For over ten years, I suffered from Carpal Tunnel Syndrome.
When I was first diagnosed, my doctor recommended wearing wrist braces for as many hours as I could during the day, and every night. What an inconvenience, but the braces actually made a difference.
Over the years, I decreased daytime usage and only wore the braces at night. Without them, the numbness would wake me up and I have enough trouble sleeping as it is (see Insomnia for that tale). I discovered certain projects and activities requiring a great deal of hand work, like staining and sanding furniture, painting rooms, and my favorite, gardening, made my fingers go numb. When possible, I would wear the braces during these activities, even if it meant wearing latex gloves over the braces.
Last summer, I’d had enough and asked my doctor to referral a surgeon. The surgeon ordered a nerve study, in which the technician attached little electrodes here and there and sent electric current through them…shocking! Not the worst test I’ve ever had done but it rates in the top five. Results indicated little to no nerve damage in my left hand, and moderate damage in my dominant right hand. I decided to only have the surgery on my right hand.
So what about the TMJ you ask? Let’s back up a little. I’ve had TMJ for as long as I can remember. Occasionally, my jaw would lock in an open position when having dental work done. Chewing gum and other tough foods like meat and some breads would hurt or make my jaw click. Knowing my condition, my dentist gives me breaks during treatments. A few weeks prior to my carpal tunnel surgery, I had a tooth extracted. It involved a few visits because time is needed to allow the extraction site time to heal before making an impression for the permanent bridge. Have I lost you yet?
Well, before the CTR surgery, I had a pre-surgery appointment with a surgical nurse. One of the questions specifically asked about TMJ. When under anesthesia, there is concern with pressure on the jaw during intubation. I pointed this out to the nurse. The morning of the surgery, a different nurse went over the paperwork with me again, and once again, I made reference to my TMJ. Next came the anesthesia nurse, again I pointed out that I have TMJ. And finally, the surgeon came in to review the notes, and yet again I reminded him of my TMJ.
Off I go for a fifteen minute procedure and was under anesthesia for about an hour. When I woke up in recovery, DJ was with me. He asked how I felt, but when I tried to talk, I couldn’t open my mouth more than an inch. I told the nurse, and her response was that it would probably clear up in a few days. I was given a list of things to watch for, and told if I had any problems to call right away.
Well, it didn’t clear up. I had difficulty chewing, swallowing and talking. Three days later with no improvement, I called the surgeons office. I explained the situation to the nurse, who told me it wasn’t due to anything they did, and no one has ever had that complaint before. Hmmm.
The end of the next week, I had a dentist appointment to take impressions for my permanent bridge. I called the dentist to explain my dilemma and she asked me to come in right away to take a look. She referred me to a Physical Therapist for evaluation and treatment, and rescheduled my appointment. I started PT two days later and was told I would likely need treatment for four to six weeks. I could expect relief in about two or three weeks.
Meanwhile, a week passes and I return to the surgeon to have the dressing removed. They were surprised I still had trouble, but because it had nothing to do with the surgery, there was nothing they could do. My wrist was re-wrapped in the ace bandage and they sent me on my way. I returned the next week to have the stitches removed.
Once that happened, I began working to rebuild the strength in my hand. Almost immediately, I had pain from what felt like a bone chip at the joint where my pinky finger attached to my palm. So, I called the surgeons office and was told by the nurse that it wasn’t due to anything they did (where have I heard that?), since they only worked on my wrist.
At this point, I still couldn’t to eat without pain and DJ had to cut my food in tiny bites. Brushing my teeth hurt, and yawning was excruciating. I went to PT three times a week, which actually felt wonderful. Nearly three weeks into therapy, progress was slow, but my mouth was opening a little more each day. Finally, I could open enough for the dentist to take impressions for the permanent bridge.
But my drama wasn’t over yet. The pain in my pinky joint decreased as I rebuilt muscle over the bone, fortunately that problem resulted from muscle atrophy. My pain and suffering hasn’t ended yet. Pushing off of anything, a wall, the steering wheel, or the arm of a wooden chair is painful in my palm. So, I call the surgeon.
He orders an X-ray to see if he might have fractured or cracked something. After two trips to the lab for X-rays, the surgeon still has no definitive explanation, and therefore, no treatment. I agreed to an oral steroid for 6 days, if that didn’t improve may pain then he didn’t know what to do. I cancelled a follow-up appointment for a month after completing the steroid treatment since the only improvement was in the flexibility of my wrist, but not the pain. And, no word since from the surgeon to see how I’m doing or why I cancelled.
Bottom line? Would I recommend CTR surgery? Yes, absolutely. I haven’t had numbness from day one. Would I recommend my surgeon? Um, NO, duh. If you have TMJ, I advise for ANY surgery requiring anesthesia, to make sure everyone involved knows you have TMJ. You might even print this article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1993864/; sure it’s technical, but it is in doctor speak, so they should understand. All I’ve read on the subject indicates it is more common that most doctors realize.
Finally, if you ever do have a problem with TMJ and surgery to correct the joint, or mouth devices to correct jaw alignment are cost prohibitive, I highly recommend asking your dentist for a referral to a Physical Therapist who specializes in TMJ. It’s usually covered by most insurances, whereas the devices and surgery are not. My therapy lasted eight weeks. After about three weeks I could open my mouth completely, but still with pain. At the end of treatment, I only had minor discomfort.
The surgery was September 29. As of this post date, yawning is still bothersome, and I can’t do push-ups (not that I’d do them anyway). Perhaps I’ll update in another month.