Numbness and pain in the hand after CTS surgery with diagnosed Thoracic Outlet Syndrome

Patient

Q: Hello -- In September of 2010 I made a gigantic mistake by allowing my doctors to persuade me into having endoscopic carpal tunnel release performed on my left hand. My life has not been the same sense, I my left hand now has an 'ambient' numbness, constant aching pain in the palm, and severe weakness... none of which was explained to me by my doc. Worse yet, I have now been diagnosed with thoracic outlet syndrome and my surgery may have been unnecessary. My question is: Can carpal release surgery be reversed? My hand is so messed up, I really just want a surgeon to reattach my TCL, I want my old hand back. I have read that some docs divide, then reattach the transverse ligament during surgery, so surely there is a way to reverse it? Thank you.

Doctor

A:   Once that it is performed, it is not likely that the release surgery can be reversed. What you need now is to focus in the treatment of your newly diagnosed Thoracic outlet syndrome, which probably is producing the symptoms that you described in your arm and hand. Thoracic outlet syndrome is a group of disorders that occur when the blood vessels or nerves in the thoracic outlet — the space between your collarbone and your first rib — become compressed. This can cause pain in your shoulders and neck and numbness in your fingers. Treatment for thoracic outlet syndrome usually involves physical therapy and pain relief measures. Most people improve with these conservative approaches. In some cases, however, your doctor may recommend surgery. If conservative treatments don't improve your symptoms or if you're experiencing signs of significant nerve damage, worsening muscle weakness or incapacitating pain, your doctor may recommend surgery. Your doctor also may recommend surgery if you've been diagnosed with true neurogenic thoracic outlet syndrome, for which surgery is often the only treatment option, and for certain blood vessel complications, such as obstructed blood flow (occlusion) or ballooning of a portion of an artery (aneurysm) due to weakness in the wall of the blood vessel. Surgery is usually effective in relieving pain associated with thoracic outlet syndrome. It may not be as successful in treating muscle weakness, especially if the condition has gone untreated for an extended period. A specialist in thoracic surgery or vascular surgery will perform the procedure. Thoracic outlet syndrome left untreated can cause permanent nerve damage; however, surgery to treat thoracic outlet syndrome is considered risky. This is because the procedure involves dividing a muscle in the neck and removing a portion of the first rib or repairing the brachial plexus nerves. For this reason, most doctors initially recommend a conservative treatment approach. If you're diagnosed with thoracic outlet syndrome, your doctor or physical therapist will instruct you on exercises to do at home to strengthen and support the muscles surrounding your thoracic outlet. In general, to avoid unnecessary stress on your shoulders and muscles surrounding the thoracic outlet:  Keep good posture at all times, take frequent breaks at work and also try to practice relaxation techniques.

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