Dr. Roach: Nerve compression at wrist causes carpal tunnel syndrome
Dear Dr. Roach: I am a 78-year-old woman. Last September I had severe pain in my right hand. The pain was so bad that I had to go to the emergency room, where they did an MRI. Results showed I have cervical radiculopathy, a pinched nerve in my neck. They put me on hydrocodone and prednisone. A few days later I had extreme pain in both upper arms. My doctor sent me to a neurologist. After her consultation about a month later, she had me take two tests, EMG and NCV (not sure what those stand for). It was a needle test and a shock test. I was told I had carpel tunnel syndrome in my right hand. I have been referred to a hand surgeon.
However, the neurologist has no idea what is causing the upper arm pain. My question is if the hand pain and possibly the arm pain is from my neck, will carpel tunnel surgery in my right hand help my arms too? Or do I have two different problems. Do I need neck surgery for both problems?
Dear R. M.: The nerves of the body carry pain signals to the brain. When a nerve is damaged, the brain usually registers the pain from the area of the body the nerve supplies, but there are times when the location of the pain differs a bit from what is expected.
In your case, you have two different nerves that are being damaged. The nerve in the neck — which is usually compressed by a disk or by arthritis in the neck — often causes pain in the shoulder, arm or hand. Carpal tunnel syndrome is when the median nerve in the wrist is compressed by excess pressure in a tunnel of bone and connective tissue. The pain of carpal tunnel syndrome is usually in the thumb and middle three fingers of the hand, but occasionally goes up to the elbow. In the rare instance, it’s felt above the elbow.
Electromyography and nerve conduction velocity (the EMG and NCV) tests should show which specific nerve is being affected and where the compression is. It is concerning to me the neurologist isn’t sure where the pain is coming from. If the hand pain is due to a problem in the neck, carpal tunnel surgery will not be helpful in relieving pain. The hand surgeon should not do surgery unless there is clear evidence that there is damage to the nerve.
The pain being in both upper arms suggests to me that the cervical radiculopathy is more likely the cause, but I would not proceed with any surgery unless your neurologist is convinced that the surgery will help.
Dear Dr. Roach: In one of your past columns, you referred to sleep medications that are not associated with dementia. However, you did not mention names of any of the medications. I have tried many “natural” sleep aids, and none works. Any suggestions would be appreciated!
Dear G.: The association between many sleep medications and later development of dementia certainly exists, although it is not clear that taking the medicines causes that increased risk. It may be that people who are in the very earliest stages of dementia are more likely to take sleep medications, causing an apparent risk.
However, the evidence is mounting that certain medicines, those with anticholinergic properties, may indeed predispose people to dementia. This group includes many over-the-counter sleep medicines, such as those containing diphenhydramine. I don’t recommend these for regular use.
I try not to prescribe sleeping medicines at all. I don’t know of any sleep medication that is both completely safe and highly effective. Many people do well with sleep hygiene techniques. Melatonin does not seem to increase risk of dementia or falls, but it does not work for many people.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.