Carpal tunnel syndrome affects persons of all ages and occupations. It’s especially prevalent among women.
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The carpal tunnel is a narrow passage of bone and cartilage at the wrist. Through it pass the nine tendons that are crucial to finger movement and the median nerve that is responsible for both sensation and movement in the hand.
Crowded as it is, this tiny passage becomes even more cramped when the tendons become inflamed and swollen for any reason. This crowding can compress the median nerve, resulting in the symptoms of carpal tunnel syndrome (CTS)–pain, numbness, tingling or burning, usually in the area of the thumb, index and middle fingers.
Marcia felt pain or pins-and-needles tingling in bed nearly every night, often waking her up. She also felt it when she was maneuvering the steering wheel of the car, pulling weeds from the garden or even turning the pages of the newspaper. Sometimes she felt a shooting pain that traveled all the way up to her shoulder. She could usually get temporary relief by shaking the hand, but not always.
Recently, carpal tunnel syndrome has been linked with repetitive occupational tasks such as typing and keyboard data entry. The number of workplace injuries attributed to carpal tunnel syndrome has increased nearly four-fold over the past 30 years.
While persons who use their hands frequently, particularly in repetitive movements, may be more vulnerable, carpal tunnel syndrome is not simply an occupational injury but affects individuals of all ages and occupations and is particularly prevalent among women. Women generally have smaller wrists than men, but the tendons passing through the carpal tunnel are nearly the same size. They also are subject to occasional fluid accumulation related to menstrual cycles.
Carpal tunnel syndrome is frequently associated with conditions that cause the body to retain fluids, such as obesity, pregnancy and use of oral contraceptives and with disorders such as diabetes, hypothyroidism and rheumatoid arthritis. It can also occur as a result of trauma to the wrist. Regardless of the cause, carpal tunnel symptoms may be made worse by intense gripping or awkward bending of the wrist when using computer keyboards, knitting needles, screw drivers or hand power tools.
When carpal tunnel is diagnosed, the first step may be treating underlying disorders such as rheumatoid arthritis or diabetes plus changing work and hobby activities to avoid repetitive stress. A splint may be recommended to keep the wrist in a straight position at night or while performing certain activities. Nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen may also be prescribed in an effort to reduce the inflammation and swelling and ease the pressure on the nerve. For a more severe case, a doctor may inject steroids into the wrist, although most doctors are reluctant to give repeated injections.
As an adjunct to other treatment, exercise may be advised. It helps relieve stress and pain, improves circulation and may treat underlying conditions such as obesity or diabetes that are contributing to fluid retention.
When symptoms are severe and persist for six months or longer, surgery may be required. The most commonly performed procedure, known as carpal tunnel release, involves cutting the band of ligament that crosses the wrist, relieving the pressure on the nerve underneath. It’s a simple procedure that generally does not require an overnight stay, and it’s successful in at least 90 percent of cases.
One recent review of research found that, over the long term, surgery was more effective at relieving CTS symptoms than splinting, NSAIDs or steroid injections. However, surgery performed after a three-month trial of non-surgical treatment was just as effective as surgery performed immediately after surgery.
Marcia balked at the first mention of surgery. Any surgery carries risks, of course. But if left untreated, carpal tunnel syndrome can eventually lead to muscle atrophy, weakness in the thumb and loss of normal function of the hand. She finally came to realize that her pain was not going to go away on its own. Her doctor had performed the procedure many times and assured her that most of his patients were pleased with the results.
After her surgery, Marcia underwent a period of rest and physical therapy but regained full use of her hand within six weeks. Soon, she began to have confidence that the pain she had suffered for so long was not going to come back.
Tips for Preventing CTS
Carpal tunnel syndrome can often be attributed to a job or hobby requiring repetitive movements of the hand or wrist. To prevent such problems:
· Keep your wrist straight when lifting or grabbing a heavy object. Use your hand rather than your fingers to lift.
· Try to alternate tasks so that you avoid repetitive hand movements.
· Keep your wrists straight when working at a computer keyboard or typewriter.
· When working for extended periods at the keyboard, give your hands a short rest at least once an hour.
· Take care when you use your hands for forceful actions such as opening a jar, lifting objects or pushing open heavy doors.
[SOURCE: “Carpal Tunnel Syndrome,” CareNotes, Annual 2001]
A Risk for Typists?
A study of 257 typists at the Mayo Clinic who spent most of every work day at a computer keyboard found no increased risk for carpal tunnel syndrome. Although 30 percent complained of numbness in their hands, only 3.5 percent actually had carpal tunnel syndrome–an incidence comparable to that of the general population.
Researchers found that typists with carpal tunnel syndrome did not differ from other subjects in occupation, habits or number of years at the keyboard.
According to some doctors, the study had methodological flaws because it did not differentiate between occupations nor account for intensity of keyboarding. Moreover, critics claim, the Mayo Clinic may have adopted good working practices to decrease the risk of workplace injuries.
[SOURCE: “Carpal Tunnel: No Worries for Typists?” Industrial Safety & Hygiene News, August, 2001; “Computer Use Doesn’t Increase Risk,” Pain & Central Nervous System Week, June 30, 2001; Marilynn Larkin, “Carpal Tunnel Syndrome Study Stirs Controversy,” The Lancet, June 16, 2001]
CTS Not a Disability
Says Supreme Court
In the case of Ella Williams, an assembly line worker who became unable to work because of carpal tunnel syndrome, the U.S. Supreme Count ruled that she did not qualify as disabled under the Americans with Disabilities Act.
To qualify, the Court ruled, a person must have substantial limitations both on and off the job, and Williams was able to bathe herself, brush her teeth and perform some household chores.
[SOURCE: Linda Greenhouse, “Verdict: Not Disabled,” New York Times Upfront, February 11, 2002]
Yoga Stops CTS Pain
In a small study of 22 patients with carpal tunnel syndrome, subjects attending yoga classes twice a week for eight weeks had significantly less pain and greater grip strength than subjects being treated with splints.
According to the authors: “Yoga classes such as the one used in this study can improve awareness of proper postures and use of the upper extremities.” Small in size, the study was designed as a preliminary study and used only a wrist splint as a control without accounting for medication use or patient compliance with therapy.
[SOURCE: Marian S. Garfinkel, et al, “Yoga-Based Intervention for Carpal Tunnel Syndrome,” JAMA, November 11, 1998; Winston Sequeira, “Yoga in Treatment of Carpal Tunnel Syndrome,” The Lancet, February 27, 1999]
Vitamin Therapy Questioned
As early as 1973 some writers cited vitamin B6 deficiency as a possible cause of carpal tunnel syndrome. In 1992, John Ellis, M.D., a researcher from Mount Pleasant, Texas wrote that signs and symptoms of B6 deficiency include numbness and impaired sensation in the fingers, swelling and pain in the hands and tenderness over the carpal tunnel–signs commonly associated with carpal tunnel syndrome.
Many alternative health publications and some doctors recommend vitamin B6 to carpal tunnel patients, but a recent study questions this practice. Among 125 workers at automotive parts plants, those who tested positive for carpal tunnel syndrome were no more likely than other workers to have a vitamin B6 deficiency. Based on this and several previous studies, the authors wrote that “treatment with vitamin B6 supplementation is unwarranted.”
The authors noted that daily doses of vitamin B6 exceeding 200 milligrams can damage the nervous system.
[SOURCE: “For Carpal Tunnel Syndrome, Skip the B6,” Tufts University Diet & Nutrition Letter, September, 1996; “Letter from the Publisher,” Townsend Letter for Doctors and Patients,” May, 2002]
Surgery Brings Relief
Among 186 patients undergoing surgery for carpal tunnel syndrome, 68 percent reported that they were completely cured, and 24 percent said they experienced only mild residual symptoms not severe enough to require further treatment. The other eight percent were left with persistent problems.
[SOURCE: A.C. Hayward, M.J. Bradley and F.D. Burke, “Primary Care Referral Protocol for Carpal Tunnel Syndrome,” Postgraduate Medical Journal, March, 2002]
REFERENCES:
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Winston Sequeira, “Yoga in Treatment of Carpal-Tunnel Syndrome,” The Lancet, February 27, 1999.
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