[47F] With progressive left hand pain and numbness

Question

Over the counter medicine does not work. What will a doctor prescribe to me?

Patient Description

A 47-year-old female has been experiencing constant pain in her left hand, particularly severe at the base of the thumb, along with numbness and tingling for over a year. The pain is rated as 8 out of 10 in severity and has progressively worsened. The patient reports a loss of use, inability to grasp, lift, or hold anything with the left hand, and muscle weakness. There is a history of a severe staph infection in the upper left arm in 2005, which caused nerve damage and required three surgeries. No recent injuries have been noted. The patient also has chronic back pain since 2003, which is manageable. No allergies or current medications are reported.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible conditions that might be causing your symptoms:

  • Carpal Tunnel Syndrome: This condition occurs when the median nerve, which runs from your forearm into the palm of your hand, becomes pressed or squeezed at the wrist. Symptoms include pain, numbness, and tingling in the hand and arm, and it can lead to muscle weakness and difficulty grasping objects.

    • Treatment: Wearing a wrist splint, especially at night, can help relieve symptoms. Anti-inflammatory medications, physical therapy, and, in severe cases, surgery might be necessary.
  • Peripheral Neuropathy: This is a result of damage to the nerves outside of the brain and spinal cord (peripheral nerves) and often causes weakness, numbness, and pain, usually in the hands and feet. It can be caused by infections, injuries, metabolic problems, and exposure to toxins.

    • Treatment: Managing underlying conditions, pain relief medications, and physical therapy can help manage symptoms.
  • Ulnar Nerve Entrapment: This condition occurs when the ulnar nerve is compressed, often at the elbow or wrist, leading to numbness, tingling, and pain in the hand and fingers, particularly the ring and little fingers.

    • Treatment: Avoiding activities that aggravate the symptoms, using elbow pads, and in some cases, surgery to relieve the pressure on the nerve.
  • Complex Regional Pain Syndrome (CRPS): This is a form of chronic pain that usually affects an arm or a leg. CRPS typically develops after an injury, surgery, stroke, or heart attack. The pain is out of proportion to the severity of the initial injury.

    • Treatment: Pain relievers, physical therapy, and sometimes nerve blocks or other interventions.

What you can do

While you should definitely consult a healthcare professional for a formal diagnosis and treatment plan, here are some steps you can take in the meantime:

  1. Rest and Immobilize: Try to rest your hand and avoid activities that exacerbate the pain. Using a wrist splint or brace can help immobilize the area and reduce symptoms.
  2. Apply Ice: Applying ice to the affected area for 15-20 minutes several times a day can help reduce inflammation and pain.
  3. Over-the-Counter Pain Relief: Non-prescription pain relievers like ibuprofen or acetaminophen can help manage pain and inflammation.
  4. Gentle Exercises: Gentle stretching and strengthening exercises can help improve function and reduce symptoms. A physical therapist can guide you on the appropriate exercises.
  5. Ergonomic Adjustments: Make ergonomic adjustments to your workspace to reduce strain on your hand and wrist.

What you should look out for

You should seek medical attention if you experience any of the following:

  • Severe or worsening pain: If your pain becomes more severe or does not improve with rest and over-the-counter pain relief.
  • Loss of function: If you continue to lose function in your hand or if the weakness progresses.
  • Changes in color or temperature: If you notice any changes in the color or temperature of your hand or fingers, such as them turning white, blue, or red.
  • Signs of infection: If you notice any signs of infection, such as increased redness, swelling, warmth, or fever.

Remember, while these suggestions can help manage your symptoms, it is important to consult with a healthcare professional to receive a formal diagnosis and appropriate treatment.

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5 mo ago


People Also Ask


What are the common symptoms of Carpal Tunnel Syndrome?

Common symptoms of Carpal Tunnel Syndrome include pain, numbness, and tingling in the hand and arm, particularly affecting the thumb, index, and middle fingers. It can also lead to muscle weakness and difficulty grasping objects.


How can Peripheral Neuropathy be managed?

Peripheral Neuropathy can be managed by addressing underlying conditions, using pain relief medications, and engaging in physical therapy. Lifestyle changes and avoiding exposure to toxins can also help manage symptoms.


What is Ulnar Nerve Entrapment and how is it treated?

Ulnar Nerve Entrapment occurs when the ulnar nerve is compressed, often at the elbow or wrist, leading to numbness, tingling, and pain in the hand and fingers, especially the ring and little fingers. Treatment includes avoiding activities that worsen symptoms, using elbow pads, and possibly surgery to relieve nerve pressure.


What are the signs that I should seek medical attention for hand pain?

You should seek medical attention if you experience severe or worsening pain, continued loss of function in your hand, changes in color or temperature of your hand or fingers, or signs of infection such as increased redness, swelling, warmth, or fever.

1 Comments


Arora (Bot)#24147

5 mo ago

If over-the-counter medications are not effective, a doctor might prescribe stronger pain relievers, such as prescription-strength NSAIDs or opioids for severe pain. They may also consider medications specifically for nerve pain, such as gabapentin or pregabalin. In some cases, corticosteroid injections might be used to reduce inflammation and pain. It's important to consult with a healthcare professional to determine the most appropriate treatment for your specific condition.

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