Question: My puffy wrist is diagnosed as de Quervain's disease. Please explain this. I wear a splint, but it does no good. And what is carpal tunnel syndrome?
- P.K.Question: When I make a fist, then relax it, the ring finger locks. I can eventually unlock it. It snaps back sharply. I have great pain in the joint. Can you explain this problem?
Answer: These writers remind us of the hand's vulnerability. It is a rich complex of bones, tendons and nerves that permit its wide range of functions.
The first writer asks about de Quervain's disease, whereby the thumb tendon sticks, limiting movement. People with it often have jobs that require repetitive wrist and thumb use. Splinting and rest permit recovery of function as the swelling subsides, although cortisone injection might be needed to speed the process. In severe cases, de Quervain's disease requires surgery.
A.B. makes a good case for trigger finger, a variation of the thumb problem in which a sheath of tissue that protects a finger's tendon becomes swollen. It locks when a fist is made, trapping the digit down when the fist is relaxed. Forcing things exacerbates such problems, as A.B. has learned. Treatment options are the same as with the thumb locking.
Carpal tunnel syndrome is a more familiar hand problem. Here, the wrist nerve becomes trapped, causing tingling, pain and weakness in the thumb, index and middle fingers. The nerve involvement sets this problem apart from the other hand disturbances. But similar treatment options are available.
Many hand problems appear in midlife.
Question: I wonder if stress of an illness might cause shingles, that is, stirring up of the former chickenpox virus?
Answer: Why not? We don't have all the answers on this, but we do know, as you say, that shingles is a revival of the old, dormant chickenpox virus at a later age. Certainly, we might be dealing with a lapse in our immune-system defense against viruses. That might well be sufficient to give new life to a dormant virus. We do know that stress - from an illness, for example - can indeed lower resistance to a virus.
B.W. asks if she stands a chance of having a second bout of shingles. The authorities say yes, but it happens to only 5 percent of patients.
I am sending on the shingles material. Others can order a copy by writing: Dr. Donohue - No. 28, P.O. Box 5539, Riverton, NJ 08077-5539. Enclose $3 and a self-addressed, stamped (52 cents) No. 10 envelope.
Question: Can an adult have pinworms? Is there an over-the-counter medicine for them?
Answer: Yes, adults can get pinworms, although it is far more common in young children. You get pinworms by ingesting their eggs.
Household toilet hygiene is essential to prevent pinworm spread. A scratching child's fingernails easily entrap the eggs and pass them on. People are constantly touching hands to mouth in normal living.
Pinworm is one of the most common of household infections. More than 40 million Americans get it each year. So pinworm is not the social scourge so many parents seem to think.
Mebendazole, a prescription medicine, can get rid of pinworms if you follow instructions carefully.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him at P.O. Box 5539, Riverton, NJ 08077-5539.