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Sports Medicine

Is it Ever Too Late for Carpal Tunnel Surgery

09/20/2010

Question:

At what point does damage to the median nerve at the wrist become permanent? How would this be determined? Would carpal tunnel release still be helpful?

I have had over ten years of symptoms in my forearms, wrists, hands, fingers and thumb with overuse, bilateral deQuervain`s and "mild" carpal tunnel diagnoses. Several years of physical therapy did not improve symptoms.

I had C5-7 ACDF six weeks ago due to severe foraminal stenosis; neck and shoulder symptoms have improved but not the arm/hand symptoms: burning in the forearms below the thumbs with tingling on light touch of the forearms in that area, weak grip, stiffness and crepitus in the wrists, fingers and thumbs, numbness of both thumbs and all fingers, pain in both wrists and across the back of the hands. There is no swelling or redness. Symptoms increase with use. I am concerned about my ability to remain independent.

There have been three EMG/NCV studies over the past ten years, in 1999, 2002 and 2010. All have shown median motor amplitude values more than twice the normal value on the right (13.3, 10.5 and 10.8mV vs. 5mV normal) and high on the left (8.2, 9.1 and 8.4). I understand from the electromyography article in Wikipedia, under the heading of abnormal results, that this may indicate denervation/reinnervation of the right median nerve. Values for the ulnar motor nerves were most recently 6.5 on the right and 6.9 on the left; needle EMG also showed "mild denervation" in the right flexor carpi radialis, which is innervated by the median nerve. No x-ray or MRI has ever been done.

I have some sort of connective tissue disease - high positive ANA, as high as 1:2560, never lower than 1:640. None of the more specific tests have been positive. Three different rheumatologists have given three different diagnoses over the past ten years - Sjogren`s, scleroderma or undifferentiated - along with severe Raynaud`s. Currently taking Plaquenil which helped immediately with fatigue.

I am trying to judge whether carpal tunnel and/or deQuervain`s release surgeries may still be helpful at this point. I am 56, female. Thanks in advance for any insight you can provide.

Answer:

Thank you for visiting NetWellness. Your question doesn't appear to relate to Sports Medicine, and this website does not currently have a Health Topic area appropriate for your questions.

On this site, we try to answer general questions about medical conditions but cannot diagnose or recommend treatment. You appear to have some very, very specific questions which can only be answered properly by a physician who is familiar with your history, physical exam, and test results. Your questions about the testing results you've been given or the risks, benefits, and alternatives for proposed treatments of this condition need to be directed to your treating physician(s). You should insist that they answer these questions in a way that you are able to understand before consenting to any treatment. If your physician is unable to help you understand these issues, you should get a second opinion. Take care.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University