Joe A Shaw PA-C - 9/29/2011

Question
Hello,
 I had a bike accident over 1 month ago. I hit a wall straight on. I put my left hand out to break my impact. Knuckles first. I had X-rays and nothing is broken. I had so much pain to the fact that nothing could even touch the top of my hand or the bottom.
I was sent to a hand specialist who sent me in to have a Motor Nerve Conduction and a EMG. The results came back. Mild Chronic nonfocal left ulnar neuropathy. I can not straighten my fingers very well without a lot of pain. It feels like ice is pouring through my forearm. Ok, the Doctor says it is Complex Regional Pain Syndrome. He would like to do a Cubital Tunnel Release Surgery  and a Carpal Tunnel Release surgery with possible Anterior Nerve Transposition. I am in PT right now for 2 weeks.

Since you have a lot of experience with Carpal Tunnel Release, can you ease my worries? I am afraid this will make the nerve pain worse. Have you ever seen these tunnel release's work for Complex regional pain syndrome?
 The nerve pain is getting worse as it seems to spread up my arm. I think it is just all the PT. I realize this is over the Internet but the Doctor says we only have a short window of time. Which makes me nervous to jump into 2 surgeries that fast. Thank you so much for your time.

Answer
If have some pieces of the puzzle that are not quite fitting together. I would get a 2nd opinion for sure. The first Doc might be right on the money..but a 2nd and 3rd opinion would be in order, if you are possibly considering two surgeries. Ulnar neuropathy typically gives you numbness and tingling into the 4-5th fingers...not much pain. CTS gives you N&T in the thumb,index,middle fingers.None of these should cause pain to oustide of knuckles or effect opening and closing hand that much. Your EMG did not show median damage per your account(this is where you would typically find CTS enough to do a release)
CRPS is perplexing at times and can mimic other conditions and vice versa.I would be very clear w your ortho as to what your expectations are AFTER the surgeries..50%,75% or 100% relief??
I don't know that I would expect a lot of relief from the CT release based on what you have described.My experience is that CRPS is usually diagnosed after a couple of mos,ie you have excluded everything else..not after 4 wks?