Patient Information Resources

Alpine Physical Therapy
Three Locations
In North, South, and Downtown Missoula
Missoula, MT 59804
Ph: 406-251-2323
Fax: 406-251-2999

Child Orthopedics
Pain Management
Spine - Cervical
Spine - General
Spine - Lumbar
Spine - Thoracic

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I just came back from a hand surgeon's office where I was evaluated for possible surgery for a problem called cubital tunnel syndrome. I have some time to think this over before scheduling anything. The surgeon told me there can be problems with this type of surgery and that there is a chance I could get worse instead of better. How do I tell if I'm one of the people who would have complications?

Predicting complications with any surgical procedure is not easy and simply can't be done most of the time. Some of the more common complications following any surgery include infection, poor wound healing, damage to the blood vessels or nerves, blood clots, and in worse case scenarios, even death. There are what researchers call predictive factors that point to patients who have an increased risk of good or poor outcomes. For example, in the case of nerve compression treated surgically, studies show that patients who are depressed, have other mood disorders, or who have poor coping skills are less likely to have a successful result following nerve decompression surgery. Dissatisfaction with the results and disability are linked with these psychologic problems and may be the real key to poor outcomes. Patients should always be counseled (as you were) ahead of time that results of nerve decompression surgery are not always perfect or even satisfactory. A full recovery is rare. And even those patients who experience a good result at first often experience a return of their former symptoms. So, the question becomes -- were those symptoms there all along and the patient didn't realize it? Or are these symptoms a recurrence (the problem got better at first and then worse later)? The answer to this question is unknown. Certainly it is possible that the patient can be so hopeful for improvement that they felt a change in their symptoms even when there was no change in the nerve physiology or function. And it is possible that another problem is present (e.g., painful neuroma over the nerve) that could be adding to the persistent symptoms. But studies show that removing the neuroma or performing a second surgery to take pressure off the nerve doesn't seem to help. If anything, patients report worse results after revision surgery. In fact, it is more often the case that the symptoms of pain or numbness, weakness, and muscle atrophy (wasting) are permanent. It's possible the first surgery was unlikely to change anything. If there have been symptoms of nerve dysfunction for a long time before you ever noticed them, results may be less than hoped for. By the time the problem became obvious, damage to the nerve was permanent. Your surgeon is really the best one to advise you. Knowing your past medical history, current state of health, state of mind, and possible risk factors for a poor outcome will help him or her guide you in making the best decision for yourself and your situation.


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