 |
Pain and Tenderness after Carpal
Tunnel Surgery
Paresthesias and scar tenderness are common in the subacute recovery phase
following carpal tunnel release. A flare or aggravation of symptoms is
common in the period of two to six weeks after surgery. Several different
situations may contribute, including the following, listed roughly in most-to-least
common:
-
Normal scar tenderness with anxiety / awareness.
-
Normal scar adhesions to the perineural tissues. This may result
in a sudden, brief electrical paresthesia, typically shooting from the
palm out the middle finger tip. It may occur while reaching, gripping,
or at rest. It may be alarming, but does not necessarily mean that there
is a technical problem with the surgery or with the healing process. Adhesions
by themselves would not explain constant pain.
-
| Pillar pain (tenderness adjacent to the actual ligament
release, where the prominences of the trapezial ridge and the hook of the
hamate are closest to the skin. The transverse retinacular ligament, divided
during carpal tunnel release, attaches to these structures, and the inflammatory
reaction of normal wound healing is most obvious at these points, often
more than the central area of the actual release. |
 |
-
Aggravation of preexisting asymptomatic basal joint, pisotriquetral or
triquetrohamate arthritis due to altered isometric stresses on these
joints.
-
Reinnervation hypersensitivity - most often occurs if there was
constant tingling, numbness or altered sensibility before surgery.
-
Reflex sympathetic dystrophy.
-
Coexisting neruritis from cervical radiculopathy, pronator syndrome,
diabetic or other peripheral neuropathy.
-
Direct nerve irritation of one of the palmar cutaneous sensory branches
to the palm or of the median nerve itself.
Clearly, treatment must be individualized, but a good start is to reassure
the patient that most problems in this situation are temporary, and to
continue to educate the patient
about the nature of carpal tunnel syndrome. Nerve gliding exercises and
patient self-help oriented desensitization
exercises are appropriate for most patients. Burning pain, worsening
pain, avoidance, even without objective signs of reflex sympathetic dystropy
may be helped with a supervised stress
loading program. Questions regarding worsening complaints of numbness,
pain, stiffness or swelling should be discussed with the surgeon at the
earliest opportunity.
Hand
Therapy Home page
 |
American
Society
for
Surgery
of the
Hand
assh.org
The Best
Resource
For Your
Hands,
Period.
|
