My wife’s arm has been swollen since she had breast cancer more than 30 years ago, how can she stop the numbness? DR MARTIN SCURR

My wife had breast cancer surgery more than 30 years ago, and ever since her left arm has been swollen with water retention. She has tried compression sleeves – to no avail – and is now losing feeling in her hand and fingers. What can she do to relieve the numbness?

David Woods, Sleaford, Lincolnshire.

Your wife’s operation was life-saving, but unfortunately it has left her with lymphoedema: swelling caused by a build-up of fluid.

This occurs as a result of damage to part of the lymphatic system, which carries fluid from the tissues to the heart, and from there into the bloodstream.

The ‘damage’ would have been the removal of lymph nodes, which act as a kind of filter for the fluid called lymph. Typically, some or all of these may be removed from the armpit during a mastectomy (the operation I think your wife had).

But this may interrupt the drainage of lymphatic fluid from the arm, and the result is the swelling your wife has had for so long.

Currently there is no surgical option (though some UK hospitals are trialling microsurgery to redirect the fluid flow).

The main treatment is long-term compression, using a tailored garment (or sleeve), which maintains external pressure to help disperse the fluid.

The ‘numbness’ your wife now experiences is, I believe, the result of years of accumulated fluid putting pressure on the nerve supply to the hand, probably within the carpal tunnel – a narrow passageway in the wrist.

It might be that a minor operation at the wrist to relieve the pressure on the nerve is called for, although the fluid accumulation may mean the incision wound would be slow to heal.

A more conservative strategy is to start with the expertise of a lymphoedema specialist, who may suggest a suitable compression garment. Expert examination and advice is needed.

I suggest your wife asks her GP about being referred to a specialist lymphoedema clinic (there is a tertiary referral service at St George’s University Hospital in London, which may be able to advise on a service in your area).

There, they may carry out nerve conduction studies, which will confirm if surgery is necessary. I hope this helps.

I am 70 and fit and active. But for a few months I have been experiencing pain – which is worse at night – in my left hip, buttock, thigh and knee. It’s noticeable after sitting down and causes me to limp. An X-ray has ruled out arthritis. What should I do?

A. Haywood, Newport.

I sense your frustration and concern. You need a diagnosis, and the key question is whether you have been examined physically and exactly what was X-rayed.

My opinion is that it’s either due to referred pain from the lower spine (for which there might be a number of causes), or osteoarthritis of the hip joint.

Hip arthritis often causes intermittent pain, frequently worse at night, and is also felt around the knee at times. The hip is usually stiff if not painful. A problem with the lower back may also cause referred pain in the buttock, hip, thigh and knee, and this may also come and go.

This may be a more likely diagnosis if a physical examination of the hip does not reveal any abnormality, such as stiffness, limitation of range and weakness of the muscles.

Possible problems of the lower back that could cause this kind of pain include a prolapsed disc, spinal stenosis (narrowing of the spinal canal which causes pressure on the spinal cord) and osteoarthritis.

There will be ways to ease your discomfort but none of this can happen without a diagnosis.

I’d suggest asking your doctor if the X-ray was of the hip and did not show any arthritic change, as then a scan of the lower spine is called for, preferably an MRI.