Persistent hand pain after carpal tunnel surgery is a common question patients have following surgery. I want to expand on post-operative pain, as the great majority of the time the pain is related to normal healing.  

Let’s start by breaking it down by time following surgery and what is abnormal and what is  normal immediate post-operative pain. This is pain within the first 4-6 weeks of surgery.  Remember that regardless of the technique used to release the structure causing carpal tunnel  syndrome, the ligament being released is a robust structure. You need to realize the transverse  carpal ligament released is roughly as thick as the thickness of a cardboard box. Immediately  after the release, there will be a period of time not only for the ligament to heal in a lengthened  position but also for the bones attached to the released ligament to adjust.  

Normal Pain After Carpal Tunnel Surgery

Two common complaints after surgery are “the base of my thumb hurts” and “when I put  weight on my hand it continues to be sore.”  

Many patients who have carpal tunnel syndrome also have arthritis at the base of the thumb.  After the ligament is released, there can be a transient increase in pain in the area of arthritis or  occasionally new onset of symptoms at the base of the thumb. As the base of the thumb  “adjusts” to its new environment the symptoms will typically resolve without any treatment. If  symptoms persist, treatment with topical medications, splinting or occasional injection are  required. It is rare that the symptoms of the thumb persist after several months.  

Weight-bearing pain in the palm and hand pain with forceful gripping or heavy lifting is normal  as well. This is expected with normal healing post surgery, and gets better over time. We ask patients to avoid weight  bearing if the pain is significant but mild pain with weight bearing is perfectly acceptable. Pain  with heavy lifting and forceful gripping is also normal post-operative healing. We typically tell  you to wait approximately three weeks after the surgery before your most heavy activities are  resumed. Each patient’s symptoms and activities vary so this needs to be addressed on an  individual basis. Patients should increase activities as tolerated at three weeks within their  tolerance.  

Abnormal Hand Pain After Carpal Tunnel Surgery

Now we need to discuss abnormal early post-operative hand pain After carpal tunnel surgery. Keep in mind that these  complications are rare but need to be differentiated from normal post-operative pain.  

Nerve injury related to carpal tunnel surgery is extremely uncommon and is sometimes difficult to  separate from normal recovery of the nerve. Significant increased numbness in the hand or  individual fingers immediately after the surgery is concerning. Local anesthetic is used during  the surgery which causes numbness lasting sometimes 6 hours or more after surgery. Wait  until the effects of the anesthetic have worn off before deciding if there is increased numbness.  If this occurs the physician would want to have you come to the office in a timely manner to  evaluate the hand.  

Infection is another rare complication following carpal tunnel surgery. Patients who develop a  surgical site infection typically have increasing pain, swelling and redness around the incision.  Most patients need few, if any, narcotic pain medications after the surgery. If controlling your  pain requires more narcotics or other meds such as NSAIDs daily rather than less meds, this can be an early sign of a developing infection. Increased drainage from the incision, and fever  are also signs of infection but typically develop later than increase swelling, redness and pain.  If you develop any of these symptoms immediately call the office or physician on call to  discuss. 

Nerve Recovery Pain After Carpal Tunnel Surgery

One other symptom post-surgical that we should comment on is “nerve recovery hand pain” after carpal tunnel surgery. This is  not a complication but can be very disturbing for the patient.

When the ligament is released the chronic pressure on the nerve is removed. In the great majority of cases the patient’s numbness is resolved without nerve recovery pain. In rare cases as the nerve recovers it is painful.

Think about when your leg goes to sleep after sitting too long. The sensation to the  leg and foot is diminished. We get up and move the leg around to “wake it up”. During the  waking up phase you can get a burning or tingling sensation in the foot before it fully recovers.  This odd sensation similar to warming hands that got too cold can be very uncomfortable. This  is similar to what happens in some patients when the pressure is relieved from the nerve.  Fortunately this is transient and is a sign that the nerve is recovering. Most of the time this is  short lived but may have a more protracted course requiring treatment.

Dr. James Post is a member of the American Society for Surgery of the Hand and is board-certified in orthopedic surgery and hand surgery by the American Board of Orthopedic Surgery. Read more about carpal tunnel surgery and many other conditions of the hand and arm on our website.

Golfers Elbow Pain, or medial epicondylitis, is caused by trauma to the tendons that attach the forearm muscles to the inner side of the elbow.   This can be related to an acute injury but most often is related to overuse and repetitive stress to the tendon attachment.   Although it is often associated with golfers, medial epicondylitis is also prevalent in baseball, weight lifting and throwing sports.   Activities involving forceful, repetitive use of the elbow and forearm such as carpentry, painting and landscaping can be associated with the condition in some cases. 

Symptoms include pain on the inner side of the elbow often radiating down the forearm.  There can be a mild ache at rest worsened with use of the arm.  Wrist and elbow flexion with resistance such as lifting boxes, carrying groceries or moving furniture may cause increased pain.  The elbow may have a feeling of stiffness and there may be a loss of strength in the arm. Occasionally, irritation of a nerve close by can present with pain radiating into the hand and numbness or tingling in the small and ring fingers.  

What are treatments for Golfers elbow pain?

Golfers elbow pain symptoms may be mild requiring no treatment or simply limiting your activities, rest and icing.   If symptoms persist, splinting, non-steroidal anti-inflammatory medications orally or topically, and a home stretching program can be implemented.  Supervised occupational therapy (OT) or physical therapy (PT) can be added in cases that do not respond to a home exercise program.  Corticosteroid injections and rarely surgery are required in patients who are significantly symptomatic and fail to respond to less invasive treatments. 

Treatment of golfers elbow pain and tennis elbow pain is available at Raleigh Hand to Shoulder Center. Non-surgical options are available in our office. Surgery is offered at our surgery center, when needed. Our doctors are members of the American Society for Surgery of the Hand and our OTs are certified hand therapists.

If you have golfers elbow pain and cannot do the things you love, give our office a call to be evaluated by a hand and upper extremity specialist!