Dear Doctor: I'm a 75-year-old man who's done hard physical farm labor since I was a young boy. Now I have painful tingling, burning and numbness in my right palm and fingers. It disrupts my sleep and makes it difficult to hold a pencil. A hand brace doesn't help. Is it carpal tunnel syndrome? What can I do?
Dear Reader: Of course, I can't make a diagnosis without a proper examination -- and I would encourage you to seek one from your physician -- but your symptoms have all the hallmarks of carpal tunnel syndrome. This syndrome occurs because of compression of the median nerve at the wrist. As you look at the wrist with the palm side up, feel the multiple tendons in this portion of the wrist. The median nerve has to share space in the area called the carpal tunnel with nine of these tendons. When the wrist or the tendons within the carpal tunnel become inflamed, the median nerve gets compressed.
Because the median nerve supplies sensation to the thumb, index and middle fingers, compression of it can cause abnormal sensations, such as tingling, burning or even a loss of sensation. The median nerve also helps control the muscles of the thumb and, to some degree, the index and middle finger, so compression can lead to a loss of coordination and difficulty holding objects with the hand. This is most evident when using the thumb to hold an object such as a pencil or a cup. Many people with carpal tunnel syndrome have reported dropping cups.
The burning/tingling sensation in the hand is often noted upon waking -- sometimes causing the waking -- because the hands tend to flex at the wrist during sleep, leading to compression of the median nerve.
Repetitive and forceful use of the hand and wrist is a primary risk factor for carpal tunnel syndrome, as is working with tools that vibrate or that keep the hands in a fixed posture. Lifelong work in farm labor does have physical benefits, but it can take a toll as well.
Additional risk factors include diabetes, low thyroid hormone levels and rheumatoid arthritis, all of which can lead to carpal tunnel syndrome.
A wrist brace is a good first treatment for carpal tunnel syndrome because it stops the hand from flexing at the wrist, further compressing the median nerve. The next step would be physical therapy, though you should continue to use the brace at night. Treatments such as acupuncture and ultrasound therapy have shown some benefit in easing the symptoms of carpal tunnel syndrome, but more study is needed.
Steroid injections into the wrist can decrease swelling around the median nerve, usually providing a short-term benefit of one to three months. Physical therapy can enhance the benefit, but truly lasting improvement will generally occur with surgery that opens up the space around the median nerve.
Follow up with your doctor regarding these symptoms. He or she may suggest nerve-conduction studies to verify carpal tunnel syndrome and recommend a specific therapy that meets your needs.
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