Repeat After Me: “Do Not Repeat”

Repeat After Me: “Do Not Repeat”

Carpal tunnel syndrome is not just the plague of the typist
By Karen Schwartz

You’re writing an e-mail, aware of a constant tingling in your wrist as you type. Or maybe you’re a musician jamming with some buddies, and you notice that there’s some numbness in your hand and wrist as you strum your guitar. It could be a cramp, but most likely it’s carpal tunnel syndrome, a painful progressive medical condition caused by the compression of a major nerve in your wrist.

What Is Carpal Tunnel?
According to the National Institute of Neurological Disorders and Stroke, (a part of the National Institutes of Health in Bethesda, MD), carpal tunnel syndrome (CTS) occurs when the median nerve, which runs from the forearm into the palm of your hand, and controls sensations to the palm side of the thumb and fingers (with the exception of your little finger) becomes pressed or squeezed at the wrist. The result may be pain radiating up the arm, weakness or numbness in the hand and wrist. Individuals with carpal tunnel often find it difficult to form a fist, grasp small objects or perform other manual tasks.

Who Gets It?
Women are more likely to have carpal tunnel problems, perhaps because of a hormonal influence, says Randy Bindra, MD, a professor and orthopedic surgeon at Loyola University Health System.

“As women near menopause, they have a tendency to retain water and fluids more than men,” says Bindra. “Also, women typically have narrower wrists than men, and there becomes an imbalance between the space available in the tunnel (of the wrist) and any additional fluid or swelling. That extra fluid or swelling in the soft tissue causes the contents to become larger than the available space, and the nerve receives all of that extra pressure.”

However, Bindra says he sees people of all ages and occupations present with CTS symptoms and that assembly-line work is more associated with it than is keyboard work. Anything that involves repetitive motion can lead to CTS. He adds that it is very rare in children.

Furthermore, individuals with diabetes are at a higher risk of experiencing carpal tunnel problems, as are people who are overweight, pregnant women and people who smoke, notes Mark S. Cohen, MD, director of the Hand and Elbow Section at Midwest Orthopedics at Rush University Medical Center.

“Nicotine from smoking causes the constriction of blood vessels, leading to less blood flow to the nerve, and with pregnancy, it’s a fluid phenomenon because there is more pressure on the nerve from swelling,” Cohen says.

Conservative Treatment
If you don’t experience continuous numbness in your hand and wrist, conservative solutions may help relieve carpal tunnel symptoms.

“As the first step in management, I might suggest a wrist splint. Sometimes, if people have a lot of swelling in their hand, I will give them anti-inflammatory medication such as ibuprofen, naproxen or nerve-gliding exercises to do,” Bindra says. These exercises would include “stretching your hand in different directions with the wrist bent backwards with the fingers straight, then closing your fingers and bending the wrist forward with the fist closed, then opening your fingers while your wrist is still in the forward position. What that does is make your nerve glide back and forth to prevent scarring around the nerve,” Bindra emphasizes.

Another solution for minor symptoms is a cortisone shot. “It is given to try to decrease inflammation around the nerve. This can be effective in mild cases that are not severe enough to warrant surgery,” says Cohen.

Surgical Solutions
If you have constant episodes of tingling and numbness that are not alleviated by other methods of  treatment, you might want to consider surgery, says Bindra.

“It’s largely a matter of how severe your symptoms are.” The most common type of surgery these days, he says, is a “10- to 15-minute procedure—not a major operative procedure—which is done under local anesthesia, with sedation if a patient is anxious.”

During surgery, Bindra notes, “We release the band that lies in front of the nerve that causes the compression. We have started doing that through smaller incisions, and now make a one-inch incision. The incision is placed over the heel of the palm.

“I also do surgery where I make the cut on the wrist crease so it’s not directly on the heel of the palm and release the nerve with an endoscope—it is a matter of patient preference,” Bindra says. “With endoscopic (keyhole) surgery, you have less discomfort in the first two weeks after surgery, but following those two weeks, the outcome is the same as open surgery.”

Preventing Carpal Tunnel
A lot of us spend much of our day squeezing that median nerve by communicating via e-mail at work or writing stories for health magazines. So, what can you do to prevent carpal tunnel from occurring in the first place?

“If you’re working at a computer, take frequent breaks, and do nerve-stretching exercises,” says Bindra. “Also make sure you use a gel wrist pad when doing keyboard work, and make sure your wrist is not bent; keep it as straight as possible.”

Cohen concurs: “If your wrist is poorly positioned as you type, you’re increasing pressure on your nerve. Making sure your hand, wrist and forearm are in the correct posture and your computer is [at] the right height is important. The more flexed (bent) your wrist is, the more pressure there is on the median nerve.”

But for those without any identifiable cause, like those of us not doing repetitive tasks day in and day out, Bindra says there’s just not a lot one can do to prevent it.

Overall, it seems that the best prevention is variety and keeping your wrists and hands from getting stuck in a routine.

Published in Chicago Health Winter/Spring 2014