Wednesday 25 April 2018

Dear Dr Nina: My RSI is getting worse, but I need to work. What can I do?

Sore hands
Sore hands

Nina Byrnes

For about two years I have been experiencing pain and numbness from the elbow, through my wrist and down into two of my fingertips - fourth and fifth digit - of my right hand. The numbness is now such that I find it hard to grip things like a cake whisk or a needle for sewing. I type for a living and use a mouse constantly with this hand. I am guessing it is RSI and have had my workstation assessed, but nothing seems to change. I can't stop typing - is there anything else I can do to bring the feeling back into my hand? Stopping work isn't an option.

A. The ulnar nerve is one of the three main nerves in the arm. It exits from the brain at the neck and travels a long path down the arm. At the elbow, it passes through a tunnel of tissue called the cubital tunnel that runs under a bump of bone ( the medial epicondyle) at the inside of the elbow. The nerve lies very close to the skin here, and bumping off it causes a shock-like feeling. The spot where the nerve runs under the medial epicondyle is commonly referred to as the "funny bone".

The ulnar nerve provides feeling to the little finger and half of the ring finger. It controls most of the little muscles in the hand that help with fine movements, and some of the bigger muscles in the forearm.

Cubital tunnel syndrome is a condition that occurs due to pressure on the ulnar nerve as it passes through a channel on the inner aspect of the arm. This causes numbness and tingling that can radiate down the arm into the fourth and firth fingers. Activities that involve repeatedly using the muscles of the lower arm are a common cause.

The pain and numbness can build up over some time and is typically worse when undertaking repetitive activity using the muscles affected. You may notice a tingling sensation in the hand on pressure to the inner aspect of your elbow. Your GP is usually able to diagnose this condition simply by taking account of the location of the pain and by examining your arm.

X-ray, bloods and scans are only rarely required if the diagnosis is unclear.

There are many different treatment options for cubital tunnel and opinions differ about the best way to treat it as studies have shown conflicting results. One of the most basic options is watchful waiting. This simply involves resting the muscles, avoiding activities that exacerbate the pain and allowing symptoms to settle on their own.

There are a number of home remedies. When at work, avoid leaning on the elbow or inside of the arm. Don't lean on this arm when driving also. Try to sleep with the elbow straight (wrapping a towel around the arm may help).

For those who prefer a treatment pathway, the first step is using anti- inflammatory medication or anti- inflammatory rubs. Results are mixed as regards taking oral anti-inflammatory medication. Using a splint at night provides relief in some people. A physiotherapist can prescribe this. Combining a night-time splint with some reduction of daytime activities over three months has been shown to help. Formal physiotherapy may involve more specific exercises or ultrasound therapy. Steroid injections are not normally recommended as they may damage the nerve.

If symptoms are problematic or prolonged, or if there is progressive weakening of the muscles in the hand, then surgery may be recommended. Surgery focuses on releasing the pressure on the nerve. About 50pc of cases resolve spontaneously.

In your case, as the symptoms are now causing weakness, I think it may be time to be referred for specialist opinion to have formal nerve conduction studies done to check for any nerve damage. You may be advised to rest it for a prolonged period or surgery may be required.

Q, My five-year-old daughter has a sore red vagina intermittently. She says it is itchy and I have changed to non-bio washing powder etc. What could it be?

A. Vulvovaginitis is a condition that causes irritation and itch of the vagina or the skin near the entrance (the vulva). This condition is very common in young girls. In the absence of significant oestrogen levels, the skin of the vagina and vulva can be thin and easily irritated. Moisture and dampness of the skin can also irritate or make it easier for infection to take hold. Lastly, the use of soaps and bubble baths can irritate the sensitive skin in this area. This condition is more common in girls who are overweight.

Those with vulvovaginitis usually complain of itch or redness and irritation. There may be some discharge visible in underwear and they may also complain of stinging or burning when passing urine.

Medical intervention is rarely required. Your GP may take a swab. If a bacterial infection is found, a 10-day course of antibiotics may be prescribed.

It is important to teach your daughter about genital hygiene. Always wipe from the front to the back. The reverse method can transfer bacteria from the anal area forwards. Using damp wipes may help as traces of dry toilet paper left behind can exacerbate symptoms. Avoid wearing restrictive clothing or tights. Loose white cotton underwear is best as it allows skin to breathe. It may be necessary to change underwear during the day to ensure it stays clean and fresh. Wearing a nightdress and no underwear at night can also help in some cases. Soaking in a bath twice a day may help, but avoid using perfumed soaps and washes. A gentle emollient or wash designed for those with eczema or sensitive skin is best. Applying a simple aqueous-based cream may help soothe the area.

The problem will reoccur in about half of those girls affected.

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