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Q: For the past month I've had pain in both wrists. Sometimes the pain goes down into my fingers. My daughter-in-law had pain in her wrists and it was helped my sleeping with a baby pillow under her hands. But it hasn't helped me.

I suffer from severe back problems and have had to use a walker for two years. But sometimes the pain in my wrists is worse.

-- M.W., Athens, Ga.
A: One of the most common causes of chronic pain in the wrist, especially if the pain extends down into the fingers, is carpal tunnel syndrome. This common painful disorder is caused by narrowing of the carpal tunnel, which results in mechanical compression of the nerves and the tendons that run through the area.

The carpal tunnel is made up of the carpal bones of the wrist on one side and a stiff ribbon of tissue on the other side. Two important structures go through this tunnel: (1) the median nerve, one of the major nerves to the hand, and (2) the tendons that are used to flex the fingers.

This narrowing of the carpal tunnel is usually caused by inflammation and subsequent swelling of coverings of the tendons or joints. This disorder is also called entrapment neuropathy because the nerve is "trapped" by the swollen tissue.

The inflammation is often the result of work-related irritation caused by improper and repetitive use of the wrists, such as assembly line work or keyboarding. In your case I am strongly suspicious of repetitive trauma to your wrists caused by using a walker for the past two years.

Narrowing of the tunnel can also be caused by healing of wrist fractures and, less frequently, tumors or congenital defects. Carpal tunnel syndrome can be a feature of systemic (throughout the body) diseases, including arthritis, diabetes, sarcoidosis and leukemia.

Also, anything that causes swelling of tissue such as pregnancy, heart disease and even PMS can increase swelling in the carpal tunnel even more.

The initial symptoms of compression of the median nerve include numbness, burning or aching pain and tingling. There may also be a decreased ability to feel with the fingers, but this may not be particularly noticeable. The pain is often worse at night, but may be worsened by activity, especially flexing of the wrist.

Carpal tunnel syndrome is usually distinguished from disorders with similar symptoms by a simple test. In this test, when pressure is applied to the carpal tunnel it causes pain. Medical imaging procedures can confirm the diagnosis even in cases with only slight entrapment of the median nerve.

Treatment should begin with limiting the offending activity, and occupational or physical therapy. I suggest that you get advice from a physical therapist about better ways to use your walker. Elevation of the affected arm and the use of a splint at night may help.

Injection of steroids directly into the carpal tunnel may help alleviate the symptoms for some people. But this procedure is difficult and best left to a health care professional knowledgeable in the anatomy of the carpal tunnel and experienced in the procedure.

Surgery is usually the treatment of last resort for carpal tunnel syndrome. However it can be very effective. Like any surgery, carpal tunnel surgery carries a risk of not working, and even making matters worse.

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