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Pillar Pain months after surgery.

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Approximately 6 months ago I underwent open CTR surgery on both hands.

The diagnosis was confirmed by an EMG and Nerve conduction study. This was directly following a traumatic event and after a second opinion, it was determined that I was suffering from "post-traumatic carpal tunnel syndrome".

I have not experienced any of the original symptoms since the release of both carpal tunnels and am thrilled to have had a favorable outcome in that respect.

I experienced pain and tenderness on either side of the incisions that did not seem to fade as quickly as the healing of the incision itself. I mentioned this to my surgeon and he advised me that this was a condition called "pillar pain" that happens occasionally in OCTR patients. He suggested I massage the incision vigorously as well as the surrounding areas that had pain and tenderness.

My concern now is that after doing the prescribed exercises and massaging my hands (even though it is painful, I stick to this regimen daily) as the surgeon suggested I am starting to reach a level of declining relief. Some 6 months later I am still suffering from pillar pain despite following all of the post-op advice to the letter.

The surgeon has recently released me after a discussion on the likelyhood that the pillar pain could very well be permanent. I was even given a permanent partial disability rating due to this and I have to admit it took me by surprise.

My question is what causes of pillar pain could make it permanent?

I'm certain the diagnosis (CTS) is correct considering all of the diagnostic evidence and the onset of this immediately following a trauma to both wrists. Steroid injections offered temporary relief (approx. 6 - 8 weeks) and were tried with multiple types in multiple sessions. Splints helped to some degree and unfortunately there wasn't much I could change about the use of my hands other than resting them considering it was a trauma causing this (I had no problems prior to this injury). I even tried physical therapy for several months doing specific stretching (nerve gliding) that offered some relief for short periods of time prior to considering surgery. I was aware of the "popular" complications with the operation and opted to accept these considering I had exhausted all non-surgical treatment avenues.

I wasn't very familiar with pillar pain or its causes because very little is mentioned on it outside of professional papers (per my internet search, and I cannot access these for details). Do some OCTR patients experience pillar pain permanently?

There isn't much literature on this available on the internet in regard to duration or what factors can cause this to be permanent.

I appreciate any response from people experiencing this specific problem or any professional insight on this topic.

*Edited to add further insight on the diagnosis*
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First Helper User Profile Gaelic
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replied October 29th, 2010
Hi i too had ctr on both my hands about 3 months ago...and pain after surgery.Even physical therapy didnt help and now almost 3 months after surgery i have been having severe pain in both my hands...this pain goes all the way up my arm to my neck and several visits to the doctor havent helped.Finally i went to a neurologist who repeated the nerve conduction study and diagnosis was the same as before the surgery.And the pain is getting worse.My physician has prescribed lyrica and iam going to see another hand specialist in a few days.I should never had opted for surgery..at least before i had stronger working hands and now iam handicapped and in trauma and depression.
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replied November 11th, 2010
I too have "Pillar Pain" - according to my Doctor, it is earlier (surgery was just 3 weeks ago) than most people get it - she suggested that I use aspercreme, ice and gentle rubbing to the effected area to alleviate the pain. These 3 techniques are helping a lot. She assures me that it will go away - Good Luck.
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replied August 19th, 2011
Post op CTS pillar pain
I too am experiencing pillar pain 2 months after carpal tunnel surgery. It's more painful that numbness i had before the surgery. No mention of possible pillar pain prior to the surgery. Going to the PT 2x a week now. The PA of the surgeon had the nerve to tell me I have high expectation for my healing. I 'm a dental hygienist and need strong hands for my work. I'm worried too that the pillar pain may not go away.
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replied February 24th, 2012
I'm a hygienist as well. I am 5 weeks post surgery,right hand only,and scheduled to return to work FT in 10 days. I was dx'd with pillar pain and was told to avoid massaging the specific area but it was ok to massage the surrounding areas and forearm. Oddly enough the workers comp doctor doesn't seem to be as concerned as my surgeon. I've been doing exercises on my own as PT can't get me in until 7 days before I'm to return to work!
My biggest concern other than the permanency is the lack of strength I have and fear that I will not be physically capable of instrumentation. My left hand was also tested positive for CTS but less severe than my dominant right hand but as you know, the other hand does just as much work. I am hesitant to move forward with surgery to my left hand.
I'm curious as to your recovery as there is very little I've found post surgery experiences for dental hygienists specifically. Thanks!
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replied August 19th, 2011
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manumon,

Physiologically, it takes about six weeks for soft tissues to "heal". While in carpal tunnel release (CTR), the nerve symptoms may resolve, or decrease significantly, very quickly, that is due to the compression on the nerve being alleviated.

The soft tissues (skin, subQ, fascia, muscle, tendon, ligaments, periosteum, synovial lining, neurovascular, etc) around the tunnel still have to go through the usual stages of healing.

At first, the researchers thought that pillar pain came from the division of the soft tissues superficial to the transverse carpal ligament (TCL). But, if this was true, then pillar pain should be significantly less in endoscopic CTR, than in open CTR. But, this did not prove to be the case.

Then, the researchers came up with the idea, that the pain was from a change in the bony architecture of the carpal tunnel. This is because the TCL makes up the volar (palmar) aspect of the carpal tunnel. It attaches to the hook of the hamate and the tubercle of the trapezium. The rest of the tunnel is bounded by the carpal bones. When the TCL is divided, it allows the tunnel to spring open slightly. Well, that's the theory.


It has been found that up to around 45% or so of patients will have pillar pain at one month post-op. However, this decreases gradually over time to less than 6% at one year follow up. In the few studies that followed patients longer than 3 years, these showed that the incidence of pillar pain had decreased to less than 1%.

Despite its prevalence, postoperative pillar pain remains a perplexing problem that has no reliable treatment other than the tincture of time.


You have a job that requires very fine, strong, and sustained movements of the hand and fingers. So, you may be putting extra stress on the muscles of the thenar and hypothenar eminences, exacerbating the pillar pain. These muscles connect to each other by a tendon that is right over the TCL, which has to be divided during the surgery. That is why it is often difficult (and painful) to touch the tip of the thumb to the tip of the small finger right after surgery. And you use that pinching type motion a lot in your occupation. I bet the muscles around the base of your thumb are really strong.

Another set of patients who also complain of pillar pain bothering them, are the ones who have to put a lot of weight on the palms of the hands, like when doing push-ups. The extra pressure on the base of the palm causes discomfort.


So, you will just have to give it more time, because that is all that can be done for pillar pain after CTR. The statistics are on your side, as very few patients have any problems with it as time goes by. Hope the pain goes down so you can do your job more comfortably. Good luck.



(*On a personal note: I had open CTRs done over 30 year ago. I got back to my job at the time of being an athletic trainer, in about 6 to 8 weeks. Right after surgery, I taped ankles with the help of the athlete - I would roll on the tape strip, but I couldn't tear the tape, so the athlete was handed a pair of bandage scissors. When I said "cut", he/she would reach down and cut the tape. It took a little longer to get the job done, but it got done. But, it was probably a good 4 months post-op before I really felt like I could do everything I needed to do. I had some pillar pain for about 6 months if I really pushed it. But, it did finally resolve completely. Or, I thought it had.

About 4 years later, I joined the military. During Officer Basic, we did a lot of push-ups, mountain climbers, squat thrusts, and other exercises that put calluses on the palms of my hands. Well, the pillar pain came back for a few weeks. I thought, "Oh great, not this again." But, it finally went away, again. I guess the hands just got used to the extra stress.

I haven't had any problems with pillar pain now, for over 26 years.)
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Users who thank Gaelic for this post: Paarna  purple99  tony66 

replied August 23rd, 2011
Thank you for your response. it gives me hope that this may go away in time. Not only do I use my hands when I work I love to golf and this has to be put off till I get my full strength back. If I had to give CPR to one of my patients I know this would be almost impossible at this time. It just bothers me that no mention of pillar pain complications prior to my surgery by the surgeon. My regular GP mentioned this was a post op complication.
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replied August 24th, 2011
Hello, I went to 4 sessons of Pt for my pillar pain.(no relief) I've been doing some research and help from professional atheletes I tried High laser therapy today for the first time. What a difference one treatment made. Insurance doesn't cover it , but I'm going every other day til the pain is gone. Dr. Anticipates 4-5 treatments should do it. More Pt's are starting to use cold laser which is low level laser about 500 nM compared to high level lasers(7,500nM). Their catching on slowly. Hope this helps anyone suffering from pillar pain.
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replied February 24th, 2012
CTR
Manumom, did the Pillar pain go away after the laser treatments?
Mine started 24 hours after surgery, and today is three weeks post surgery. How long did yours last?
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replied February 26th, 2012
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cowgirl99,

You are still within the physiological healing period of tissues. It takes at least six weeks for tissues to heal. So, you still have some healing to do.

Pillar pain is usually described as an aching pain, about a centimeter off to either side of the incision. It is not incisional pain. It can often be brought on by weight bearing on the hands or with strong grasping (such as using pliers or wrenches).


So, you may just need to just give it some more time to heal and rehabilitate. If you have recently increased your activity level, you may be doing too much, and need to back off a little.

However, since this has basically been going on from day one, if you think there is something else going on, you need to contact your hand surgeon. Again, three weeks is still within the post-operative period, but your pain should be getting less and less as time goes on.


Hope your hand feels better soon. Good luck.
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replied October 8th, 2012
still having pillar pain after carpel tunnel release surgery
I had surgery a little over 5 months ago and am still suffering with much "pillar pain. My doctor now wants to send me to a hand specialist, possibly for another surgery. Not sure what to do. Is it normal to still be having this much pain?
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replied October 11th, 2012
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LaJean,

While it is not "normal", it does occur. However, further surgery is usually not recommended for pillar pain.

It is usually felt that the pain at the base of the palm, along side the incision is mainly from the slight destabilization of the carpal bones after the transverse carpal ligament was divided. This is mostly an aching pain, which can be made worse with weight bearing on the hands (such as doing push-ups).


If the patient has the same type of pain as before surgery (from ischemia to the nerve from compression), that is different than pillar pain. If that is the case, then the nerve may still be under compression, and as such, further surgery may be needed.


While many orthopedic surgeons can do carpal tunnel releases, it is not as simple of a surgery as many state that it is. Which is one reason that many hand surgeons feel that, unless the orthopedic surgeon is very well veseded in hand conditions, that carpal tunnel releases should really be done by hand surgeons.


So, if you are continuing to have problems, and they are not really getting any better, you probably should be seen by a hand surgeon.

Good luck.
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replied October 17th, 2012
Thanks Gaelic for your good responses.

Getting follow-up appts with the surgeon is very difficult, and the literature often seems to contradict each other and not really describe our concerns.

I am 9 wks post-op with all seeming good the first 3 wks, then warmth, swelling, stffness, sharp thumb and deep hand pains, decreasing range of motion, and sometimes seeming negative impact from attempted massages, exercises, etc.

Most of us who have had cts for decades can tolerate fairly bad pain if we know that we are not doing more serious harm. But when it seems to accompany greater debility we know we better find out what to do and what not to do...

Paarna
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replied October 17th, 2012
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Paarna,

Sorry that you are having problems after your CTR.

From the description of your symptoms, there are a couple of things which come to mind. And, it depends upon what was happening at the three week mark.

If you increased your activity level significantly at about that time, you may have started up an inflammatory reaction around the healing tissues. At three weeks, though the skin is basically healed, the other soft tissues are not. It does take about six weeks for the soft tissues to heal physiologically.

However, this type of problem should respond to some rest, cutting back on aggravating activities, and maybe some NSAIDs. Along with the usual occupational therapy type of interventions as ice/heat, gentle range of motion, specific hand exercises, and the like.


But, if there really wasn't much of an increase in activity and the symptoms just appeared out of the blue, then one would have to check to make sure that you are not developing CRPS I (chronic regional pain syndrome type I). This was formerly known as RSD (reflex sympathetic dystrophy).

The usual presenting symptoms of this are pain out of proportion to what would be expected (by now, you should really not be having much pain at all), warmth, redness, swelling, symptoms seemingly made worse with manipulation or movement. The symptoms of CRPS I seem to get worse with time, rather than better, as would be the expected course after surgery.


So, if rest and decreased activity, judicious use of some NSAIDs, and then a gradual return to the activities you were doing before the symptoms started, does not do the trick, you probably need to see your hand surgeon.

Good luck.
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replied October 23rd, 2012
post-CTS Inflammation - specific hand exercises?
Thank you again, Gaelic.
Per your description, I surely used my hand for too much hard work within the first 6 weeks after surgery. (My surgeon had said I couldn't do it any harm... apparently not appreciating my reference to putting a new roof on my cabin, and other heavy jobs that needed to be done before winter.)
Your inflammation-from doing too much explanation seems to fit. Where might I find diagrams of appropriate specific hand exercises?
I had been doing the exercises described in END YOUR CARPAL TUNNEL PAIN WITHOUT SURGERY by Kate Montgomery, CSMT, HHP, ND, PKP, which seem to assume patients have desk jobs but otherwise seemed to make sense...

Again, thank you.
Paarna
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replied October 30th, 2012
Carpal Tunnel, Dequervain's,Trigger Thumb surgery pain
Hi everyone. I am a cake decorator and have made a living doing that job for nearly 40 years. I had to have carpal tunnel--AND Dequervain's release surgery on both hands; and trigger thumb release on my right hand (which also was the stronger of my two hands--even though I'm left-handed.) The surgery was done over 6 months ago, and I am still very much in pain especially on my right hand. The pain is such that I have trouble doing very normal activities such as washing dishes, using a stapler, and anything that requires certain movements especially with my right hand. I can use the computer fairly easily because it doesn't require that much dexterity--thank the good Lord! I lost my business, my livelihood, my home, and pretty much my whole life because of the surgery! My husband and I had to move out of the state where we were living, because we couldn't afford it. I no longer have any health insurance, so that just about counts me out of having anyone look at my hands or do any therapy on them. I'm REALLY frustrated to say the least, and I don't know where to turn. I have been looking for jobs in my area, but I can't even do simple things. My husband wants me to apply for some sort of disablilty, but I'm reluctant to do this because I am really hoping this pain will go away! I told him that I want to see if my hands get better in a few more months. I really don't know where to turn, because it's a difficult situation all around. I don't have money to throw around at lawyers, doctors, and such, so suggestions would be appreciated for sure. I hope all of you are doing better. God bless y'all.
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replied January 5th, 2013
Wrist pain 7 months after CT surgery
I had open CTR surgery on both hands last summer (7 months). I did PT for 5 weeks and my hands and wrists were feeling great when I was done. In the last 8 weeks, however, it has been more and more difficult to bend my right wrist back and forth without pain. It will really bother me for a few days then it feels better. Then it will happen a weeks later and this continues... I don't have any symptoms of CT (numb or sharp pains in fingers) but I don't know if this could be pillar pain or not? Any advice would be great!
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replied January 6th, 2013
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BSimm,

Pillar pain is usually pain along side of the incision when pressure is applied to the palm of the hand (just for example, such as when doing push ups).

Pillar pain is located on the sides of the incision, at the proximal end (at the base of the palm).

While the exact cause of pillar pain is unknown, it is theorized to be that there is a bit of instability in the carpal bone, due to the transverse carpal ligament being transected. When the tranverse carpal ligament is cut, the tunnel made up of the carpal bones and the ligament is no longer intact. Thus, the carpal bones are no longer being held tightly, thus it is theorized that this is what is causing the pillar pain.

But, other have theorized that it is due to cutting some of the tiny skin nerves or possibly disrupting the fascia and muscles of the base of the palm

Who knows.


But, pillar pain does not include wrist pain. So, you may be manifesting some wrist arthropathy or other condition within the wrist.

Sometimes, releasing the carpal tunnel will bring up some underlying wrist conditions.

If the symptoms do not do away shortly, you might want to see your hand surgeon about the new symptoms.

Good luck.
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replied April 5th, 2013
Pain after carpal tunnel surgery
I had carpal tunnel surgery about 5 weeks ago, after having been diagnosed 28 years ago. I put it off way too long, I know, am having pillar pain and just recently also a kind of electric feeling pain that seems to be right at the nerves from the base of my hands and a few inches up my arms.
I did some searching on this and read that it can be the nerves regenerating after having been compressed for so long. What is your opinion on this? I am reluctant to go back to my doctor, his only advice was,"If it hurts, don't do it." (I had to look online to find rehab exercises and post op instructions.) I am a shipping clerk and although I get help with the heavier packing duties for the time being I would really like to be able to get some ease from this discomfort. I am also a musician and have not been able to go back to performing yet due to the pain.
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replied September 21st, 2013
It will be 2 years in December since I had my 'open carpel release surgery' and have suffered with significant pillar pain ever since. I am unable to use my hand to open things like jars, or use it for anything that requires putting any pressure in my upper palm area. I have had to learn to use my left hand for the many things that I was once able to do. I went to physio for 5 months which did not help at all. Have been to a specialist and now after being on a wait list for almost a year am having an MRI done on Monday to see if they can see what the problem is. I am wondering if the theory of the bones becoming unstable is correct... is there a way that they can stabilize them? I am not saying that is what my problem is, as there could be other reasons ... but there must be something they can do.

After 2 years, I am sure hoping to get some answers and hoping even more for a solution because this really sucks!
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replied November 7th, 2014
Hearing that you're still having significant pillar pain two years later is scaring me to death. It's only been two weeks for me and it's getting worse by the day. I can't even see myself sane after two years of it. Everything I've found out about it including the actual issue called pillar pain was found by ME because I had to do my own research online. My Dr denied pillar pain for the entire two weeks following my surgery and only admitted it a couple of days ago when I got my stitches out. He hasn't given me any exercises, no suggestions on how to relieve the pain or get strength back in my right hand. I'm at a loss. Seeing my GP on the 12th to go over it and hoping for options. All the surgeon says is "give it time", "you're being impatient", "you're doing too much", as if the expectation that I could pull up a pair of pants or put on socks is too much, let alone the fact that I am due to go back to work on Monday. He also said he won't prescribe physical therapy for me so I'm on my own for any solution. If I had known this beforehand I wouldn't have had the surgery at all. This is so much worse than the carpal tunnel was.
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