Handling hand pain: Arthritis, carpal tunnel syndrome and more

Thanks for joining us June 1 for a live chat on hand pain issues with Dr. Paul Christo , a pain specialist from Johns Hopkins. Many people suffer from arthritis, carpal tunnel syndrome, tendinitis of the wrist, ganglion cysts and other conditions.

Christo is director of the Multidisciplinary Pain Fellowship Training Program at Johns Hopkins University School of Medicine. He also has a radio talk show Saturday nights on WBAL.

Read the transcript below.

Comments made here are for informational purposes only and do not represent or substitute as medical advice. Patients are advised to consult their own physician or pharmacist for advice, diagnosis and treatment.

 Health chat: Hand pain(06/01/2011) 
Baltimore Sun Health: 

Hi, Dr. Christo will join us at noon. But you can add your questions on hand/wrist pain to the queue now and we'll address them when the chat begins.
Wednesday June 1, 2011 11:30 Baltimore Sun Health
Baltimore Sun Health: 
Welcome to our live chat on hand and wrist pain. Dr. Christo, a pain specialist from Johns Hopkins will take your questions. Questions will be addressed based on first come and relevance to the topic. If an issue was addressed during a previous question, we'll move on to the next. So fire away.
Wednesday June 1, 2011 12:02 Baltimore Sun Health
[Comment From JanJan: ] 
Please explain "double crush" phenomenon....effects of elbow/shoulder issues on continued wrist pain/stiffness/numbness post carpal tunnel surgery.
Wednesday June 1, 2011 12:02 Jan
Hi, I look forward to your questions.
Wednesday June 1, 2011 12:02 drchristo
Jan, Double crush injury refers to carpal tunnel syndrome and nerve compression in the neck. Carpal tunnel may cause pain above the hand and rarely causes numbness above the carpal tunnel area. Nerve blocks of the carpal tunnel may sort out which injury is causing the pain. Usually, a carpal tunnel surgery is performed before a neck surgery due to the lower risk of side effects and disability. If you've had carpal tunnel surgery already, then a full work up of any spine or disc problems in the neck is probably indicated.
Wednesday June 1, 2011 12:07 drchristo
[Comment From DanDan: ] 
Are there external treatments for symptoms of DeQuervain's and EPL Tendonitis where there is enlargement of the Radius Styloid Process?
Wednesday June 1, 2011 12:08 Dan
Baltimore Sun Health: 

While Dr. Christo works on answer, here are some resources on DeQuervain's

Wednesday June 1, 2011 12:10 Baltimore Sun Health
Baltimore Sun Health:
Wednesday June 1, 2011 12:10 Baltimore Sun Health
Dan, De Quervain's Tendinitis occurs when the tendons around the base of the thumb are irritated or constricted. In fact, it occurs from inflammation and narrowing of the sheath surrounding the extensor pollicis longus (EPL) tendon. This causes pain and tenderness along the thumb side of the wrist often noticeable when making a fist, grasping, or gripping things, or when turning the wrist. Splints can be used to rest the thumb and wrist, anti-inflammatory meds by mouth are used, avoiding activities that cause the pain and swelling are recommended, and injection of steroids into the tendon sheath may help reduce swelling and pain.
Wednesday June 1, 2011 12:13 drchristo
[Comment From MoMo: ] 
Lately I have been waking up in the morning to painful numbness in my hands--mostly fingers, and the numbness does not subside quickly or easily. The numbness sometimes returns during the day for no discernible reason. I am a 50yr old caucasian woman, very physically active, and have been working on a home-remodeling project (sanding, painting, etc.)
Wednesday June 1, 2011 12:15 Mo
Your symptoms can be due to carpal tunnel syndrome (CTS) or ulnar tunnel syndrome among other possibilities. If you're positioning your wrist in a bent position for long periods during your home projects, this could be compressing the median nerve at the wrist (carpal tunnel syndrome) and causing the numbness. Other things like repetitive up and down movements of the wrist, repetitive motion of the fingers or forceful squeezing and releasing of a tool can also cause CTS. Ulnar tunnel Syndrome is usually due to things that use the palm of the hand like a hammer or with repetitive use of tools such as a screwdriver or pliers. I would have you primary care doctor examine you first to determine a diagnosis. Either of these two syndromes can be treated with splinting, anti-inflammatory meds, steroid injections, occupational therapy. Surgery would be a final option.
Wednesday June 1, 2011 12:22 drchristo
[Comment From DaisyDaisy: ] 
Dr. Christo, I have Fibromyalgia and it seems that whenever I complain about a pain, I am quickly told it is due to the Fibromyalgia. I have neck, shoulder, bicep, elbow arm and hand pain with my fingertips going numb mostly at night and when I wake up in the morning. Is there any way to tell whether these are all symptoms of my Fibromyalgia or it there is something else going on. I also have lower back pain and pain between the shoulders and am developing a hump. I can't recall the name of the disease an orthopedic doctor told me I had last year but he said there was nothing anyone could do about it and it would get worse. My mother had a hump as well. This was from X-rays.
Wednesday June 1, 2011 12:24 Daisy
Your symptoms sound like they're related to fibromyalgia. Patients do report tingling or numbness in their hands. I would try medications approved for fibromyalgia (lyrica, cymbalta, savella). Conditions like carpal tunnel, ulnar tunnel syndrome, neck problems, tendon disorders, or arthritic conditions in the hand typically cause pain and/or numbness in specific regions of the hand or fingers rather than numbness in the fingertips.
Wednesday June 1, 2011 12:28 drchristo
[Comment From mbcantonmbcanton: ] 
Can you discuss wrist pain associated with pregnancy and new moms?
Wednesday June 1, 2011 12:30 mbcanton
MB Canton,
Indeed, carpal tunnel syndrome (CTS) can occur in pregnancy or from thyroid disorders, and diabetes. The symptoms usually get better after delivery. Pregnancy can cause swelling of the lining of the tendon which puts pressure on the median nerve leading to pain, pins and needles, or numbness on the surface of the hand (thumb, index finger, middle finger, part of the wring finger, and most of the hand other than the part below the pinky finger to the wrist). If the pain doesn't get better after a month or two, have the symptoms evaluated.
Wednesday June 1, 2011 12:36 drchristo
[Comment From DBSDBS: ] 
I had a ganglion cyst on the top of my hand removed in September and how it's back. Should I go back and have it removed again or just live with it?
Wednesday June 1, 2011 12:37 DBS
DBS, Ganglion cysts are actually the most common of all benign hand tumors. They're commonly found on the wrist and cause pain when under pressure or when they compress tendons or nerves. I have had patients who undergo repeat surgery to remove these, but only if the ganglion causes discomfort . The surgery is done arthroscopically as well now. Talk to your surgeon about the risk of having the ganglion recur if you have it removed again. If it's note causing pain, then you may want to hold off on another surgery.
Wednesday June 1, 2011 12:42 drchristo
[Comment From DanDan: ] 
What preventive measures can a guitarist take to avoid injury from wide spreading of the fingers while the wrist is supinated? In other words, how can one recognize when he is exceeding his capacity before injury occurs? Can hand exercises increase finger spread safely?
Wednesday June 1, 2011 12:43 Dan
You could seek the guidance of an occupational therapist for specific finger and wrist exercises. When playing the guitar, the risk relates more to excessive flexion (bending) of the wrist for long periods. That could induce carpal tunnel syndrome, but I believe that occurs infrequently. I haven't seen many patients with chronic pain in the fingers or hand from guitar playing.
Wednesday June 1, 2011 12:50 drchristo
[Comment From columbiacolumbia: ] 
How long does it take for tendonitis to improve? My dr suggested wrist splints, naproxen, and ice. It's been approx. 2 months now, and while I'm OK with the splints on, I still get pain through my hand and sometimes shooting up my arm when driving, lifting anything more than 5 lbs, holding up a book to read to my three-year-old, etc.
Wednesday June 1, 2011 12:51 columbia
It can take several months for tendonitis to improve. Your symptoms sound like carpal tunnel syndrome, but you would need to see your doctor for a work up to establish the diagnosis. Splinting and anti-inflammatories sound reasonable. Sometimes, steroid injections around the tendon or affected nerve can also help to lessen the pain. If your symptoms continue for close to 3 months, consider seeing your doctor again for further diagnostic measures.
Wednesday June 1, 2011 12:55 drchristo
[Comment From JoeVJoeV: ] 
I just had surgery on both hands for trigger finger release. 9 weeks after the first procedure my finger is still swollen and stiff. How ling should it take to be “normal” again. I also have pain at the base of my thumbs, but I won’t do anything until my fingers are 100%. I¿ve read a lot but don¿t know yet if it¿s arthritis or carpal tunnel.
Wednesday June 1, 2011 12:58 JoeV
Joe V,
Trigger fingers (flexor tenosynovitis) treated with surgery usually produce very good results. Nine weeks sounds a bit long, so I would talk to your surgeon about what to do next. For mild symptoms, short term anti-inflammatory meds (e.g, motrin) can help with the swelling. Occupational therapy can be very helpful with restoring flexibility and motion of the fingers, but talk to your surgeon before beginning any therapy.
Wednesday June 1, 2011 1:04 drchristo
Baltimore Sun Health: 
That's all the time we have for today. Thanks for your questions.
Wednesday June 1, 2011 1:04 Baltimore Sun Health
Thank you for your questions today. I hope the session was useful.
Wednesday June 1, 2011 1:04 drchristo