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Wrist Brace Helps Carpal Tunnel Pain; About Porokeratosis

Dear Dr. Roach: I have been waking up at night with my hands “asleep,” but it isn’t the kind with the “pins and needles” feeling. I mentioned it at a routine physical, and my doctor said that it sounded like carpal tunnel syndrome and to try to sleep with my wrists straight. Is there any reason why I would develop this, and anything I can do to prevent it from getting worse?

Thank you for any help you can provide. — L.S.

Answer: Carpal tunnel syndrome is a type of neuropathy where the nerve in the wrist gets compressed as it goes through a “tunnel,” an anatomically limited space with wrist bones on one side and the flexor retinaculum, a tough fibrous band, on the other. If there isn’t enough room in that space, the nerve can be pressed on, and the pain seems to be coming from the nerve endings, which are in the thumb and middle three fingers of the affected hand. Symptoms may include pain, numbness or an “asleep” feeling, and eventually weakness and atrophy of the hand muscles.

Carpal tunnel syndrome can happen with no particular cause, but is more frequent in pregnancy, in people with thyroid conditions and in those who overuse the wrist — especially in high-impact, high-frequency occupations like jackhammer operators and meat packers. The increased risk in computer users or data-entry technicians is much smaller.

Diagnosis of carpal tunnel syndrome often can be made by physical exam if the history is suggestive. Tapping gently on the nerve (called Tinel’s sign) can cause the symptoms to immediately worsen. Pressing the wrists together with the backs of the hands touching (called Phalen’s sign) also can reproduce symptoms. Either of these strongly suggests the diagnosis.

I recommend checking thyroid levels on all people with carpal tunnel syndrome. As far as treatment goes, it’s hard to remember to keep your wrists straight when you are asleep, so using wrist braces that keep your wrists straight can be helpful, especially at night. Anti-inflammatories help, and injection of a steroid into the carpal tunnel may help, but these often don’t bring long-lasting relief. Definitive treatment is with surgery, but I recommend an EMG test to be sure of the diagnosis before contemplating surgery. The success rate of surgery is better than 95 percent.

Dear Dr. Roach: Would you please tell me if there is any way to get rid of a porokeratosis? I have lived with one on the bottom of my foot for five years now, and it can be very painful when walking. Doctors aren’t very forthcoming; all they want to do is dig at it every so often and recommend shoes that don’t do any good. — C.P.

Answer: A porokeratosis is a benign skin condition that can occur anywhere on the body, but more commonly on an extremity. It appears to be an area of skin atrophy, usually paler than nearby skin, surrounded by a thickened ridge-like border of skin. The diagnosis is made via a skin biopsy.

There are many ways to treat it, so I am concerned that you have been suffering for five years without getting it successfully treated. In addition to surgery, freezing the area with liquid nitrogen is sometimes successful. Medicines like imiquimod (Aldara) and 5-fluorouracil also are effective in many cases. It sounds to me like you should search out a local expert in dermatology in your area.

About 10 percent of the time, these can become cancerous, so regardless of any treatment, they need to be carefully followed.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.