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Ask the doctor: How can I stop my fingers tingling?
By Dr Martin Scurr
Updated: 00:27 GMT, 8 February 2011
Dr Martin Scurr has been treating patients for more than 30 years and is one of the country's leading GPs. Here he answers your questions...
Some months ago, I started to experience tingling and numbness in my fingers.
I’ve been diagnosed with carpal tunnel syndrome in both hands.
The tingling sensation has eased, but it’s been suggested a steroid injection or surgery might help (but is unlikely to provide a long-term cure).
Can you give me any other advice?
Adrian Smith, Stourbridge, W. Mids.
Dr Scurr says...
Tingling fingers: Carpal tunnel syndrome occurs when a nerve is compressed in the wrist
Carpal tunnel syndrome is the term for pain, tingling and numbness in the median nerve in the hand. This is one of the two main nerves of the hand, dealing with the thumb, index and middle fingers.
The problem occurs when the nerve becomes compressed as it passes through the carpal tunnel in the wrist. The tunnel is formed of a semicircle of bones, with a ligament for a roof. Competing for space in this tiny space are other nerves, tendons and blood vessels, so it’s a tight squeeze.
Anything that causes the soft tissue in the wrist to swell, or the carpal tunnel to reduce, can put pressure on the median nerve.
So inflammatory conditions, such as rheumatoid arthritis or gout, are potential causes (due to swelling of the nearby joints), as are an underactive thyroid gland, diabetes and acromegaly (when your body produces too much growth hormone), fluid retention (such as with heart failure or pregnancy) and repetitive forceful movements of your wrist (such as using a tool).
Typically, the symptoms wake you at night, with burning pain, along with tingling.
Shaking the hand for a few moments relieves the discomfort and restores sensation.
If the nerve has been compressed for months or longer, the muscles by the base of the thumb can waste, leaving the thumb weak when trying to grip.
The condition is diagnosed on the basis of the history of symptoms and examination.
CONTACT DR SCURR
To contact Dr Scurr with a health query, write to him at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email firstname.lastname@example.org - including contact details.
Dr Scurr cannot enter into personal correspondence.
His replies cannot apply to individual cases and should be taken in a general context.
Always consult your own GP with any health worries.
Treatment involves eliminating any underlying cause, though in most cases there’s no obvious trigger. In this event, the problem often resolves itself spontaneously after a few months.
However, if it’s interfering with sleep, wearing a splint at night to maintain the wrist at a neutral angle (fairly straight) helps half of people in a month or two.
It’s also essential to minimise activities that might be contributing, notably the use of computer keyboards.
If a wrist splint doesn’t help then typically you’re offered a steroid injection into the carpal tunnel. This reduces the swelling and most people respond well. However, you can suffer a relapse.
A minor operation — under local anaesthetic — is a safe and straightforward option.
This involves an incision of less than 2 cm in the wrist; the roof of the carpal tunnel is then cut through to create a little more space, reducing pressure on the median nerve.
This heals quickly, though the sensations caused by the months of nerve compression might take some weeks to resolve fully.
Surprisingly, the function and strength of the wrist joint and hand are unimpaired.
From your description, it sounds as if your symptoms are abating and you are one of those who will experience a spontaneous recovery.
To help the improvement along I’d consider a wrist splint. A chemist can supply you or, better, a physiotherapist can make sure it is fitted properly. Your GP might agree to referral for this.
I’ve recently been diagnosed with abdominal aorta enlargement (6 cm), but have been turned down for surgery because it’s too risky.
I’m 86 and like to play golf, albeit using a buggy.
Are there any measures I need to take to avoid unnecessary risks?
John Brewer, Bristol.
Dr Scurr says...
The abdominal aorta is the main artery running down through the centre of the abdomen — it divides in the pelvis, with each branch supplying a leg.
The aorta is usually about 2.5 cm in diameter. However, yours has stretched to more than double that due to weakness of the wall of the artery, a weakness with which you will have been born.
This is known as an aortic aneurysm. It occurs from middle age onwards and the most common location is the lower part of the abdomen, just below where the aorta branches off to the kidneys.
You can also get an aneurysm in the chest as the aorta emerges from the heart. In some patients, the entire artery is affected.
Around 2 per cent of people are thought to have aneurysms of the abdominal aorta.
Usually these are detected by chance when a patient is having an ultrasound scan
or imaging for some other reason — abdominal pain, for example.
An aneurysm does not usually cause pain, or any symptoms. If it’s less than 5 cm, we usually keep an eye on it with ultrasound scanning every six or 12 months; many increase only very slowly or even remain static.
However, once the diameter reaches 5.5 cm or over the risk is that the blood vessel will rupture. Preventative surgery should be discussed (the risk of rupture in aneurysms under 5.5 cm is 1 per cent; this rises to nearly 20 per cent for those of 7cm).
This is a major operation, not without risk — which is increased if you have high blood pressure, chronic lung trouble, kidney failure or a history of heart attack.
In your case, the balance of judgment has been against an operation. Increasingly in the past few years a minimally invasive procedure has evolved for elderly patients such as yourself — here a stent graft (a long tube) is inserted, under local anaesthetic or a light general, via the artery at the top of the leg.
Around the size of a banana, once placed, the device acts as scaffolding to give strength to the failing aortic wall.
The body lines it with new cells to form a new endothelium, or lining membrane, over a number of weeks.
My most recent patient to have this done was given a prosthesis tailored exactly to the size and shape of the aneurysm.
Sophisticated scanning technology allowed suitable planning and the frail patient was home on the second day.
It could be that, in due course, you will be offered this. Equally, it might have been considered, but there are other contraindications of which I’m unaware.
Whatever the case, do not treat yourself like a piece of fragile china: go on with life as normal, play golf, do all that you feel able or inclined to do.
Your doctor will be monitoring your blood pressure (this should be controlled below 140/90). I would advise, though, against heavy lifting.
By the way... I've seen the tragedy of obesity close up
Ambulance crews are having to be equipped with heavy lifting gear and special vehicles because patients are much more obese.
In the past, heavy patients were 13st to 15st, but now 15st to 20st is common, and this is causing problems.
One of my patients recently called me early one morning because he had developed acute diarrhoea overnight.
Obesity is on the rise... and Dr Scurr gives an example of a tragic case where a patient was so overweight, they could not get him to hospital on time
When I arrived at his house he was sweaty and worryingly pale. He was suffering from melaena, the black diarrhoea that is the hallmark of gastro-intestinal bleeding.
I discovered that a few days earlier he’d put himself on low-dose aspirin for no other reason except that, being grossly overweight, he was worried about his heart. He was one of the unlucky ones, because the aspirin had caused his stomach lining to bleed.
I measured his blood pressure; worryingly low; pulse, worryingly high. His body was in what we call surgical shock, and he urgently needed fluid put into his circulation with a drip.
The paramedics arrived within minutes but, as the patient weighed 24st, they were unable to lift him.
We called the fire brigade, and four officers arrived — by then there were eight of us in a tiny room — but in the 20 minutes it had taken for this extra help to arrive, the patient was sinking fast, despite the drip I’d inserted.
That itself had been far from easy, as finding a suitable vein in a fat person can be very tricky indeed. The four sturdy firemen could lift the patient, but they couldn’t fit down the staircase as a group. In the end, the only way we could extract this mortally ill man from the house was to slide him down the stairs in a body bag — bump, bump, bump. What a ghastly, ugly, tragic and painful way to be handled.
He required emergency surgery, during which he had 24 units of blood. Sadly, he died on the operating table during a second operation the next day.
When we are told about the perils of obesity we hear about diabetes, arthritis, heart attack or stroke.
Yet simple, practical issues can be the cause of tragedy, such as the delay in getting to hospital or in reversing surgical shock because of the difficulty in inserting a drip — both of which contributed to the death of this individual.
These are the factors most people never consider. Please don’t let yourself get fat.
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