Carpal Tunnel Syndrome or Not? Part Two

  • As the story was unfolding in Part One, I shared that my neurologist had referred me to a hand surgeon to be evaluated for treatment of Carpal Tunnel Syndrome.  The hand surgeon injected steroids into each wrist which relieved the swelling, pain, and dysfunction.  He stated that when/if the pain returned that my next step would be Carpal Tunnel Release surgery, a procedure I was greatly fearful of and didn’t want to undergo.  However, he also referred me to a rheumatologist to be evaluated.


    My first appointment with the rheumatologist was exactly two years ago.  I brought to the appointment: x-rays of the swollen (and immobile) finger, a note detailing my symptoms and attempted treatments, and a history of blood work.  The rheumatologist used a nifty ultrasound machine to detect inflammation around the joints and possible erosion of the bones in the joints due to arthritis.  The evidence seen on ultrasound combined with the examination, my history of symptoms and treatments, and the current complaints earned me a diagnosis of Rheumatoid Arthritis.

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    I was thankful to finally get an accurate diagnosis and one for which treatments are available.  “Let’s kick this thing in the butt,” I said.  First decision to be made: which drug therapy(s) to use.  The anti-tumor necrosis factor (anti-TNF) biologics are powerful drugs (Enbrel, Humira, Remicade) but cannot be used by persons who have multiple sclerosis or other demyelinating disease as I do. 


    So the recommendation was to utilize a Triple Therapy approach which combines Methotrexate, Sulfasalazine, and Hydroxychloroquine (Plaquenil).   The concept of Triple Therapy is not new, but one which has been popular for over a decade.  (See O’Dell JR, Haire C, et al. Treatment of Rheumatoid Arthritis with Methotrexate Alone, Sulfasalazine and Hydroxychloroquine, or a Combination of All Three MedicationsThe New England Journal of Medicine.  1996(20);334:1287-1291.)


    I started with Methotrexate, added Sulfasalazine, and finally Plaquenil.  However, plaquenil caused an odd side-effect in me: overwhelming fatigue and lassitude.  Basically, I couldn’t stay awake during the day, so I quit that drug within the first week, leaving me with a double combination therapy to battle the rheumatoid arthritis.

    Thankfully, I responded well to the drugs.  However, when the swelling finally went down, I was left with two crooked fingers which no longer could be pointed directly straight.  I had developed a Boutonniere Finger deformity. 


    Next stop on my journey was to the Occupational Therapist at the local hospital outpatient rehabilitation center.  The prescription was for the therapist, who specializeds in hands, to teach me proper joint protection techniques and to be evaluated for intervention and treatment of the mild Boutonniere deformity.

    Some of the therapies used during OT sessions include: range-of-motion exercises, deep heat therapy with paraffin wax and heating pads, mild strength training with Theraputty, and the creation of several unique finger splints used to encourage correction of the finger deformities I had developed. 


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    We decided which wrist splints (that I already owned) were preferred for maximum fit and protection.  And, I learned the value of sleeping in compression gloves which help to limit swelling from mild edema and provide an increased level of comfort in the mornings.  The occupational therapist also showed me better ways to cope with day-to-day tasks at work and at home, despite limitations caused by rheumatoid arthritis.


    The journey to this point in time had been long and involved a few detours along the way.  Fortunate for me, what was believed to be Carpal Tunnel Syndrome was not, so I never did need surgery.  After the active inflammation from rheumatoid arthritis was under control and after the effects of the steroid injections into my wrists had worn off, I did not experience a return of the carpal tunnel pain in my wrists and hands.  I even found that, after about six months, I no longer needed to sleep in wrist splints.

    Since then, I’ve been learning how to manage the varying symptoms of having multiple chronic illnesses which include rheumatoid arthritis and multiple sclerosis.  Sometimes it’s a question of “What is it which is causing my troubles today?”  Other times, it’s a blessing to realize that I’m not experiencing any great pain or disability.


    Such is life, unpredictable, variable, and full of unknowns.  But one known factor which I can share with you is that I will be writing here at on the topic of rheumatoid arthritis and dealing with it while living with other chronic illness.


    Lisa Emrich is author of the blog Brass and Ivory: Life with MS and RA and founder of the Carnival of MS Bloggers.

Published On: May 06, 2009