Carpal tunnel symptoms and PMR: What choices do I have?

Posted by pfafpa @pfafpa, Aug 12 10:20am

I had reduced Prednisone from 40mg to 3 before I started to get some numbness in my right (dominant) hand. I thought perhaps I cut off circulation while sleeping, but as I decreased the Prednisone to zero the hand got worse. My rheumatologist urged me to stay off Prednisone if possible and see a hand specialist, which I am doing tomorrow. In the meantime, I have discovered that 2 1/2 Mg knocks out the pain. So now I have to choose whether to stay on Prednisone and manage the pain, or treat the CPS with surgery or other modality. I’m semi-retired and do nothing repetitive that could cause CPS except perhaps golf, which I have played 50 years with no CPS. Anyone else faced this dilemma?

Hello @pfafpa, You will notice I changed the title of your discussion to hopefully help members find the discussion a little easier. I also have carpal tunnel syndrome and PMR but my PMR is in remission. I have episodes with my hands probably due to keyboarding for many years in a computer related job and hobby. I used to play golf a lot when I was younger but haven't played for years. Your question peaked my interest so I was able to find a reference supporting golf as a cause of carpal tunnel syndrome — Carpal Tunnel Syndrome and Golf: https://golfoperatormagazine.com/carpal-tunnel-syndrome-and-golf/. For me the CTS symptoms seemed distinctly different than my PMR symptoms. The CTS was more numbness in the hands and wrist and the PMR was pain in all of my joints but mostly in the shoulders, arms and legs. Because I still have the CTS and have never had the surgery I still have numbness in my hands and wrists but it is something I've learned to live with as it's worse some days but not all of the time. It's especially bad if I've slept on my arm/hand on my left side.

You may find the follow CTS related discussion helpful.
— Carpal tunnel release: https://connect.mayoclinic.org/discussion/carpal-tunnel-release/
— carpal tunnel surgery side effects: https://connect.mayoclinic.org/discussion/carpal-tunnel-surgery-side-effects/

@dawn_giacabazi, @IndianaScott, and @bernese53 may be able to share their experience with Carpal Tunnel Syndrome and prednisone also.

It sounds like you are debating whether to have the CTS surgery or continue to take prednisone to treat the pain. Are you worried about the long term side effects of prednisone?

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@pfapfa I had carpal tunnel pain come on very quickly requiring bracing back in 2003; by early 2004 it required surgery. The surgery was very simple (I watched!), and recovery was quick. I'd urge you to go ahead with the surgery.

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Hi @pfafpa & Thank you John for the tag 😉 @johnbishop
I am a Certified Nurses Aide by trade and currently over use my hands daily – I care for many patients every day and teach transfers to staff, patients and caregivers daily and utilize computers to document everything daily. By the end of my day I can barely lift a 4oz glass of water.

My experience with carpal tunnel is a bit different as I do not have PMR. I have bilateral CTS and DeQuervain tenosynovitis. Although CTS is one of the most common workplace injuries, it is not as common as people think. It is estimated to affect roughly 8 million people in the United States, but if consider the total population it only equates to about 2.5%. Because there is some overlap in symptoms, it’s understandable who actually have wrist tendonitis may confuse it with CTS.

The key difference lies in the location of the pain. I was told by my doctor that CTS is felt on the palm side of the wrist and in the thumb, index and middle fingers. When pain occurs on the other side of the wrist, it likely tendonitis or another nerve problem. A common sign of wrist tendonitis is numbness in the pinky finger. This symptom does not overlap with CTS because the median nerve does not reach the pinky.

Now to add yet another twist to finding a differential diagnosis I currently am suffering with a flare up DeQuervain’s tenosynovitis. Which mimics a lot of the symptoms of CTS and often sends me to bed in tears. I have been in physical therapy 3 times a week for treatment for over 3 months with very little relief. I see the orthopedic surgeon next week and am very eager to see him.

There is a very special test my orthopedic does that tells him exactly what the cause is. The most common test is called the Finkelstein maneuver. Your clinician will have you make a fist with your fingers closed over the thumb, then quickly bend your wrist down toward your little finger, pulling the tendon through the narrowed sheath. This movement is quite painful in people who have de Quervain's tenosynovitis. I had it in my right hand about 3 years ago and now it plagues me in the left. In the past a special hand brace designed much simpler to CTS brace provided much needed rest and relief and doc prescribed Methylprednisolone (Depo Medrol) was very successful treatment.

Here’s a link to some information on De Quervain.
https://sportsmedicine.mayoclinic.org/condition/dequervains-tenosynovitis/
Can you share what kind of tests and other treatments you have tried?

Thanks
Dawn

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@dawn_giacabazi

Hi @pfafpa & Thank you John for the tag 😉 @johnbishop
I am a Certified Nurses Aide by trade and currently over use my hands daily – I care for many patients every day and teach transfers to staff, patients and caregivers daily and utilize computers to document everything daily. By the end of my day I can barely lift a 4oz glass of water.

My experience with carpal tunnel is a bit different as I do not have PMR. I have bilateral CTS and DeQuervain tenosynovitis. Although CTS is one of the most common workplace injuries, it is not as common as people think. It is estimated to affect roughly 8 million people in the United States, but if consider the total population it only equates to about 2.5%. Because there is some overlap in symptoms, it’s understandable who actually have wrist tendonitis may confuse it with CTS.

The key difference lies in the location of the pain. I was told by my doctor that CTS is felt on the palm side of the wrist and in the thumb, index and middle fingers. When pain occurs on the other side of the wrist, it likely tendonitis or another nerve problem. A common sign of wrist tendonitis is numbness in the pinky finger. This symptom does not overlap with CTS because the median nerve does not reach the pinky.

Now to add yet another twist to finding a differential diagnosis I currently am suffering with a flare up DeQuervain’s tenosynovitis. Which mimics a lot of the symptoms of CTS and often sends me to bed in tears. I have been in physical therapy 3 times a week for treatment for over 3 months with very little relief. I see the orthopedic surgeon next week and am very eager to see him.

There is a very special test my orthopedic does that tells him exactly what the cause is. The most common test is called the Finkelstein maneuver. Your clinician will have you make a fist with your fingers closed over the thumb, then quickly bend your wrist down toward your little finger, pulling the tendon through the narrowed sheath. This movement is quite painful in people who have de Quervain's tenosynovitis. I had it in my right hand about 3 years ago and now it plagues me in the left. In the past a special hand brace designed much simpler to CTS brace provided much needed rest and relief and doc prescribed Methylprednisolone (Depo Medrol) was very successful treatment.

Here’s a link to some information on De Quervain.
https://sportsmedicine.mayoclinic.org/condition/dequervains-tenosynovitis/
Can you share what kind of tests and other treatments you have tried?

Thanks
Dawn

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John and Dawn, thank you for your emails. Yes, I do want to stay off Prednisone if possible. A lot of work to taper all the way to zero and don’t want to go backward. I’ve had some side effects (thin skin, weight gain, etc.). And my rheumatologist wants me to stay off if possible. I went to hand specialist this morning, who did diagnose CTS after doing a number of neurological tests. He gave me a cortisone shot (more steroids!) and said brace it at night and give it 6-8 weeks. So we’ll see.

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My hands were a very big part of my 12 year experience with PMR and taking prednisone. My original problem was with trigger fingers which would occur in almost any finger at almost any time. The trigger fingers were painful until I could get them released. I think the trigger fingers were caused by tendonitis.

Something more serious was a spontaneous rupture of the tendon going to my thumb. It was a weird experience because all I was doing was pushing a button with my thumb. It was like my thumb became unattached at I couldn't move it. There was no pain involved. I had hand surgery within a week of it happening. Apparently, there are two tendons that control the index finger so one of those tendons was moved over to reattach my thumb. No definitive cause was determined but it was suggested that inflammation and/or prednisone were likely the cause.

Over the years I learned that stiff hands were a very good indicator of ongoing inflammation. I would wake of in the middle of the night just to check if I could make a fist. The degree to which I could close my hand sometimes determine whether or not I would increase my prednisone dose.

Another thing that I attributed to PMR was Raynauds syndrome. In Raynaud's phenomenon, smaller arteries that supply blood to the skin constrict excessively in response to cold, limiting blood supply to the affected area. The fingers are commonly involved and feel numb and cool in response to cold temperatures or stress. In my case, my fingers would feel like they were frost bit and I would blow warm air into my hands except my hands were warm and it could happen while indoors and during the summer.

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