Q: I am a 52 years old man having pain in my left wrist on the inner side since many months. It is now increasing day by day. I read about carpal tunnel syndrome but my problem may be different. When I touch at any one spot over a vein, I can locate the pain right there. It is nowhere else. But today, I can feel a bit of tingling in the smallest and ring fingers. I feel my problem may be related to the blood vessels. Sometimes the pain just shoots up. Kindly let me know which specialist should I consult, as some doctors I know, could not diagnose it? I am in New Delhi. My age is 51 years and I do a lot of my work on the computer.

A:Occupational overuse syndrome (OOS) can present as Guyons canal syndrome (wrist) in computer keyboard users. Occupational overuse syndrome (OOS) describes a range of ergonomic injuries that result from repetitive demand over time and may be induced by occupation, recreational or leisure activity Guyons canal syndrome is a well-described ulnar nerve entrapment syndrome at the wrist level. Various aetiologies such as trauma, ganglia, ulnar artery aneurysm, anomalous muscle, lipoma, rheumatoid arthritis and fracture of carpal bones have been reported. Diagnosis is obtained through careful medical and occupational history, clinical examination and exclusion of non-occupational diseases. Identification of a treatable cause and early intervention can lead to resolution of symptoms and help to preserve function. It has been reported that approximately 10% of computer users who have work-related symptoms were found to have positive Tinels sign (tingling sensation in ring and little finger) and over the Guyons canal (wrist). In fact, frequent and regular pressure of against the ulnar nerve during keyboard use may have resulted in symptoms that would not have otherwise manifested until later. Guyons canal syndrome due to occupational overuse has been attributed to prolonged flexion or extension of the wrist and repeated pressure on the hypothenar eminence (wrist buckle). Guyons canal syndrome due to occupational trauma can be improved by behavioural modification and change of hand typing, giving rest to the involved wrist. Identification of a treatable cause and early intervention can lead to resolution of symptoms and help to preserve function. We recommend the nerve conduction or imaging studies be performed in patients like you presenting with similar complaints. A trial of muscle strengthening exercise, splintage or activity avoidance is often suggested to relieve these symptoms. Decompression of the Guyons canal (surgery) is the main stay of treatment if these conservative methods fail. In Delhi, you could consult Dr. Mathew Varghese, MS, Head of the department, Orthopedics, St Stephens Hospital, Tiz Hazari, Delhi 54.