Doc: Physical exam can diagnose carpal tunnel syndrome
Dear Dr. Roach: Recently, I was diagnosed as having carpal tunnel syndrome. It seems to be getting worse, despite my having been given a cortisone injection in my wrist and wearing a sling when I sleep or do repetitive work, as advised by my primary and orthopedic physicians. I would appreciate any advice from you and would like your opinion on whether surgery would be advisable. The condition is in my left hand, but I’m not left-handed. I seem to feel the most pain while in bed, and it often keeps me from getting a good night’s sleep. My symptoms run the gamut from numbness and tingling to pain and stiffness. I’m now starting to get some numbness in my right hand, as well.
Can this condition be present in both of my hands? Could this be something other than CTS?
Dear B.B.: It could very well be carpal tunnel syndrome, which is caused by compression of the median nerve in the carpal tunnel, an anatomic structure in the wrist. You have identified some of the major symptoms: pain (usually in the thumb, index, middle and half of the ring finger, often radiating up to the elbow, but rarely above), tingling sensation in the same distribution, and with severe disease, weakness and atrophy of the hand muscles (specifically the large muscles at the base of the thumb, called the thenar eminence).
A physical exam usually is sufficient to make the diagnosis; however, I would not recommend surgery without a definitive diagnosis, which can be made by an electromyography test. An EMG can differentiate carpal tunnel syndrome from other causes, such as compression of the nerves of the brachial plexus, in the axilla, or of the nerve roots as they exit the cervical spinal cord in the neck.
The relief from injections in the wrist seldom lasts for more than a few months, and braces and lifestyle changes also sometimes are ineffective, though they are always worth trying. Surgery is effective about 98 percent of the time, as long as the diagnosis is correct.
Dear Dr. Roach: After being stuck in a hospital bed battling a painful bout of constipation — winning with the help of stool softeners, grunting and not a small amount of anguish — I finally took the advice from caregivers to drink prune juice at breakfast. Although difficult to stomach initially, it grew on me, and it works. It is a wonderful combatant to constipation! I now drink about 4 ounces every morning. Constipation is no longer a problem. Please extol the virtues of prune juice and how it works.
Together, we can up the prune juice industry significantly. It’s time to buy prune juice supplier stock.
Dear H.R.: Prunes contain several naturally occurring laxatives, including sorbitol and phenolic compounds. Prunes themselves have a lot of fiber, but most juices have the fiber removed. Prunes and prune juice have been shown to be a safe and effective treatment for constipation, and they raise the blood sugar only modestly. Some data suggest that prunes may have benefit in preventing bone loss.
Mixing with water and drinking it cold can make the juice more palatable for some people.
I know you are joking, but I don’t have any financial relationship with any pharmaceutical or nutrition company that I know of.
Email questions to ToYourGoodHealth@med.cornell.edu.