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Neurology (Expert Forum)
Hands numbness and tingling after the surgey
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Hands numbness and tingling after the surgey
by Praha, Jan 06, 2007 12:00AM
Hello, I am a 57 old male. I went on December 4th 2006 for the Abdominal Pelvic Resection surgery which lasted for about 8 hours and went very well. However, something happened to both my hands; right after surgery when I woke up I could not feel my hands, left one from the elbow and the right one from the wrist. My wife told me that my hands were icy cold (like a dead person) and started to massage them. When I lifted my left hand using my right hand and then dropped it, it went down without any feeling or control. All fingers - except the little one on both hands were numb. It improved in couple of days to the condition that I was able to move both hands, but the strong tingling and numbness still remains. Surgical doctors told me that my hands were in "T" position, bended over the edge of table. They also said that they pumped a lots of fluid during the surgery to my body and that this numbness will disappear after some time. However, I am already 4 weeks from hospital and my condition is worse, I am in constant pain. I am not able to make a fist on my left hand. My palms and fingers on both hands strongly tingle, and if I am washing my hands, it feels like to have a sand between them. But in the same moment it is also numb. I did a little research on Internet and symptoms seem like Carpal Tunnel Syndrom, because the only finger not affected is the little one and the half of ring finger (the side to the little finger). I will appreciate any help or advise on how to calm my pain. I am using Hydrocodone 5/500 for 1 month, but it only helps a little. Thank you.
Doctor's Answer
by CCF-Neuro-M.D.-SH, Jan 27, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms and story you relate suggests peripheral nerve compressions during surgery and is actually quite common. When nerves are compressed they react to the damage in 2 different ways. One type of damage is due to the loss of the insulating coating that covers the nerves (also called demyelination) which causes the nerve signals to slow down and causes weakness/ numbness/ tingling. Demyelination is the more mild form of damage and generally improves with in a few days to 6 months. The other form of damage is relates to loss of the wires that transmit the nerve signals (also called axon loss). This is the more severe type of damage, and may result is permanent weakness, atrophy and numbness. To evaluate the extent and type of nerve damage that you have suffered you should have an EMG of both arms to evaluate your nerves from the nerve roots, brachial plexus and individual peripheral nerves. By examining your EMG, you can arive at a prognosis for your recovery. The discomfort that you describe should be treated with medications that treat neuropathic pain, such as neurontin, lyrica, elavil, cymbalta etc. I would suggest starting with neurontin at 300mg a day, then increasing by 300mg every 3 days until the pain is controlled (up to 4000mg per day), but the usuall dose is around 2400mg per day (800mgs three times per day).
I hope this has been helpful.
The symptoms and story you relate suggests peripheral nerve compressions during surgery and is actually quite common. When nerves are compressed they react to the damage in 2 different ways. One type of damage is due to the loss of the insulating coating that covers the nerves (also called demyelination) which causes the nerve signals to slow down and causes weakness/ numbness/ tingling. Demyelination is the more mild form of damage and generally improves with in a few days to 6 months. The other form of damage is relates to loss of the wires that transmit the nerve signals (also called axon loss). This is the more severe type of damage, and may result is permanent weakness, atrophy and numbness. To evaluate the extent and type of nerve damage that you have suffered you should have an EMG of both arms to evaluate your nerves from the nerve roots, brachial plexus and individual peripheral nerves. By examining your EMG, you can arive at a prognosis for your recovery. The discomfort that you describe should be treated with medications that treat neuropathic pain, such as neurontin, lyrica, elavil, cymbalta etc. I would suggest starting with neurontin at 300mg a day, then increasing by 300mg every 3 days until the pain is controlled (up to 4000mg per day), but the usuall dose is around 2400mg per day (800mgs three times per day).
I hope this has been helpful.
Member Comments (3)
by mike1105, Jan 07, 2007 12:00AM
you are corret in terms of the inervation. the median nrve affects digits 1,2,3 and the medial pat of 4, while the ulnar nerve affects the outside of 4, and 5. It is possible the median nerve was stretched during the surgery. hopefully this was explained to you as one of the risks before the surgery, ie that this might happen due to the positioning of your body during the procedure. This happenned to a freind of mine although both is ulnar nerves were traumatized (he had lowr spinal surgery) and he was forcd to give up dentistry. I personally stretched my ulnar nerve (not due to surgery) and it took 16 mnths for the feling to come back to the affected fingers. nerves heal very very slwly, and pain, at least for me, was part of the healing proces.hopefully you'll get better with time. At this point, I'd see a nuerologist to review your case.
by Praha, Jan 09, 2007 12:00AM
To: Mike
Thank you for comment