Thursday, December 05, 2019

A woman once walked into my office and told me that her hands hurt. At first I did not think much of it, after all I am a hand surgeon and many of my patients come in with that very complaint. I asked her the usual questions that a complaint such as hers triggers. Have you had an injury? Do they wake you up at night? Do they feel stiff when you wake up in the morning? Do certain specific activities cause you to have to reposition your hands or shake them out? Do they get numb? To my surprise she answered no to all of them. As we talked more about this she told me that for the last 5 years or so she had been having this problem, but that over the previous 6 months it had worsened significantly causing her to be quite concerned. She also pointed out that she had seen two hand surgeons over the previous 5 years who could not explain her hand problems. They sent her for nerve testing as well as x-rays and even an MRI of both of her hands. They found nothing and they offered her no diagnosis and no treatment plan.

Though she was quite frustrated, she told me that what really scared her was that the problem had gotten so severe that she often found that she didn’t even notice things slipping out of her hands. She had broken more China in the last 6 months than she could keep track of and she had burned herself cooking for her family a number of times and had not even noticed it. Her husband had grown so concerned that she had developed a neurological problem that he suggested that she see a neurologist urgently. She explained to me that this was why she was in my office and that this was a last ditch effort to calm her fears and convince herself that this was a localized problem confined to her hands, rather than a terrible neurological condition as she and her husband feared. Shortly thereafter I examined her and there were telltale signs of what her problem might be, but this was certainly not a textbook case.

After a long discussion about what I felt was carpal tunnel syndrome, with relief shining through a cloud of skepticism, we agreed to start treatment. Though I felt that with the severity and duration of her symptoms her best bet would be a common 15-minute carpal tunnel surgery, given her previous experience we settled on a course of non-operative treatment to start. She wore nighttime splints and began a course of occupational therapy, a regimen that when instituted early is often all that is needed to treat this condition. Over the next few weeks she found that though her hands felt better things still did not feel right.  At that point she underwent outpatient carpal tunnel surgery, and I am glad to say that she has purchased more china since both of her hands have recovered completely.

Carpal tunnel syndrome is a common problem that affects many people of in all age groups. If you are concerned about a problem with your hands seek treatment early. Though its presentation is quite variable, if treated properly early on many of the scary symptoms can be avoided completely and often surgery can be avoided as well.

Dr. Michael Horowitz can be reached at: 201-510-3777 or you can visit his website at: www.centerforhanddisorders.com

By Michael Horowitz, MD