Letrozole side effect CTS

Albizia
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After a quadrantectomy because of ILC I got hormone therapy with Letrozole. A few months later both my hands began to tingle and feel numb. Especially in the night. CTS was diagnosed and I could apply for an operation. Whereas my mother suffered from CTS I supposed that the cause might be genetic but later I learned that rather a lot of women suffer from CTS as a side effect of Letrozole. However only on websites which deal with cancer and never on websites which deal with CTS, which wonders me.
I still really hesitate about an operation and hope I can manage without it. At first splints helped me through the night and now I use the adhesive plaster from "The Carpal Solution" from which is claimed that it is a patented Medical Technology. I feel they are helpful but alas I cannot do without them as is suggested by the supplier.
Another option I consider is quitting for 4-6 weeks with Letrozole and see if my complaints subside.
Probably you cannot advise me about this but I sure would like to read your opinion about it.

jeremydpbland
Online

The best known link between drugs for breast cancer and CTS is with exemestane as that one has been quite well documented. It does get a mention here on my site. Letrozole is just another of this group of drugs. All the other hormonal manipulations for breast cancer probably carry similar risks of CTS however. The CTS in these cases seems to respond just as well to treatment as idiopathic CTS and generally the oncologists seem to feel that it is not worth stopping the hormonal treatments because of CTS - so treat it with splints, steroids and surgery just as you would CTS in any other circumstance. Any other treatment sould be considered 'experimental' The carpal solution may be patented but that doesn't mean a lot - it has not been demonstrated to have any useful effect in properly designed randomised trials so that too remains experimental. JB

Albizia
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Dear Dr. Bland, Thank you for your answer. Since then I had my thyroid examined, which was o.k.; stopped 6 weeks with the hormonal treatment, which made no difference; forgot about the Carpal Solution and wore normal splints during the night; did exercises and applied ultrasound during approx. 5 months. Maybe the ultrasound did something because without the splint my left hand is giving me no trouble anymore during the night. Fingers of both hands however start to tingle a/o hurt with activities during daytime and the tip of the middle finger of the RH feels always numb.
May 15th a EMNC test of both hands was made. The results showed clearly that I am suffering from CTS. A Sens.Nerve Conduction test could also be done but whereas it seems to be a rather 'unpleasant' experience I could also skip it. Which I did. The grade of CTS however is not mentioned.
Surgery of the right hand is now planned. Would you please be so kind to give your opinion about the test results? I will send them separately.
Thanking you in advance.

jeremydpbland
Online

The sensory measurements would probably have been less unpleasant than having the median nerve stimulated at the elbow, which I see they did do. Even without the sensory studies though your median nerve motor conduction is bad enough to make your results bilateral grade 5 CTS, slightly worse in the right hand. For grade 5 surgery is the option most likely to produce a satisfactory result. It's a pity the tests were not done much earlier in the course of the illness as it could probably have saved you a lot of messing about with other treatments which were probably never likely to have much effect. If you've done the basic website diagnostic questionnaire here you could now try out the new prognostic estimate for surgery - there are just a few additional questions to answer and the site will try to give you an estimate of the chances of a good result from the operation. JB

Albizia
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Dear Dr. Bland, Surgery of my right hand was successfully done by a neurosurgeon in May 2019. Since then my middle finger is more stiff than the rest of my hand and sometimes pops up if I bend it too far (early stage of trigger finger?) and the whole hand is more sensitive but I can do almost anything I want to.
Surgery of the left hand was suggested to be done in a few months time. During this procedure a plastic surgeon could fix the middle finger of this hand that showed signs of tendinitis. Funny enough however my left hand recovered also during recovery time of the right one. Which does not seem to be uncommon, I learned. So I decided to forgo surgery and wait and see how things would develop.
Then recently bending the thumbs of both my hands became painful. But not all the time, pain comes and goes. And after some time the complaints in the operated on right hand has almost disappeared completely whereas the pain in the left hand and wrist gets worse and studying what Mayo Clinic says about it learns me that I recognize the symptoms of Quervain’s tenosynovitis.

I am at a loss: Is this another side effect of Letrozole (quote: numbness/tingling/weakness/stiffness in hand or fingers a/o
pain in hand that spreads to arm, wrist, forearm, or shoulder) and is the best treatment: splint, Voltaren and ice?
Or: Is this due to the fact that I did not yet have CTS surgery of my left hand and would it be advisable to do so?

I thank you very much for your opinion. At the same time for your super website and commitment to CTS patients everywhere. (I am dutch and living in Croatia).

jeremydpbland
Online

It's not uncommon for the second hand to improve when the first is operated but it usually does become a problem again in the long-term so it may well be that the left CTS needs treating now. Trigger digits and various forms of tenosynovitis are common in CTS patients so you may well have more than one thing going on. Repeating the nerve studies would be my first choice to see how things have altered. I wouldn't worry too much about the Letrozole.

(I wouldn't mind being Dutch and living in Croatia! - lovely country) JB

Albizia
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Thank you!

(Living on a Croatian island indeed is nothing less but wonderful :-))

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