Social and functional impact of minor fractures in elderly people.

Abstract

The carpal tunnel syndrome is five times more common in women than in men'; it is found most often in women aged over 40 and is therefore common postmenopausally. The ultimate form of treatment is surgical relief of nerve entrapment.2 There is, however, general agreement that conservative measures should be tried first. These include mainly splinting, injection of steroids into the carpal tunnel, and nonsteroidal anti-inflammatory agents.2 3 Treatment with vitamin B-6 has also been advocated, but the therapeutic effect was not corroborated by controlled studies.3 4 We describe two women with severe carpal tunnel syndrome unresponsive to medical treatment, whose symptoms resolved unexpectedly soon after starting hormone replacement therapy for their menopausal symptoms. Case reportsCase 1-A 52 year old healthy woman had a six month history of numbness and pain in both hands. Examination showed paresthesia in the distribution area ofthe median nerve. Electromyography confirmed the severity of the disease. Non-steroidal antiinflammatory agents gave no relief, and she was referred for surgical release of the entrapped nerve. While waiting for surgery and independently of the carpal tunnel syndrome, cyclic hormone replacement therapy (conjugated oestrogen 0-625 mg/day for 25 consecutive days and medroxyprogesterone acetate 5 mg/day for the last 13 days) was started for her climacteric symptoms. A gradual alleviation of her carpal tunnel symptoms followed, and the pain and numbness resolved completely about three weeks subsequently. Surgery was withheld; she was subsequently followed up for 20 months and remained asymptomatic. An interruption of oestrogen treatment for three months did not exacerbate her symptoms.Case 2-A 54 year old healthy housewife was examined because of typical complaints of the carpal tunnel syndrome in both hands. At the age of 47 she had had a panhysterectomy because ofuterine bleeding due to a submucosal myoma. Pain and numbness began in both hands at the age of48. Electromyography disclosed findings typical of the syndrome, and after failure of conservative measures division of the left transverse carpal ligament was performed. The outcome of surgery was poor, and she did not submit for surgery of the other hand. At the age of 50 substitution hormone therapy was started. The pain in her hands regressed gradually over several weeks subsequently until both hands became free of pain. During the subsequent three years hormone therapy was interrupted on several occasions for three to four months. Consistently, pain and numbness recurred shortly after cessation of the hormone therapy, only to resolve once the treatment was renewed. CommentAlthough a temporal relation between the onset of the menopause and the carpal tunnel syndrome has been reported,' the effect of hormone replacement on the syndrome has not been referred to. In these two patients the beneficial effect of combined oestrogen and progesterone therapy on the symptoms of the carpal tunnel syndrome was unequivocal. In the second pati...

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Social Predictors of Recovery in Late Middle-Aged and Older Persons After Injury to the Extremities: A Prospective Study

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