272010Sep

Common Breast Cancer Treatment Increases Likelihood of Carpal Tunnel Syndrome and Trigger Finger

Guest Blogger and SWFHS Nurse Practitioner Carolyn Clark blogs about Aromatase Inhibitors used to treat breast cancer in post-menopausal women and the drug’s correlation to certain hand problems:

I have been reading this article in the July 2010 issue of The Journal of Hand Surgery, titled “Aromatase Inhibitors and Their Side Effects: What Hand Surgeons Should Know” and thought this information might be important to some of our patients.

Aromatase inhibitors are used as adjuvant treatment of hormone-receptor-positive breast cancer in post menopausal women, and are slowly replacing Tamoxifen as the drugs of choice.Though usually well-tolerated, there is increasing evidence that links aromatase inhibitors with carpal tunnel syndrome and trigger finger, as well as other painful conditions of the hand and wrist.

The symptoms can be severe, with about 10% of patients on these drugs developing incapacitating symptoms.  The most common symptoms reported are early morning stiffness and hand/wrist pain that affects performance of activities of daily living.

The incidence of carpal tunnel syndrome is about 3%, which is seven times that of patients taking Tamoxifen.  Lab tests that check autoimmune and inflammatory markers are all normal.  MRIs show tendon thickening.

The exact cause of this correlation is unknown, but there is a theory that the mechanism is similar to that which occurs in diabetics, who are also more likely to experience carpal tunnel syndrome and trigger finger.  Carpal tunnel symptoms are thought to be caused by digital flexor tendon thickening and increased peritendinous fluid within the sheath, which compresses the median nerve in the carpal canal causing numbness and tingling (symptoms worsen at night) and the sensation that the hands “fall asleep”.

Trigger finger may similarly occur when the thickened flexor tendon sheaths try to glide through the pulley system of the hand, but have difficulty sliding easily.  Symptoms of trigger finger included of locking and clicking of the fingers and persistent finger pain.

Treatment with NSAIDs (anti-inflammatories) rarely helped, according to one study, and steroid injections and splinting were not as helpful, when compared with the typical  carpal tunnel syndrome patient or and trigger finger patient.  The article suggests that a carpal tunnel or trigger finger release may be necessary, if symptoms are severe.

SWFHS is quite aggressive in treating both carpal tunnel syndrome and trigger finger and there is no benefit to ignoring the problem, when patients can be simply and effectively treated.The endoscopic carpal tunnel release and the in-office trigger finger release are both minimally invasive, which reduces post operative pain and recovery time, and are permanent solutions.

If it is not an option for the patient to come off of their aromatase inhibitor, then surgical treatment should not be postponed.  We can also treat the other painful conditions that arise as a side effect of these drugs.

Carolyn Clark is a board certified family nurse practitioner and has been in nursing for thirty years.  She holds a Bachelor’s degree in nursing from University of Washington Seattle and a Master’s degree in nursing from University of Missouri St. Louis.  Carolyn has been a valued member of the Southwest Florida Hand Specialists’ team since 2006.