confusion of dianosis

[Ev__]

Nine weeks following ulna nerve tranfer surgery, I have been advised that I might have RSDS.  This is based on the fact that since surgery the numbness in the two fingers continues and any compression on the elbow causes throbbing in the fingers.  The heat test on the two hands showed the same temperature in both.  I only complain of the numbness, not coldness, swelling, burning heat pain. Have been told a new EMG can not be performed until 4-6 months following surgery.  Isn't it risky to do nerve blocks as a diagnostic tool of this disease?  Can therapy to force this nerve in a path do further damage if the nerve is still trapped?  The therapist states that she thinks this could be mechanical and she is limited to what she can do in therapy as the reaction limits my two fingers after certain activity  - pulling up of the wrist.  I can not believe that I am left with another six months or face six nerve blocks which can be risky and might not help but could even cause more damage with forced therapy.  Please offer any suggestion.

[CCF Neuro[P] MD, RPS]

Dear ev:

I am sorry that your still having trouble with your fingers after surgery.  Alot depends upon the extent of the surgery and the surgeon.  What did he/she tell you?  It sounds like sensory and motor function are intact, but your experiencing numbness although you feel heat and cold.  We usually think of RSD as pain in an area of an extremity caused by trauma or injury that is inappropriate for the injury.  Most of our experience is that therapy and rehab through the pain is the only real way to resolve the RSD.  Medications usually have little effect, but only serve to help the rehab process.  Since you only feel numbness, I cannot be sure if your talking about RSD or some variant that I am not familar with.  Nine weeks is still in the rehab and recovery time.  I am also not sure if nerve blocks for numbness is the ideal treatment.  So much depends on actually seeing the patient, how they react to stimulation, knowing the extent of the lesion before surgery, seeing the studies, doing the exam and I am alittle in the dark with these.  I am not sure what to tell you so I am sorry I am not much help.

Sincerely,

CCF Neuro MD

[carolyn robles]

Having been through surgery on my right wrist (dominant) I should
like to point out, my GP (no one else) told me, he had seen patients require two or more years to regain strength and/or lose
numbness following surgery.  Two 1/2 years later, I had full use.

[kt]

An an occupational therapist who treats both ulnar nerve transposition and RSD patients, I would agree with the doc and the other poster.  My experience with RSD is that it entails a lot of pain, usually throughout the limb below the injury site, frequently is accompanied by swelling, and changes to the hair, nails and skin in the hand.  

It sounds to me like you're still having ulnar nerve problems, given that only the 4th and 5th digits are involved.  I would ask the following questions of your doc.  How severe was the nerve compression before the surgery,as this will be a factor in how long it takes for the nerve to recover (was there actual damage to the nerve or just pressure) and what sort of transposition was done?  At a conference I was at a few months ago, a surgeon reported that some transpositions seemed to be more effective than others (sorry, I can't remember which sort was best, and I'm sure its down to one doc's feeling about what works sometimes).  

As an added thought, I've seen some patients who have ongoing compression problems with scar tissue secondary to the surgery.  Has your therapist been doing scar massaage/mobilisation techniques?

[P.__]

Hi Ev, I have RSDS and what you wrote doesn't sound like what I have and I've been suffering with rsd in the upper extremity for 6 years now.  I have had well over 30 nerve blocks which gave me great relief for a very short period of time.  The only probem with the nerve blocks were the risks involved each time I had one.  The therapist I went to following the blocks worked with me so I could work through the pain.  I stopped the nerve blocks due to the risks involved.  I had bracial plexus blocks which also gave minimal relief.  I still have the burning swelling nails thinned and split easily.  I'm currently taking prescriptions and try to live one day at a time.  Through the therapy I had and the great support team I had when I went through all the treatments it has taught me to work through my pain.  Although I still don't know what only go just beyond the pain I keep pushing myself and fighting this nasty disorder I have and pray one day there will be a cure.  The problem with pushing myself is that I put myself into such severe pain that I'm no good to anyone for days even weeks.  If I were you I'd have a second opinion about your problem.  I had gone to several doctors before I was actually convinced that I had this disorder.  Keep your chin up and keep on fighting, never give up.
Theresa