Doctor Says

Nerve problem likely cause of symptoms

Your polyclinic doctor is right.

The symptoms are usually due to a problem with the nerves.

There are a few common possible causes for your symptoms.

CARPAL TUNNEL SYNDROME

One of the main nerves in the hand, the median nerve, gets pinched while passing through a naturally occurring tunnel formed by bones and strong fibrous tissue at the front of the wrist, called the carpal tunnel. Overuse of the hand - from excessive housework, for instance - pregnancy or a wrist fracture can cause the tissues in the wrist region to swell and squeeze the median nerve. This results in numbness, usually of the thumb, index and middle fingers, and side of the ring finger. The symptoms usually occur in the early hours of the morning, but may last for many hours.

In severe cases, there can be loss of muscle bulk at the base of the thumb, and even hand weakness.

You can test if you have this condition by performing a nerve conduction study, where small electric currents are applied to the nerves in the hands and elbows to see if electrical impulses are slowed in the carpal tunnel.

CARPAL TUNNEL SYNDROME WITH RHEUMATOID ARTHRITIS

A type of joint problem called rheumatoid arthritis can cause a similar swelling of tissue at the wrist as explained above, as well as stiffness (like the "frozen" feeling) and even pain in the joints on the fingers, especially in the morning. X-ray scans of the hands and blood tests for erythrocyte sedimentation rate and rheumatoid factor may be helpful in making the diagnosis.

GENERALISED NEUROPATHY

All the nerves in the limbs are affected, causing numbness or tingling, usually in the feet and, as time passes, in the hands too. In some people, there is weakness of the limbs as well, and muscles may shrink.

The symptoms can occur at any time of the day, and are persistent.

The most common cause of peripheral neuropathy is longstanding diabetes mellitus.

As you have not mentioned numbness of the feet, it is likely that you do not have this. However, patients with a generalised neuropathy are at higher risk of carpal tunnel syndrome. This condition can be tested for by performing a nerve conduction study.

CERVICAL SPONDYLOSIS WITH RADICULOPATHY

Degeneration of the neck spine, known as the cervical spine, is more common as you get older or if you have had a previous neck injury.

The body spurs or slipped or bulging discs can squeeze the nerves as they exit the spine on their way to supply the arm and hand.

The arm, including the hand, may be weak or numb, depending on which nerve is squeezed.

I note your X-ray findings of "wear and tear", so you probably have some spondylosis. If needed, a magnetic resonance imaging scan can be performed to study the bones, nerves and tissues in the neck in greater detail, as an X-ray scan only reveals bone structure.

Many patients have more than one condition, but only one of them may be the main cause of your symptoms. You should see a neurologist for a thorough assessment.

In the meantime, if you feel you are getting worse, see your polyclinic doctor again soon.

As you are likely to have carpal tunnel syndrome, try to reduce excessive use of your hands . This may reduce your symptoms until you see your neurologist.

Dr N. V. Ramani

Specialist in neurology and consultant at Raffles Neuroscience Centre

A version of this article appeared in the print edition of The Straits Times on February 23, 2016, with the headline 'Nerve problem likely cause of symptoms'. Print Edition | Subscribe