Prognosis in treating carpal tunnel left untreated for 50 years

Posted by elucidator @elucidator, Jan 11 5:00pm

I just learned that the numbness in my non-dominant hand, which has always been attributed to complications of an elbow fracture 50 years ago, is in fact due to Carpal Tunnel. My thumb muscle is atrophied, and the index and middle fingers never grew to full size (I was 8 at the time of the fracture). I have read that the longer one waits, the less likely that surgery will be successful. Any ideas on probability of success? Would you do it or not? Already had EMG/NCV, and have referral to hand surgeon, for consult. Test results are worse that those of 5 years ago. I have functioned successfully this long in this condition. . . . but, part of me feels cheated.

Back story: severe break of elbow. Immediately complained of numbness in hand. Was put in traction for a few weeks. The pin pinched the median nerve between the bone. Five months later, had surgery to retrieve nerve from bone. Six months later, still no feeling. Within the next six months, changed doctor, and he said I was good to go. No physical therapy. No nerve testing back then, other than the tinel (?) test.

Has anyone had surgery after real long term carpal tunnel? Did it work? What is the worst that could happen?

Welcome to Connect, @elucidator. Am I understanding correctly that pain you've lived with for 50 years was only recently diagnosed as carpal tunnel? Wow.

I'm tagging @bernese53 @IndianaScott @daniel2709 and @bonnieh218 to share their thoughts and experiences with you. You can read more about them in these discussions:
– Carpal tunnel release https://connect.mayoclinic.org/discussion/carpal-tunnel-release/
– carpal tunnel surgery side effects https://connect.mayoclinic.org/discussion/carpal-tunnel-surgery-side-effects/

Elucidator, You're asking great questions to put to the hand surgeon when you have your consult. In addition to gathering information here from fellow carpal tunnel patients, I hope you'll return to tell us what you learn from the hand surgeon. You mention tests are worse than 5 years ago. Was surgery suggested back then?

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@colleenyoung

Welcome to Connect, @elucidator. Am I understanding correctly that pain you've lived with for 50 years was only recently diagnosed as carpal tunnel? Wow.

I'm tagging @bernese53 @IndianaScott @daniel2709 and @bonnieh218 to share their thoughts and experiences with you. You can read more about them in these discussions:
– Carpal tunnel release https://connect.mayoclinic.org/discussion/carpal-tunnel-release/
– carpal tunnel surgery side effects https://connect.mayoclinic.org/discussion/carpal-tunnel-surgery-side-effects/

Elucidator, You're asking great questions to put to the hand surgeon when you have your consult. In addition to gathering information here from fellow carpal tunnel patients, I hope you'll return to tell us what you learn from the hand surgeon. You mention tests are worse than 5 years ago. Was surgery suggested back then?

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Hi Colleen! Yes, the diagnosis is recent. But, it's not pain. I never had the pain. Just numbness. I also have CTS in the other hand, so I know what the pain is like!

When the traction pinched the median nerve, everyone "assumed" that was the cause of the problems! I just accessed my medical records from back then, and noticed that I complained of loss of sensation prior to any traction activity ever taking place! And, I found a really great article by Dr Friedhelm Sandbrink of Georgetown University, saying that arm fractures can cause acute carpal tunnel, which should be immediately operated on! They said this is "usually" from wrist fractures. Not sure if this was known "back in the day."

So, five years ago, I had a different doctor, and did not have good rapport. I was complaining of upper extremity weakness. They tried talking to me about carpal tunnel, but I was like, "no, my hand has always been that way – it's from the elbow – this HAS to be something different!" Stubborn me.

Two weird things that have happened in the past few years. First, shortly after having rotator cuff surgery on the affected arm, I was slicing strawberries, when my thumb simply fell out of the socket! I put it back in (painless), and the doctors were at a loss to explain it. More recently, after using the weedeater, the nerves/muscles around the affected elbow started twitching for about a minute, fingers started twitching, and I regained a little bit of use of that hand. Just a little.

Anyway, I just finished 8 weeks of therapy to address neck/shoulder issues, then got the EMG, so it should be the best possible results. Oh, and they also said there is axon damage. Forgot to mention that.

Thanks for the help, and I will check out the other postings!

(why am I suddenly looking into all this? Because I am trying to get my body in the best possible shape as I prepare to enter my older years, and, being that I am no longer working, have the time to actually commit to such a goal)

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I had right hand carpal tunnel surgery at 65+. It was just fine and I experience none now at 70. I also had trigger thumb release. Same success and it has not returned. I felt in the long run that both interventions were very worthwhile.

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I had carpal tunnel release surgery on both sides when I was 64. The surgery relieved the numbness, tingling, and weaknesd in my right hand but did nothing in terms of tne problems in my left hand. Those problems stemmed from cervical spine issues; I had cervical spine surgery almost a year ago and it helped immensely. The recovery from carpal tunnel surgery was not too bad and did not take long. Best of luck to you and keep us posted.

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Update: The Hand Surgeon was reluctant to recommend surgery. However, he did an injection, and, it IS helping. That means surgery would too. He said surgery could get me back to the degree of functionality I had after the fracture. I now realize it has slowly gotten worse over time. So, I am considering it. For now, I am concentrating on hand exercises to take advantage of the benefits of the injection. Thanks all for the feedback!

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@elucidator

Update: The Hand Surgeon was reluctant to recommend surgery. However, he did an injection, and, it IS helping. That means surgery would too. He said surgery could get me back to the degree of functionality I had after the fracture. I now realize it has slowly gotten worse over time. So, I am considering it. For now, I am concentrating on hand exercises to take advantage of the benefits of the injection. Thanks all for the feedback!

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@elucidator I just came across your post. One thing to consider is when you have multiple places of nerve compression, they could all be contributing to symptoms, and can confuse things a lot. I had carpal tunnel surgery that helped somewhat, but did not relieve pain completely because I also had thoracic outlet syndrome that was missed at the time. TOS causes a compression of the ulnar nerve. Much later, I also developed a spine problem due to a collapsed disc in my neck, and that contributed to muscle loss too. TOS is often missed by doctors because they don't understand it. It's good the injection was done as a diagnostic test, and that it helped you. TOS has overlapping symptoms with carpal tunnel syndrome. I would recommend being evaluated for TOS at a place that treats TOS if you have not done that already. It might give you a better picture or rule it out. TOS is often posture related, or from injury or repetitive stress. I was evaluated at mayo for TOS prior to my spine surgery there.

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@jenniferhunter

@elucidator I just came across your post. One thing to consider is when you have multiple places of nerve compression, they could all be contributing to symptoms, and can confuse things a lot. I had carpal tunnel surgery that helped somewhat, but did not relieve pain completely because I also had thoracic outlet syndrome that was missed at the time. TOS causes a compression of the ulnar nerve. Much later, I also developed a spine problem due to a collapsed disc in my neck, and that contributed to muscle loss too. TOS is often missed by doctors because they don't understand it. It's good the injection was done as a diagnostic test, and that it helped you. TOS has overlapping symptoms with carpal tunnel syndrome. I would recommend being evaluated for TOS at a place that treats TOS if you have not done that already. It might give you a better picture or rule it out. TOS is often posture related, or from injury or repetitive stress. I was evaluated at mayo for TOS prior to my spine surgery there.

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My doc suspects carpal tunnel in both wrists and wants me too go out for a special test. I live very far North in Canada so I need to fly out. I have wrist/hand braces,take Diclofenac,Aleve,,Tylenal and Tramedol and it is helping. Throw in a little cannibus and I can usually dull the pain. It all started with trigger finger and got worse? I hear that Tumeric is a help and B6 . I am 76 soon and do not Really want an operation.

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@popolopo

My doc suspects carpal tunnel in both wrists and wants me too go out for a special test. I live very far North in Canada so I need to fly out. I have wrist/hand braces,take Diclofenac,Aleve,,Tylenal and Tramedol and it is helping. Throw in a little cannibus and I can usually dull the pain. It all started with trigger finger and got worse? I hear that Tumeric is a help and B6 . I am 76 soon and do not Really want an operation.

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@popolopo I understand not wanting surgery. I can tell you, as surgeries go, carpal tunnel release was not a bad recovery. I have also had cervical spine surgery and just recently 2 surgeries for an ankle fracture that were much more involved with longer recovery time. By far the ankle is the worst and I am still working on it and in a cast now 2 months after the injury. There are times that surgery improves a patient's quality of life when nothing else works. If wearing braces and reducing use of your hands helps, that 's good. Turmeric is a natural anti-inflammatory. Some people have talked about hand therapist stretches that can help carpal tunnel. In my case, I had carpal tunnel already and had picked up a small box in one hand when I was shopping and spread my fingers to hold it. My entire arm suddenly went completely numb for a few minutes, and after that, I had pains in my hand and wrist. What happened according to my surgeon, was that due to the pressure I was exerting, a nerve position was moved in my hand. If I touched the area between my thumb and forefinger, I got an electric shock because the nerve was compressed. That could only be resolved with surgery. My other hand has not had surgery, but when I overuse it, I do get some wrist pain. Topical arnica gel helps to relieve pain and that's over the counter. Also consider that muscles up and down your arm act like levers and pullies, and when something is overly tight, it affects everything because it has to compensate. It's common to have tight shoulders and neck muscles and through improper postures, the same nerves that pass through the wrist can be affected higher up in the shoulder or elbow. When you have multiple points of compression, they refer to this as a "double crush." That is why it is so important for doctors to figure out where the compression is because if they don't find all of it, and do surgery to fix something, the patient still has pain. That happened to me because thoracic outlet syndrome was missed, and the surgeon accused me of malingering, took my pulse and told me I was fine. I was telling him that my hand was turning blue and getting cold and he should have known that was a symptom of TOS, but it was easier to blame me for his mistake of not catching it. It was a few years later that I got a proper diagnosis form a neurologist. The job of a neurologist is to pinpoint the source of nerve pain and assess nerve function. The hand surgeon had only done a test where I put my hands together in a praying position, and then back of hands together… if that produced pain after a minute or 2, it was carpal tunnel and needed surgery, but that didn't address any other issues that contributed to that pain. I have been doing physical therapy with myofascial release which helps the TOS and it works by stretching the overly tight fascia and muscle which rehydrates it and gets it moving properly again. That would also be something you could try or a hand therapy specialist. We have a discussion on MFR. Here is the link. There is a provider search on the MFR website. According to my physical therapist, there is a point where physical therapy doesn't help when a condition has gone too far. That becomes a question for a surgeon at that point. You have to balance that against what your expectations are for your quality of life and do what you think is best. Any systemic cause of inflammation in your body can also make the inflammation of carpal tunnel worse. Sometimes, it is a dietary cause, and changing the diet to avoid inflammatory foods will help. It can also be related to something like thyroid issues, and these causes need to be ruled out or addressed if you have them for optimal health.
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

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@elucidator

Hi Colleen! Yes, the diagnosis is recent. But, it's not pain. I never had the pain. Just numbness. I also have CTS in the other hand, so I know what the pain is like!

When the traction pinched the median nerve, everyone "assumed" that was the cause of the problems! I just accessed my medical records from back then, and noticed that I complained of loss of sensation prior to any traction activity ever taking place! And, I found a really great article by Dr Friedhelm Sandbrink of Georgetown University, saying that arm fractures can cause acute carpal tunnel, which should be immediately operated on! They said this is "usually" from wrist fractures. Not sure if this was known "back in the day."

So, five years ago, I had a different doctor, and did not have good rapport. I was complaining of upper extremity weakness. They tried talking to me about carpal tunnel, but I was like, "no, my hand has always been that way – it's from the elbow – this HAS to be something different!" Stubborn me.

Two weird things that have happened in the past few years. First, shortly after having rotator cuff surgery on the affected arm, I was slicing strawberries, when my thumb simply fell out of the socket! I put it back in (painless), and the doctors were at a loss to explain it. More recently, after using the weedeater, the nerves/muscles around the affected elbow started twitching for about a minute, fingers started twitching, and I regained a little bit of use of that hand. Just a little.

Anyway, I just finished 8 weeks of therapy to address neck/shoulder issues, then got the EMG, so it should be the best possible results. Oh, and they also said there is axon damage. Forgot to mention that.

Thanks for the help, and I will check out the other postings!

(why am I suddenly looking into all this? Because I am trying to get my body in the best possible shape as I prepare to enter my older years, and, being that I am no longer working, have the time to actually commit to such a goal)

Jump to this post

Hi and welcome to connect. I have had carpal tunnel for many years. You might seek advice from a NUCCA chiropractor. NUCCA is National Upper Cervical Chiropractic Association. The practice is gentle compared to traditional chiropractic. See http://www.nucca.org for more information. This may be an alternative to surgery for you, it was for me. My condition was not as severe as yours sounds. But it their is NUCCA practice in your area it might be worth investing. Blessings to you.

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