loss of sensation, if there all the time before the operation, usually does not immediately disappear after surgery but takes some time to recover. That is because, in most such cases, you are waiting for regrowth of nerve fibres. That does not mean that it cannot recover though. Intermittent numbness before surgery usually does recover quickly because in that case the nerve fibres are still intact - the loss of sensation only results from them temporarily stopping working. If there was no numbness before surgery and there is afterwards then that is more worrying. As usual in medicine, even something as 'simple' as CTS turns out to be more complex than one might imagine from simple 'rules of thumb'. Dr J Bland

Doctor You mention your website? the rules on this one wont allow you to post it here? How do i fid it?

Bob

There is a link under 'related information' at bottom right - look for the one with the two little figures icon.

I'm starting to get irritated with the amount of advertising here on patient UK which is so obtrusive that it keeps redrawing my browser screen while I'm trying to type. Dr J Bland

i completely understand doctor. i did locate your site if it has east kent prominately displayed on it. i read a bit on your site and i am impressed. thank you for it. it is very dificult to type one handed so i will not complete your servey for a week or two. i just had surgery on my dominant hand (R) and trigger finger release on the same. thank you very much for the info to you and my medical team from my health care. so far all is well. i am experiencing discomfort relating to fatigue and some use early on. i am now resting it on ice.

That's the one. Alternate warmth and cooling certainly seems to help some people. I hope it settles soon. Best wishes - Jeremy Bland