Recovery after Carpel Tunnel Release Surgery

Question: I am a polio survivor who contracted polio at the age of two. I am now 61 years old. I started having pain after a fall two years ago and I’ve been told that I needed carpel tunnel release surgery. The muscle in my right thumb is starting to atrophy. I walk with two forearm crutches and have been using them since I was two. I never had any problems prior to my fall.

I am not 100% convinced that the pain is originating in my wrist. Also, the main concern that I have is that I am worried that after the surgery I may not be able to use my crutches and will have to be confined to a wheelchair.

I’ve tried to look up support groups to see if anyone in my situation can offer some insight to no avail. Any help or info you can give me will be much appreciated.

Marny Eulberg, MD: Your long-term crutch use does increase your risk of developing carpal tunnel syndrome (CTS). You did not mention how the diagnosis of CTS was made. If it was by EMG (electromyogram), then it is very likely that you do have CTS. No one can absolutely guarantee that having the surgery to correct CTS will solve the problem of your hand pain, but it is concerning to me that you are developing atrophy of your thumb muscles. If this is related to CTS, unless the pressure on the nerve is relieved the damage will be permanent. The longer the nerve has been compromised the longer it will take for any recovery to occur and as time goes on the odds that recovery will happen go down and down.

As for your concern about not being able to use your crutches, it is likely that in the immediate post-operative period (10 days to up to a month) the surgeon will not want you putting any weight on that wrist/hand and during that time you may need to use a wheelchair. Some of the newer methods of carpal tunnel release surgery such as using a small “scope” through a small incision rather than an open approach may allow you to resume using your hand/wrist sooner than in the past.

Frederick Maynard, MD: I agree with Dr. Eulberg that you are at high risk of developing carpal tunnel syndrome because of your years of walking with forearm crutches and that electrodiagnostic testing that shows severe compromise of median nerve function at the wrist with motor axonal damage to explain your thumb muscle atrophy would confirm your diagnosis of CTS and indicate an urgent need for a surgical procedure to release and decompress your median nerve at the wrist.

My experience with post-polio people like yourself who rely on forearm crutch use walking and who develop CTS suggests that an open surgical procedure to explore and decompress the carpal tunnel may be advantageous in the long run to the newer arthroscopic methods of carpal tunnel release because, after full post-operative healing, there remains adequate decompression of the nerve in spite of returning to heavy stress on the wrist again from crutch walking. Healing time is longer with the open procedures, but most surgeons will permit the use of the operated upper limb for immediate/early walking with the use of a platform crutch which creates weight-bearing of the upper limb throughout the forearm and avoids weight-bearing through the wrist. You could obtain such a crutch pre-operatively and learn to use it in advance in order to remain independent in walking post-operatively. A physical therapist and/or physical medicine & rehabilitation physician evaluation may be helpful in accomplishing all this.

Post-Polio Health (Vol. 39, No. 3, Summer 2023)