Brief Answer:
Multiple Possibilities, Limited Options

Detailed Answer:
Hello there, thanks for coming to HealthCareMagic. I'm really sorry to hear about the infectious complication of your Carpal Tunnel Release. It's a tough situation to deal with. MRSA is a nasty infection that requires long term antibiotics, which it seems like you are getting.

I'd like to ask you for a bit in info to clarify the timecourse of your problem in my head.

The sharp pains and numbness that you suffer from post-op, you mention they started 3 months after the surgery. What was your situation in the intervening 3 months post-op? Were you healing well? Was there any pain or numbness at that point? (Beyond the immediate post-op surgical pain I mean).

Reason I ask is that will tell me if the problem was due to something happening in surgery.. or something that happened while healing or due to the infection. If there was pain and numbness immediately after the surgery. That makes me think that there may have been a problem intra-op ( a surgical complication). I can't be sure, but the time course would match then.

On the other hand, if everything was fine for the ensuing 3 months, that would lead me to 2 possibilities:

1) Scar tissue formation independent of the infection: It's rare, but tough fibrous scar tissue that forms under the surgical site in the hand might recompress the nerve that was affected originally. This is exceedingly rare. I've only heard of it myself, though i've done plenty of these surgeries in my training.

That kind of scar tissue would require re-exploration of the wound. Now given that you had an infection at this point.. re-exploration is incredibly dangerous. we risk turning the MRSA infection from a surgical site infection, to something that has gotten into your blood stream and migrated to the rest of the body. That would probably be lethal.

2) Pain and swelling is due to the infection itself: This, though not an ideal outcome is what i am most hopeful of, given the current circumstance. If the infection is still active.. it may be causing tissue swelling that is leading to your pain and numbness. That means, curing the infection would get rid of your problems once and for all without the need for further surgery.

In both of these scenarios , I would be giving you high level antibiotics (abx) to kill the MRSA and I would be sending you for Physiotherapy to try and control the swelling in the hand. After several weeks.. to months of abx, if the symptoms weren't getting any better, I would re-examine you and probably get an MRI to look at the surgical site. If it saw alot of scar tissue, then i would send you to a hand specialist to look into re-exploration of the site and a re-release. I wouldn't be confident of doing it myself because I've only operated on uncomplicated cases myself.

so, to sum up

1) The time course of your symptoms will give us clues as to their cause: If the pain and numbness started before the infection.. then it MIGHT be a surgical complication. It would be tough to prove though

2) Regardless of the cause, the treatment plan has to be getting rid of that darned infection first. NOTHING can be achieved unless that is handled. After that, scanning and re-examination and MAYBE a re-exploration of the site would be in order. A good hand specialist would need to be on board by then.

I hope this has helped you clarify your next move. If there is anything you didn't understand or if you want to discuss this furthur, I will always be happy to help.
Let me know what you are thinking.

Vinay

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Brief Answer:
Small possibility of surgical complication

Detailed Answer:
Hey XXXXXXX Thanks for following up. There is a small possibility that the pain you are suffering from may be due to the surgery itself. But I can't be sure.

At this point, i think we need to find out which nerves are affected and if there is any permanent nerve damage.

I recommend the following:

1) Get an opinion from an orthopedic surgeon who specializes in hand surgery. Your local university hospital should have someone.

2) You will probably need an MRI of the Hand, as i discussed in my earlier message.

3) You may need a test called an ElectroNeuroMyoGraphy (ENMG) test done on the hand to check which nerves are affected here and what the activity in these nerve is. It's a test where they mildly stimulate each nerve and chart the signals coming through it. It's a functional test and I think it would give us alot of information.

All of this in my mind leads up to a simple choice: Should there be another operation or not? In my opinion, operating again is a VERY risky situation and should only be done IF ALL of the evidence (MRI, ENMG) shows that it will help. If there is even a slight doubt to that, then it is safer to avoid surgery. The risks of worsening the situation are ever present.

I wish I were such an expert, but i'm a Neurosurgeon, so i only do the plain vanilla CTS's. I strongly suggest that you head to a good hospital and make sure you are seen by a hand surgeon.

Let me know, how else I can help.

Vinay

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