Nathan Wei, MD

How to clobber carpal tunnel syndrome

Repetitive stress injury (RSI) is a term that describes musculoskeletal pain syndromes that occur as a result of repetitive motion. This article discusses carpal tunnel syndrome- a common type of RSI

Probably the most common form of repetitive stress injury (RSI) is carpal tunnel syndrome (CTS). This condition is due to pressure on the median nerve, the major nerve that runs from the forearm into the hand.  The median nerve courses through a narrow channel formed by the eight carpal bones of the wrist.  The roof of the channel is formed by a tough piece of fibrous tissue called the flexor retinaculum.

CTS affects approximately 9 million individuals in the U.S.  While CTS is often due to other medical conditions such as rheumatoid arthritis, hypothyroidism, gout, trauma, and pregnancy, it most commonly develops from repetitive motion.

Those people most susceptible to developing CTS are mechanics, cashiers, carpenters, grocery store checkers, manufacturing or assembly-line workers, violinists, gardeners, golfers and knitters. Heavy computer use and typing also are suspected of bringing on CTS.

Symptoms of CTS include:

• Wrist pain radiating into the hand or up the forearm
• Swelling in the wrist and hand
• Numbness, burning and/or tingling in the hand
• Pain with movement of the hand or wrist
• Weakness in the thumb and first three fingers
• Loss of grip strength
• Pain and/or numbness of the hand at night
• Muscle atrophy.

Women are three times more likely than men to suffer from CTS.  This gender difference may be due to the fact that, in general, female wrists are smaller, creating a narrower channel through which the nerves and tendons must pass. Hormonal changes occurring during pregnancy and menopause may make women more susceptible.

To prevent CTS from developing in the workplace, there are a few steps that can be taken:

Modify the workspace and make it ergonomically friendly. The workspace and equipment should be at the proper height and distance for the hands and wrist. The computer keyboard should be placed high enough to allow the wrist to rest comfortably without bending. For most people, the workspace should be about 27 to 29 inches above the floor. Keep your elbows close to your sides as you type to reduce the strain on your forearm.

Take a 10-to-15-minute break at least every 1-2 hours to relieve the repetitive stress on the hands and wrists.

Try to “cross train”.  In other words, do different types of tasks and rotate them so repetitive stress becomes less of a problem. That way you work different muscle groups.

Practice gentle, loose hand and wrist exercises to loosen things up.  By doing these exercises in directions counter to the direction of repetitive motion, you can place less stress on the wrists.

Avoid hard grasping and gripping motions that might aggravate repetitive stress.

Keep your hands warm, even if you have to wear fingerless gloves during work.

If you develop carpal tunnel, see a physician, either a rheumatologist or orthopedist.

Treatment options include:

• Non-invasive measures such as physical therapy, yoga, ultrasound, chiropractic manipulation, acupuncture, and massage.
• These non-invasive modalities may help a great deal.
• A wrist splint worn at night can also help with symptoms.
• Rest from the repetitive motion is a must.
• Non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen and other non-prescription pain relievers can help relieve symptoms.
• Corticosteroid injections may be very helpful.  These injections should be done using ultrasound guidance and a splint should be applied for at least a week following the injection.
• CTS surgery is reserved for severe cases after other treatments have failed.  Most patients can have their surgery done endoscopically which reduces “down” time.

Article Tags: Carpal Tunnel Syndrome, Carpal Tunnel, Tunnel Syndrome, Repetitive Stress

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