Carpal Tunnel Syndrome: A Hands-On Approach

Stephanie S. Saunders

It's another Tuesday. You're sitting at your desk, and as you continue to type your report, you feel a dull ache in your wrist and hand. Sometimes you can put it out of your mind, but often the pain that travels up your arm is too sharp to ignore. Is it tendinitis? Is it bursitis? Has your hand been possessed by some otherworldly demon? Or is it a case of carpal tunnel syndrome (CTS)? And if it is CTS, what should you do? Let's take a look at CTS, a condition that plagues 50 of every 1,000 Americans, and perhaps discover how you can avoid both the condition and the surgery that is often performed to treat it.

The carpal tunnel is a passageway on the palm side of the wrist that connects the forearm to the middle compartment of the palm. Housed in this passageway are 10 long flexor tendons. When any of these tendons swell or degenerate, the narrowing of the tunnel often compresses the median nerve, which can cause pain. This is what is known as CTS. Those suffering from carpal tunnel syndrome experience pain, numbness, and tingling sensations in the arm, which can extend to the shoulder and neck area. Symptoms may increase over time, and may include burning, swelling, and the loss of grip strength. If left untreated, in extreme circumstances CTS can cause loss of mobility in one or both hands.

What actually causes CTS is unknown and is a subject of heated debate among workers' compensation case handlers. CTS can be associated with anything that causes stress on the wrist. Genetic disposition, pregnancy, arthritis, obesity, hypothyroidism, smoking, and diabetes are all factors. Pressure on the outside of the tunnel, be it from benign tumors or vascular malformation, can also play a part in CTS. Then there are overuse issues, which is where the debate begins. Some believe that repetitive and manipulative motion is the cause of CTS, but there's no scientific data to date to establish that this type of work is actually the cause. There is greater incidence of CTS in industrial jobs where force, posture, and vibration play a part, but little distinction has been made between work-related arm pain and CTS. CTS is most prevalent in those performing assembly line work, and, believe it or not, in musicians.There is actually, however, little evidence to support CTS in compter based jobs.

Prevention

If CTS is in fact determined by genetics and structure, than acquiring it would seem to be unavoidable. However, if recent research is correct, there are quite a few things you can do to avoid CTS:

1. When possible, avoid repetitive stress. If you work in an industry that requires you to perform the same hand and arm motions every day, that might be difficult. You can try to offset these activities performed during your required work hours by taking appropriate breaks and stretching your fingers, hands, wrists, and arms. Shorter, more frequent breaks have been shown to help alleviate this repetitive stress more effectively than longer, less frequent breaks.
2. Working in an environment that lets you maintain an ergonomically correct position can help you keep CTS at bay. Finding and maintaining that correct position for your hands and wrists can make a huge difference. For desk jobs, proper placement of your keyboard and positioning your body correctly while sitting play an important role. Wearing wrist splints to maintain proper wrist angle can help stabilize the area and avoid inflammation.
3. Using supplements like turmeric, omega-3 fatty acids, and B vitamins can be helpful. Turmeric is a natural anti-inflammatory, and B vitamins and omega-3 fatty acids also seem to help with the symptoms of CTS.
4. Psychosocial factors, extreme deadlines, and low levels of job satisfaction seem to play a role in the numbers of CTS cases reported. Finding a balance between work and rest might be the key, as stress can take a toll on any part of your body.
5. If you're in a highly repetitive job, ask your employer about rotating jobs among employees, so each person doesn't have to perform the same repetitive action all day long, or every day of the week. Your employer might be especially receptive to the idea if you point out that preventing CTS can help him or her save money on workers' compensation claims.

Treatment

So if you wake up in the middle of the night with shooting pain in your wrist and arm and a numb hand, what should you do? First of all, get tested and find out if what you're dealing with is actually CTS. The diagnosis is fairly simple, from muscle testing to electrodiagnosis. And if you are indeed suffering from CTS, remember that although it isn't life-threatening, it can truly alter the quality of your life. The following are some ways to treat CTS:

1. Rest is your first order of defense with CTS. Keep the area immobile for a couple of weeks, and allow the swelling to return to normal. Ice and compression can be extremely helpful too.
2. Stretching is not only helpful in the prevention of CTS, but it can actually alleviate pain. You should put your wrists, hands, and forearms through range-of-motion exercises, stretching them just to the point before you can feel pain. Traditional yoga has also been shown to create vast improvements in CTS by actually increasing grip strength in patients who try it.
3. There are also a few simple exercises you can do to help with CTS. Our resident fitness guru, Steve Edwards, recommends extensor exercises. "So far, I've had a 100 percent success rate curing CTS over time using simple reverse wrist curls," he explains. "In one case, with someone who had two surgeries and a couple of cortisone injections, she was better in three weeks!"
4. Physiotherapy is extremely effective in alleviating and managing the symptoms of CTS. This can include soft tissue massage and exercises to directly mobilize the nerve tissue. Seek the advice of your physical therapist about effective stretches you can do.
5. Although there is little hard scientific evidence about the effectiveness of chiropractic and acupuncture in treating CTS, there are many patients who consider these two systems of therapy to be their salvation. A chiropractor can help realign the wrist and upper spine, which may take some pressure off the median nerve. Acupuncture can release natural pain-relieving chemicals into the body and promote circulation in the affected region.
6. Anti-inflammatory over-the-counter medications, including NSAIDs like aspirin, ibuprofen, and naproxen sodium, can help reduce swelling. Steroid injections can reduce pain by taking pressure off of the nerve. Steroids can also be taken by mouth, but can have some extra side effects.
7. Surgery is the most extreme form of treatment for CTS, but it has been shown to correct the problem approximately 95% of the time. Once the pressure is taken off of the nerve, it tends to stay off. The goal in carpal tunnel release surgery is to cut the transverse carpal ligament in two. This takes pressure off of the median nerve. Surgery can be performed openly, or as an endoscopic procedure; both leave a small scar on the wrist or hand. Recovery is fairly rapid, from a few weeks to a couple of months, and results are generally positive. Damage to the median nerve is a possibility, but this happens in a fairly small percentage of cases.

If you think you feel CTS coming on, as with any medical condition, you should seek advice from your health care provider. Remember, addressing the problem immediately may help you avoid severe pain, numbness, tingling, and even atrophy of the muscles in the hand and wrist.