I have numbness and painful pins and needles in my hands and am waiting to be seen by a consultant to check for carpal tunnel. But as it affects both hands, could it stem from a common neural point, i.e. the vertebrae in my neck?
Gerwyn Thomas, Llantwit Major, Wales.
Dr Martin Scurr replies: I can see your logic, but for symptoms in both hands to be caused by neck vertebrae would mean something pressing on the nerves – for example, a prolapsed disc pressing on both sides of the spine. But those symptoms would be more widespread than the thumb and index finger on each hand.
Carpal tunnel syndrome occurs when the median nerve, which passes through the carpal tunnel (a passageway in the wrist) is compressed, causing pain, tingling and muscle wasting in the area supplied by the nerve. Most people associate it with repetitive use of one hand – but studies suggest that in around 40 per cent of cases both hands are affected. For example, in people with fluid retention due to an underactive thyroid gland, or conditions such as diabetes or rheumatoid arthritis, which cause inflammation of the tissues in the carpal tunnel itself.
It’s diagnosed by sending a tiny electrical impulse along the nerve via small electrodes – in carpal tunnel the impulse is slowed down. If the tests are normal, then the test would be repeated on the neck.
In your case, the question will be whether the problem is fluid retention, heavy occupational trauma to the hands and wrists, or arthritic change. Hopefully your symptoms will resolve once the diagnosis is confirmed and suitable treatment commenced.
Carpal tunnel syndrome is when the median nerve, which passes through a passageway in the wrist is compressed, causing pain, tingling and muscle wasting in the area, writes Dr Scurr
My mother has lost her sight due to age-related macular degeneration and suffers terrible hallucinations. Is there anything we can do?
Leonna Laverty, Ballycastle, Co Antrim.
Dr Martin Scurr replies: This is a relatively common, if terrifying, symptom of age-related macular degeneration (AMD) – a condition that strikes from around 60 and is the leading cause of blindness in the UK. It develops when the macula – the part of the retina in the eye responsible for detailed central vision – starts to degrade.
When someone becomes almost completely visually impaired, as in your mother’s case, the lack of input to the brain from the eyes can lead to a neurological disorder, where the brain ‘makes up’ for lost sight by inventing images.
The hallucinations can be so vivid they feel real. For some, the images may be merely coloured shapes or patterns, but others ‘see’ complex animals or humans, even dragons and monsters. The hallucinations can be brief and episodic, but are sometimes long lasting and distressing.
Known as Charles Bonnet Syndrome (CBS), it’s thought to affect up to half of people with visual loss, including AMD. In time, the hallucinations fade away as the brain adjusts to the lack of visual input.
But in the meantime there are some adaptations that might help. The first is to make sure that when your mother is awake, she’s in a brightly lit environment to make her blink. Blinking is known to help dismiss a hallucination. Simply being around other people may also help.
There are effective drugs for severe CBS, such as the anticonvulsants carbamazepine (sometimes used in epilepsy) and sodium valproate (used in epilepsy and bipolar disorder).
Another option is mirtazapine, an antidepressant, or the tranquilliser olanzapine. It’s not clear how these help – and each can cause unpleasant side-effects, particularly in the elderly.
In time, it is to be hoped these visions will subside, but it can take as long as one or two years. Helping your mother cope with the anxiety will be important and a minor tranquilliser, prescribed by her GP, might be a safe option, starting at the lowest dose, as a trial, for two or three weeks.
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