[55M] With chronic severe hand and wrist pain

What might be happening

Based on the symptoms and history you've provided, here are some possible explanations for your condition:

1. Carpal Tunnel Syndrome (CTS)

• Rationale: Your symptoms of numbness, tingling, and pain in the hands and wrists, especially at night or during specific activities, are classic signs of carpal tunnel syndrome. CTS occurs when the median nerve is compressed as it travels through the carpal tunnel in the wrist.
• Typical Treatments: Treatment often includes wrist splinting, especially at night, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, corticosteroid injections, and in severe cases, surgery to relieve the pressure on the median nerve.

2. Rheumatoid Arthritis (RA)

• Rationale: The swelling, stiffness (especially in the morning), and severe pain in your hands and wrists could be indicative of rheumatoid arthritis, an autoimmune condition that causes inflammation in the joints.
• Typical Treatments: RA is usually managed with disease-modifying antirheumatic drugs (DMARDs), biologics, NSAIDs, and corticosteroids. Early diagnosis and treatment are crucial to prevent joint damage.

3. Peripheral Neuropathy

• Rationale: The constant feeling of your hands being asleep and the burning sensation could be due to peripheral neuropathy, which involves damage to the peripheral nerves. This can be caused by various factors, including diabetes, vitamin deficiencies, and other underlying conditions.
• Typical Treatments: Treatment focuses on managing the underlying cause, pain relief with medications like gabapentin or pregabalin, and physical therapy.

What you can do

Carpal Tunnel Syndrome (CTS)

• Wrist Splinting: Wear a wrist splint, especially at night, to keep your wrist in a neutral position and reduce pressure on the median nerve.
• Activity Modification: Avoid activities that exacerbate your symptoms. Take frequent breaks to rest your hands and wrists.
• NSAIDs: Continue taking ibuprofen as needed for pain relief, but be mindful of the recommended dosage.

Rheumatoid Arthritis (RA)

• Consult a Rheumatologist: Seek a referral to a rheumatologist for a thorough evaluation and potential diagnosis. Early intervention is key.
• Anti-inflammatory Diet: Consider adopting an anti-inflammatory diet rich in fruits, vegetables, whole grains, and omega-3 fatty acids.
• Physical Therapy: Engage in gentle exercises and stretches to maintain joint flexibility and strength.

Peripheral Neuropathy

• Medical Evaluation: Consult your healthcare provider for a comprehensive evaluation to identify any underlying causes of peripheral neuropathy.
• Vitamin Supplements: If a vitamin deficiency is suspected, your doctor may recommend supplements.
• Pain Management: Discuss pain management options with your doctor, including medications and physical therapy.

General Tips

• Symptom Journal: Use MDandMe to journal your symptoms, track your progress, and share longitudinal medical notes with your provider. This can help in identifying patterns and triggers.
• Stay Active: Engage in regular, low-impact exercises like walking or swimming to maintain overall health and joint function.
• Hydration and Nutrition: Ensure you stay well-hydrated and maintain a balanced diet to support overall health.

What you should look out for

Given the severity of your symptoms and the potential for underlying conditions, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

• Increased Weakness: If you notice a significant increase in weakness or loss of function in your hands.
• Severe Swelling: If the swelling in your hands and wrists becomes severe or is accompanied by redness and warmth.
• New Symptoms: If you develop new symptoms such as fever, unexplained weight loss, or other systemic signs.

Remember, while I can provide guidance based on the information you've shared, it's important to consult with a healthcare professional for a formal diagnosis and appropriate treatment. If you have more questions or need further assistance, feel free to continue the conversation.