Years of labor likely cause of tingling
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?
DEAR READER: Your symptoms have all the hallmarks of carpal tunnel syndrome, which 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.
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.
A wrist brace is a good first treatment 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. 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.