Nearly a month post an open carpal tunnel release

So i should wait three months before considering the second operation

Add to this

I'm a teacher and i use my hands alot.

Till now I didn't start the real work .

Is it allright to overwork using it or it is advisable to have a sick leave ?

There's no set rule on how long to wait for anything - return to work, symptoms to resolve, re-operation - it all depends on your individual circumstances. Come over to my website and read the section on analysing what is wrong when symptoms do not improve as expected after surgery and we can take it from there.

Dr J Bland - Consultant Neurophysiologist, Canterbury CTS Clinic

Thanks alot for your cooperation

Just need to know your website please

If I put a link in a message here it will get moderated and you won't see it for days. There is a link from the resources page of this site or just google carpal tunnel syndrome and bland. If you can guess where to put the dots it is carpal-tunnel net

Jeremy Bland

I suspect, though there is no proof at present, that re-operation is better done sooner rather than later when the reason for failure of the first operation is inadequate surgery. The challenge lies in recognising when the primary operation has not been done properly as few surgeons will give credence to the possibility that they might have got it wrong until months after the operation. Failure to fully section the ligament however can generally be recognised using NCS and ultrasound within a few weeks of surgery if someone just thinks about the possibility and gets on with investigating it.

Dr J Bland - Consultant Neurophysiologist, Canterbury CTS clinic

Hi Dr. Bland,

I had both hands operated on in January of this year. My hand surgeon advised me not to expect a full recovery until (somewhere between tax day, 4/15 and Memorial Day 5/29) He was completely accurate. I had all sorts of pain, numbness, tingling, stabbing, shooting, etc., during the recovery time and was getting anxious. I had loss of use where it was difficult to do any tasks that required finger strength and it was extremely painful to push down on my hands as if I was going to do a push up.  I never thought I was going to have a normal day again. As I approached mid-April, I could feel the improvement and less of a sideshow or distraction with the hands. I believe I am fully recovered 7 months later. 

At what point should patients feel their surgery was a failure? Again, mine took 4-5 months for a complete recovery. Despite whining to my surgeon continually, he stuck to his guns on my recovery and he was right on the money. I was glad I listened to him rather than shop for a doctor that would consider going back in.

Maybe I am more of the exception than the rule?

It depends on a variety of factors. I too can make fairly accurate predictions of which patients and which symptoms are likely to take longer to resolve but the fact remains that, for the average, moderately severe CTS case, the main symptoms of nocturnal tingling, pain and numbness causing sleep disturbance should resolve very quickly after surgery and if they do not then something is wrong and the widespread surgical practice of telling all patients who have persistent symptoms 4 weeks after surgery that it 'will get better eventually' is not good medicine. A true cynic might ask - how many patients has your surgeon told that in order to be right about you?

Dr J Bland (Consultant Neurophysiologist, Canterbury CTS clinic)

Dear Dr Bland

I had my surgery in December even though nothing showed on the nerve test but I knew something was wrong I was advised during my operation that the nerve was squashed and looked hour glass shaped, I am due to go on 4th September for more nerve tests but was advised if nothing shows then I have to live with it??? I still wake with numbness this has not changed at all can you advise?

Nicola

That's a pretty complex question. The nerve tests, even when they are done very all (and they are often done very poorly) can miss CTS so normal results do not preclude successful surgery. The appearance of the nerve at surgery is a pretty poor guide to what is going on I'm afraid. There are a variety of ways you could proceed depending on exactly what the symptoms are. Try doing the symptom questionnaire on carpal tunnel net and then ask me in the forum there.

Dr J Bland (Consultant Neurophysiologist, Canterbury CTS clinic)

Thanks for your reply Dr. Bland - I truly believe it has to do with trust in the doctor. I had trust in my doctor due to his longstanding reputation of over 40 years in hand surgery and operating on athletes and movie stars around the world with great success. I was all in before and after the surgery and again, trusted his surgical ability and post surgery recommendations. 

If my hands weren't deteriorating so fast, I would have taken alternative steps but the end result was a completely successful and effective surgery. 

In my case, he was absolutely on the money and based on his reputation, I would imagine a very high percent of his surgeries on CTS are successful. I'm imagining a surgeon that is as successful as mine, can roll the dice time and time again and run a very high success rate on CTS surgeries. I was only trying to convey my experience as a patient.

Pretty much every surgeon who does carpal tunnel surgery has a high success rate. It's generally a very successful operation which is why surgeons like doing it. There is however no such thing as 100% guaranteed successful surgery, in any surgical field, and carpal tunnel surgery is no exception. There are patients with problems after surgery - two in my clinic just this afternoon - and all too often the story I hear from these people is that they spent months telling their surgeon that it wasn't right - only to be sent away repeatedly with assurances that it would improve. What I can't tell for sure is what proportion of people who are given this spiel really do improve and what proportion do not. It needs a serial outcome study doing where say a thousand or so patients record their symptoms weekly for a year or so after surgery so that we could get a true picture of the range of variation in the ways symptoms change after surgery.