Take steps to protect against carpal tunnel syndrome

June 06, 2005|by Dr. Mark Yacyk

Carpal tunnel syndrome is a localized compression of the median nerve at the wrist. Although many people assume it is a new condition, resulting from various careers requiring computer usage, carpal tunnel syndrome was first described in the 19th century. CTS is the most commonly reported nerve compression syndrome.

The roof of the carpal tunnel is made up of the transverse carpal ligament, which attaches to the wrist bone. The floor of the tunnel is made up of two wrist bones. Inside the carpal tunnel resides several finger flexor tendons and the median nerves. The median nerve is one of the major nerves supplying sensation and motor control to the arm and hand.

Prolonged compression of the nerve results in numbness and tingling of the thumb, index, middle and ring fingers. There also might be pain radiating from the wrist down into the hand and occasionally up into the shoulder. Some people experience weakness in the hand with a tendency to drop objects. Typically, patients wake up in the middle of their sleep with pain and or numbness in the hand.

Some common conditions that can lead to carpal tunnel syndrome include obesity, pregnancy, diabetes, arthritis, repetitive work and trauma.

Carpal tunnel syndrome is diagnosed by performing a nerve conduction study. It can show the presence and extent of nerve damage. It also might help explain other reasons for the symptoms not caused by carpal tunnel syndrome.

The syndrome affects primarily women between ages 50 and 70. Women are three times more likely than men to develop it. Any job that requires repetitive wrist action can place a person at risk. Industries reporting a problem with CTS include data entry, check-out clerks, meat processors, butchers and assembly-line workers. Additional risk factors include incorrect wrist and hand positioning, temperature extremes and vibration.

Conservative management might be helpful. Mild symptoms can be relieved with frequent rest breaks and ice packs to reduce swelling. At other times, treatment might consist of splinting the wrist in a neutral position. The splint usually is worn at night. Anti-inflammatory medication taken by mouth or injected directly into the carpal tunnel might be tried. Also, vitamin B6 has been associated in helping nerves to heal.

Surgery is the definitive treatment of the disease and involves cutting the transverse carpal ligament, either through an open incision or with the use of an endoscope. The surgeon will decide which method to use.

Occupational therapists play an important role in the recovery from carpal tunnel syndrome. They are specially trained in wrist and hand posture, fitting splints and choosing adaptive equipment in order to perform a task in a safe and efficient manner.

While there are no proven ways to prevent carpal tunnel syndrome, there are precautions people can take to protect hand function. The best way to prevent carpal tunnel syndrome is through education and providing an ergonomically correct workplace. Other precautions include reducing force and relaxing your grip - most people do not realize the force they use to perform basic tasks with their hands. People also can take rest breaks every 15 to 20 minutes; avoid bending the wrist all the way up or down; and improve posture. Poor posture in the shoulders can cause compression of nerves in the neck, resulting in problems with the wrist, hand and fingers. When working in a cold environment, keeping hands warm will prevent pain and stiffness.

Carpal tunnel syndrome is best treated when diagnosed early. When the symptoms first appear, see a doctor for an examination and treatment recommendations.

Dr. Mark Yacyk is a physiatrist with Washington County Health Systems.

|

|

|