Carpal tunnel and trigger finger on aromatase inhibitors

Aromatase inhibitors, such as letrozole, anastrozole and exemestane, lower oestrogen levels. Low oestrogen can make the tendons and their protective sheaths in the hand and wrist thicker, stiffer and more inflamed. At the wrist, this swelling can squeeze the median nerve, causing carpal tunnel syndrome, with tingling, numbness or pain in the thumb and first fingers, often worse at night. In the fingers, thickened tendon sheaths can make a finger catch or lock when it bends, called trigger finger. Both are more common on aromatase inhibitors than in the general population, and both can usually be treated without stopping hormone therapy.

How it usually feels

Carpal tunnel often causes tingling or burning in the thumb, index and middle fingers, waking you at night, and a weak grip. Trigger finger causes a painful click or lock when bending or straightening a finger, often worse in the morning.

What helps

Wrist splints at night, hand exercises, avoiding repeated gripping, steroid injections for persistent symptoms and, occasionally, a minor operation. Switching aromatase inhibitors helps some women.

When to be checked quickly

Constant numbness, weakness or wasting of the muscles at the base of the thumb, or dropping objects frequently should be assessed promptly, as prolonged nerve pressure can cause lasting damage.

Hand symptoms on aromatase inhibitors can be painful and frustrating, especially when they affect cooking, writing, work or sleep. Most women improve with simple treatments, and very few need to stop hormone therapy because of them.

Symptoms may ease after treatment ends

For many women, carpal tunnel and trigger finger improve after aromatase inhibitors are completed, though some need treatment in the meantime.

Surgery is simple but still surgery

Carpal tunnel release and trigger finger release are common day-case operations with good results. Recovery takes a few weeks, and on the arm where lymph nodes were removed, your surgeon may take extra care.

Switching tablets helps some women

Changing to a different aromatase inhibitor or to tamoxifen can ease symptoms for some, though not all.

What this page cannot tell you

It cannot diagnose your hand symptoms. Ask your team for an assessment, and a hand specialist if needed.

Small changes to how you use your hands reduce strain and help symptoms settle.

In the kitchen

Use electric choppers or a mixer instead of hand grinding, thicker-handled knives and ladles, and lighter pots. Take breaks when kneading dough or chopping.

At work

Keep wrists straight while typing, use a supportive wrist rest, and take short breaks to stretch fingers every half hour.

Warm-ups and rest

Soaking hands in warm water in the morning and gentle stretching before tasks can reduce stiffness and catching.

A hand therapist, usually a specialist physiotherapist or occupational therapist, can make a big difference before injections or surgery are considered.

Custom splints

They can fit splints that hold the wrist or finger in the right position, more comfortably than off-the-shelf versions.

Exercises and advice

Tendon and nerve gliding exercises, advice on joint protection and ways to adapt daily tasks reduce strain and help symptoms settle.

Tracking progress

Regular reviews show whether conservative treatment is working, or whether it is time to discuss an injection or surgery.