To Your Good Health: Help For Persistent Carpal Tunnel Syndrome

Dear Dr. Roach: In August 2013, I had surgery on my right wrist for carpal tunnel syndrome. The numbness in my fingers has not changed. Now I’m faced with the same problem in my left hand. I’m going to forget surgery, seeing as it wasn’t successful in my right hand.

I decided to go to an acupuncturist for laser treatments. I also had a cortisone shot. Neither of these has helped. Do you know of a solution for my problem? — P.M.

Answer: Carpal tunnel syndrome is caused by compression on the median nerve, as it runs down the arm through a “tunnel” of bone and connective tissue deep in the wrist. It may cause pain, numbness and weakness of the wrist and hand. The thumb and middle three fingers are most often affected. In advanced cases, the hand muscles may become atrophied. The sooner the pressure on the nerve is relieved, the more likely there will not be permanent nerve damage.

It sounds to me like the first surgery was not done soon enough to prevent damage. If that’s the case, then surgery on your left hand, done sooner after the onset of symptoms, might prevent the long-term numbness present in your right hand. However, it’s possible that the diagnosis was wrong or that the surgery might not have been effective, even if done promptly.

At least one study of needle acupuncture showed that it is as effective as a cortisone injection. This study excluded people who already had fixed numbness in the fingers, who are less likely to be helped by any treatment. I have not found any evidence that laser treatment is effective.

My advice is to first be sure of the diagnosis. An EMG test is a study of nerve function, which can confirm the diagnosis and may be able to predict how much damage there is and provide guidance on treatment. If damage is not too severe, other treatments, such as splinting, medication, yoga or ultrasound may be helpful. If advanced, surgery done quickly still may be your best bet.

Dear Dr. Roach: My husband might have an ear condition called cholesteatoma. He had a CT scan, and the specialist recommended an MRI. The specialist is not sure if it is cholesteatoma or fluid, and cannot proceed without an MRI, which my husband does not want to do. What are the consequences of not doing anything? He no longer has pain and feels it has gotten better. He already has permanent ear damage and cannot hear without hearing aids. He is 78 years old. — B.M.

Answer: Cholesteatomas (koe-les-tee-a-TOH-mahs) are cysts of the tympanic membrane (eardrum), which fill up with keratin, the major protein of the skin. They aren’t strictly tumors, but they behave like tumors, as they can progressively grow and even erode important structures, like the bones of the middle ear, and even grow through the bone into the brain. Very rarely, this can cause infection and abscess in the brain.

Because of the possibility of serious complications, it is important to make the diagnosis. Most commonly, an ENT doctor is able to make the diagnosis during an exam after a careful cleaning of the area. Sometimes the diagnosis is in doubt. Other possibilities do include cancer of the nose and throat, and infection.

I’m not sure why your husband doesn’t want to proceed with MRI, but I would recommend doing so. Getting a second opinion also is a reasonable option.

Once the condition is correctly diagnosed, then the proper treatment can be decided upon. Most cholesteatomas need surgery in order to be completely removed and to prevent further destruction of tissue.
