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Thread: What are the current views on Carpal Tunnel Surgery?

  1. #1
    Senior Member
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    Question What are the current views on Carpal Tunnel Surgery?

    I am a T-5, ASIA-B para, quite active in the maker community, an adaptive rock climber (one of two paras I know of to lead climb) and a heavy user of power tools and computers.

    I am primarily left handed, do some stuff with my right but mouse, drive my power chair, steer the car, and write etc. with my left... I am highly (stubbornly and determinedly so) independent, except where the environment prevents it (I don't do laundry because the laundry room isn't WC accessible for instance) I do all my own ADL's without assistance, etc. I don't get any sort of PCA services, and my GF would be very limited in what she could do if I wasn't able to do for myself.

    I am diagnosed with carpal tunnel in my left wrist, confirmed by EMG study. The ortho Dr. is pushing me very hard to get surgery. I'm hesitant, primarily because of concerns about 'down time' as I don't have the ability to live without transferring and so on if I can't load bear on my hands... A couple years back I had a car accident where I broke the 5th metacarpal in my left hand, which would be a relatively trivial injury for an AB, but left me stuck in a nursing home for a month...

    I'm also a bit wary when a surgeon pushes an operation, as I wonder if it isn't a case of 'If your only tool is a hammer, everything you see is a nail...."

    He did give me two cortisone shots, each seemed to work for about 3-4 months, but he says he won't give me any more as there is to much risk of the tendons or nerves breaking. I do sleep in wrist splints, but they seem to not do a lot of good, my hands are most likely to be 'asleep' when I wake up.

    He expressed very low opinion about any of the other sorts of exercises or 'lotions and potions' doing much good.

    The surgeon claims that the surgery is no big deal, and that while they would WANT me to stay off it as much as possible, that I could 'Do what you have to' although it would hurt, almost the same day...

    I've done a search on the forums here, and found SCI Nurse advice from circa 2007-8 saying that they didn't allow their patients to load bear for 6 weeks... I didn't see any useful comment from SCI-Nurse about what the current protocol is - I would hope that medical progress has been made

    I have seen some more recent mixed stories from users about the newer less invasive procedures having faster recoveries, but still some amount of down time - accounts vary....

    Is there any current info about what sort of down-time and recovery is expected for an SCI patient?

    What are the current protocols?

    What are the sort of things I should plan on?

    What sort of extra rehab / support should I be talking to the insurance company (Mass Health / aka RomneyCare / Medicaid) about that an AB patient wouldn't need?

    Are there any alternatives that have reasonably good evidence of effectiveness that I should try before giving the surgeon the go-ahead?

    Thanks,

    ex-Gooserider
    T-5 ASIA-B para, currently working on building own power chair, as being in a manual is an EXTRA handicap.

  2. #2
    You should definitely get a second opinion, and also have an evaluation by an hand therapist (usually an OT) to see if yours can be managed by exercise and learning some new hand skills that don't put as much strain on your CT. I would only have it done by an orthopedist or neurosurgeon who specializes in hand surgery as well.

    Up until I retired this last winter, we were still requiring no weight bearing through the hand/wrist involved with surgery for 6 weeks post-op; I assume it is still the same. It sounds to me like this orthopedist does not really understand how much someone with paralysis needs to weight bear on their hands.

    If you have sufficient help at home, and access to equipment such as a patient lift, power chair, etc. you can recover at home. For ABs, this is a day-surgery procedure, but they can walk out of the surgery center and only have to make a few adjustments in their ADLs afterwards, unlike someone with paralysis.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  3. #3
    Senior Member
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    Thank you for the response, I'm definitely planning on seeking second opinions and the hand OT -

    I normally use a power chair when not at home (most of the time) as I find manual chairs to be a major handicap (why should I be forced to give up using my arms just because my legs don't work any more...?) but I drive with my left hand, and I don't have any of the other gear, nor room to use it, and my GF has her own limitations that make her unable to help me much.... So even though a nursing home verges on 'fate worse than death' for short term, it sounds like I'd need at least a short stay....

    The surgeon is supposed to be a good one, I'm told he is 'the hand guy' at Lahey Medical Center in Burlington which is where I get almost all of my medical care....

    ex-Gooserider
    T-5 ASIA-B para, currently working on building own power chair, as being in a manual is an EXTRA handicap.

  4. #4
    Can you move your wheelchair controls over to the other side? How do you do weight shifts? I have seen people get into trouble with their skin if unable to do a push-up type weight shift, so if you can do side-to-side or forward leans instead that should be considered. If you cannot do these types of weight shifts alone, you will need someone to help you with those techniques. Turning independently in bed can also be problematic. Driving is usually also not allowed.

    You will need to have someone (at home or in a nursing home) do a good amount of your ADLs...dressings, transfers, perhaps even bowel and bladder care if you are unable to do this one-handed without putting pressure on the operated hand at all.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  5. #5
    Senior Member
    Join Date
    Nov 2011
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    North Billerica, MA
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    Sorry for the delay in replying - for some reason, even though I've set the reply options to tell me, I don't get a message when there are new posts in the thread...

    As an update, I have been getting a wide range of answers on the 'down time' question, but the two that seem most SCI relevant are the 6 weeks from here, and a booklet put out by the Paralyzed Veterans Assoc. that says 3 weeks for the endoscopic surgery, and 8 weeks for the open palm version... I also found some stuff on Pubmed that says recovery can take several weeks...

    This is very different from the hand surgeon that seemingly implied that I could just about do a full weight bearing transfer off the operating table.... While I don't doubt his expertise as a surgeon, I suspect he doesn't have a lot of experience w/ SCI patients, the examples he mentioned of "Do what you have to" activities weren't as heavy duty as what we need to do....

    My physiatrist said she was putting in a referral for me to see a surgeon that she said she sent a lot of her SCI patients to, and thought was good. I haven't heard from him, so I have started calling to see what is happening, but haven't heard yet. I'd hope that this doctor would have a better idea of what the surgery means for someone like me....

    I've also started seeing an OT who has been doing ultrasound treatments and giving me some exercises to do... It has only been a couple of days so hard to tell how much good that is doing, but will see...

    SCI-Nurse

    Can you move your wheelchair controls over to the other side? How do you do weight shifts? I have seen people get into trouble with their skin if unable to do a push-up type weight shift, so if you can do side-to-side or forward leans instead that should be considered. If you cannot do these types of weight shifts alone, you will need someone to help you with those techniques. Turning independently in bed can also be problematic. Driving is usually also not allowed.

    You will need to have someone (at home or in a nursing home) do a good amount of your ADLs...dressings, transfers, perhaps even bowel and bladder care if you are unable to do this one-handed without putting pressure on the operated hand at all.

    (KLD)
    I can move the controls on the power chair over, though I am terrible at driving w/ my right hand, and it would make some of my transfers and plugging in the charger for the lead bricks a bit awkward... However it would be tolerable.

    Right now I do my weight shifts with a combination of pushing up with either my elbows or hands, depending on whether I'm in the power or manual chair, and moving my butt around... I also do a bit of leaning in all directions, though usually that is more activity related than strictly weigh shifting... However I'd probably be able to cope with mostly leaning for weight shifts.

    I wouldn't be able to turn independently in my normal bed, as I have to do a weight bearing move to slide my butt from one side to the other - a hospital type bed would be easier as it might be possible to push on the side rails with the non-surgery hand...

    If I'm at home, I'd go nuts if I couldn't drive, less of a problem if I'm stuck in a nursing home....

    Other ADLs are a mixed bag - I use both hands to cath, but not a lot of pressure, more just manipulation of bits and supplies - one hand holds things steady while the other does stuff... I might try swapping hands just to see if I can do it the opposite way... Bowel care isn't a big concern in terms of BP, but cleaning up after might be...

    Dressing would be a concern, both because I wear pressure socks, and the shifting around I need to do in order to get my underwear and pants on....

    In any of the needing help situations, my GF is not physically able to help because of her own medical issues, and the home setup wouldn't have enough room for a lift, so I don't see any way to avoid the nursing home incarceration if I have to do the surgery....

    ex-Gooserider
    T-5 ASIA-B para, currently working on building own power chair, as being in a manual is an EXTRA handicap.

  6. #6
    It sounds as though you might need the nursing home should you have the surgery. It is good to plan ahead and figure out what you may need. You will need to give that area a bit of rest to heal so take all the precations that they recommend and also any that you may think would stress it doing your daily activities.
    ckf
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  7. #7
    Does your health insurance cover any post-surgical care at home? Once I was discharged from hospital I had personal care attendant for several weeks. Also had OT and PT for about 3 weeks.

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