Spina Bifida and later issues in life

Dear Ask The Doctor: When I was born I underwent 2 operations for Meningocele Spina Bifida. The sac was removed (s4 or s5 area)and my back was repaired with a skin graph. I have had some orthopedic issues throughout my life but no neurological issues. I am 45 years old and overweight. I have attributed my problems to my weight but recently my "ailments" are affecting my quality of life. I have for many years had a numbness in my right thigh that comes on when I am walking too much or on my feet for too long. This is more than a tingling sensation and I actually have to sit down as the pain and burning sensation can become very intense. Most recently I have had the same feeling in my hands and fingers. This comes on at night. My doctor said it might be carpal tunnel and gave me braces. This did not work. My hands can remain numb as they are right now for hours after I wake. I am unable to sleep through this and I find my self getting up to walk around. Sometimes getting out of bed and walking can awaken my hands and a normal sensation returns. Could either of these 2 issues be a result of my spina bifida? I should also mention that I have sufferd from migraines since adolescence. Thank you for your time!

Dear Jennifer: Spina bifida is a broad term that may be used to describe a number of open defects of the spinal column of various degrees of severity in affecting nervous functions for example: movement of lower limbs,  absence of perineal sensation are common symptoms as incontinence (bladder an fecal) or sex problems. Other alterations may be found in the arrangement or configuration of the toes, along with discrepancies in lower extremity muscle size and strength, weakness, or abnormal gait. In your particular case, according to your description the symptoms in your right leg and foot probably are related with your previous history of Spina bifida as a sequel. Regarding the other issue with your hands, yes, possibly you are having a Carpal tunnel syndrome which is an entrapment of the median nerve within the carpal tunnel at the level of the wrist. Usual symptoms include numbness, tingling, and pain in the wrist and hand which is worse at night. The conservative treatment includes first of all a work-site ergonomic assessment may help to reduce potentially exacerbating factors, , for example , the use of an ergonomic keyboard and modify all the postures or activities that reproduce the pain. The use of a wrist-hand brace that sets the wrist joint in neutral position (to be worn at nighttime for a minimum of 3-4 weeks) many off-the-shelf wrist splints seem to work well. A specific stretching/strengthening program for the hand and wrist may be useful in improving strength and dexterity. The use of anti inflammatory medications (i.e.: “Aleve”) may be of benefit to control de pain. Lack of aerobic exercise (along with increased Body Mass Index, meaning Overweight) is a risk factor for the development of CTS and should be addressed. Overuse of legal drugs (e.g., caffeine, nicotine, alcohol) can contribute to CTS and should therefore be reduced. The local corticosteroid injection may be considered in those cases that show poor improvement with the conservative treatment.