Email a Friend
Print Article
Pain in the Hand: Additional Thoughts
Bloggers have pointed out correctly that cervical radiculopathy and/or thoracic outlet syndrome may be the problem causing pain radiating to the hands - and not carpal tunnel syndrome. That is why anyone with persistent symptoms should first be examined by an experienced doctor, hand specialist, orthopedic specialist or neurologist, or any specialist who deals with these problems on a regular basis.
There are tests which can confirm the diagnosis. The EMG is the definitive test for carpal tunnel syndrome. MRI may also be helpful in documenting other problems.
Anyone who has persistent pain and numbness in the upper extremity should try to perceive or localize where the problem originates - neck, wrist, elbow, etc. I know that pain radiates and it may not be easy to localize the originating site, but if you can, it is very helpful in diagnosing the problem.
Approach to treatment: Rest the hands and wrist - stop the offending activity for at least a short time. If possible, use splints to maintain extension of the wrists especially at night (flexion is thought to increase pressure in the wrists) and use mild anti-inflammatory analgesic medications i.e. Tylenol, Advil, etc.
I am not an advocate of injecting the carpal tunnel with steroids and I do not think massage will help in the long term either. B vitamins as suggested by a commenter may help - I'm neutral about B vitamins.
If there's no relief from rest, restricting activity, use of splints and mild analgesic and anti-inflammatory medications then consider surgical release. If there is persistent unrelieved pain which affects one's ability to function and use the hands, then surgery should be considered.
Surgery is designed to relieve pressure on the median nerve within the carpal tunnel. The thick covering over the carpal tunnel (volar carpal ligament) is opened and I also remove the lining around the nerve and flexor tendons. Most people are limited in the first week after surgery but by the 2nd or 3rd week function is normal.
Some commenters have reported that surgery has not helped. It's difficult to judge - presumably diagnosis was correct, perhaps the procedure was not complete or scar tissue formed, not a common problem. Lastly an individual may have waited too long and permanent damage to the median nerve occurred.
Related Topics:
Technorati Tags: carpal tunnel, hand pain
There are tests which can confirm the diagnosis. The EMG is the definitive test for carpal tunnel syndrome. MRI may also be helpful in documenting other problems.
Anyone who has persistent pain and numbness in the upper extremity should try to perceive or localize where the problem originates - neck, wrist, elbow, etc. I know that pain radiates and it may not be easy to localize the originating site, but if you can, it is very helpful in diagnosing the problem.
Approach to treatment: Rest the hands and wrist - stop the offending activity for at least a short time. If possible, use splints to maintain extension of the wrists especially at night (flexion is thought to increase pressure in the wrists) and use mild anti-inflammatory analgesic medications i.e. Tylenol, Advil, etc.
I am not an advocate of injecting the carpal tunnel with steroids and I do not think massage will help in the long term either. B vitamins as suggested by a commenter may help - I'm neutral about B vitamins.
If there's no relief from rest, restricting activity, use of splints and mild analgesic and anti-inflammatory medications then consider surgical release. If there is persistent unrelieved pain which affects one's ability to function and use the hands, then surgery should be considered.
Surgery is designed to relieve pressure on the median nerve within the carpal tunnel. The thick covering over the carpal tunnel (volar carpal ligament) is opened and I also remove the lining around the nerve and flexor tendons. Most people are limited in the first week after surgery but by the 2nd or 3rd week function is normal.
Some commenters have reported that surgery has not helped. It's difficult to judge - presumably diagnosis was correct, perhaps the procedure was not complete or scar tissue formed, not a common problem. Lastly an individual may have waited too long and permanent damage to the median nerve occurred.
Related Topics:
Technorati Tags: carpal tunnel, hand pain
