A 43-year-old woman with hand weakness and pale skin of the hand gets diagnosed with carpal tunnel syndrome. Upon receiving an injection in the carpal tunnel the colour of the hand changed to red!
A 43-year-old female presented to the neuromuscular clinic with complaints of weakness and paresthesia in the thumb and three fingers of the left hand for the past 6 months. The patient explained that she felt mild weakness along with progressive numbness in the thumb, and index-, middle-, and ring fingers of the left hand. The doctors made a working diagnosis of carpal tunnel syndrome.
Therefore, they administered 0.33 ml of glucocorticoid injection into the left carpal tunnel. Thereafter, she instantly reported an “odd sensation” in the affected portion of the hand. Within the next 5 minutes after the glucocorticoid injection, the overlying skin of the thumb, the affected fingers, and adjacent area of the palm turned red.
The patient presumably had the vasomotor disturbance due to irritation of autonomic fibers of the median nerve.
After glucocorticoid injection, it took almost 20 minutes for the changes to resolve. No further interventions were required.
On the 1-month follow-up, the paresthesia had resolved and the patient had no other complaints.
Carpal Tunnel Syndrome:
Carpal tunnel is a small passageway of vessels, nerves, tendons, and ligaments on the palmar side of the wrist. When the median nerve gets compressed in the tunnel its called the carpal tunnel syndrome. Since the median nerve supplies the palmer side of the thumb, index-, middle- and ring fingers, therefore the symptoms of numbness and tingling develop in these parts of the hand. Symptoms usually begin at night and progress gradually. Also, in some cases, patients may feel hand weakness making it difficult to perform fine motor tasks such as grasping small objects. Moreover, severe cases may lead to temperature insensitivity.
Causes of carpal tunnel syndrome are often multifactorial. Multiple factors contribute to increasing the pressure on the median nerve and the tendons. For example, gender (females are thrice more likely to develop CTS than males), trauma, swelling, sprain, fracture, overactive pituitary gland; hypothyroidism, pregnancy, menopause, and rheumatoid arthritis. Other important factors include repetitive use of wrist joint and occupations that require excessive use of wrist joint. Besides, sometimes there is no identified cause making it idiopathic.
Management can be either surgical or non-surgical. The latter includes splinting, treating the cause, reducing excessive wrist movements, giving rest to the hand. Some cases may benefit from cool compresses.
Pharmacological medications include nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.
Acupuncture and yoga may also help some individuals.
References
David Burke, M. (2021, January 28). Changing Hand Color after Carpal Tunnel Injection. Retrieved from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm2005527
