Carpal tunnel syndrome: when work hurts

by Rick Alan

Desk jobs are supposed to be easy, right? Easy on the body at least. That's why we all need to go to the gym now to get exercise. It turns out that the computer age has brought too much exercise to our hands and wrists. Now those people with the desk jobs have become casualties of the computer age as they join the ranks of those suffering from carpal tunnel syndrome.

With the large spike in computer use over the past 20 years—both at home and in the office—has come a steady rise in the incidence of carpal tunnel syndrome (CTS). Often overlooked or misdiagnosed in the past, CTS has become a well-recognized and routinely diagnosed condition.

Anyone can suffer from CTS, but the most common sufferers are women between the ages of 30 and 60. In fact, approximately three times more women than men suffer from CTS.

The carpal tunnel is a canal formed on the underside of the wrist by the wrist bones and the carpal tunnel ligament. Through this canal passes a group of nine tendons and the median nerve, which supplies feeling to your thumb, index and middle finger, and part of your ring finger. Compression of the median nerve, either due to swelling of the these tendons or a decrease in the size of the carpal canal, results in carpal tunnel syndrome— pain, numbness, tingling and/or weakness in the wrist, hand or, in some cases, the arm and shoulder.

In addition to repetitive hand motion, CTS can also result from underlying medical conditions.

Anything that causes an increased pressure on the carpal tunnel can cause CTS. The most recognized causes are jobs and activities that require a repetitive motion of the wrists and/or hands, including:

• typing
• writing
• assembly line work
• using a computer mouse
• knitting
• operating a cash register
• playing video games
• racquetball

CTS can also result from underlying medical conditions, including diabetes, obesity, hypothyroidism, alcoholism, arthritis or lupus. In addition, as Dr. Michael Tantillo, a plastic and hand surgeon at Boston's Beth Israel Deaconess Medical Center points out, \"Pregnancy and nursing are a very common cause of carpal tunnel syndrome. However, after giving birth or weaning the infant, the CTS will go away in virtually every case.\"

In diagnosing CTS, doctors first obtain a complete history of your symptoms and conduct a very thorough examination of the affected area. In addition to looking for the presence of pain, numbness and/or tingling in the hands, wrists and arms, doctors will look for three other, more specific symptoms:

• Pain and numbness on waking from sleep- This is often a telltale sign. The natural increase of fluids in the body extremities, including the wrists and hands, during sleep puts additional pressure on the carpal tunnel and thus, the median nerve.
• No pain in the little finger, in the presence of other finger pain - Since the median nerve doesn't supply feeling to the little fingers, absence of pain there is often a clue that the pain in the other parts of your hands and wrists is due to carpal tunnel syndrome.
• Thumb weakness - In its more advanced stages, CTS often causes weakness in the thumb muscles.

Once CTS is suspected, an electromyogram test (EMG) is usually done to verify the diagnosis.

Carpal Tunnel Syndrome Depending on the cause and the severity, CTS is treated in different ways. The first step generally involves trying to relieve the underlying cause, either by controlling the underlying medical condition or by decreasing or eliminating the activity requiring a repetitive motion of the hands and/or wrists.

In many instances, this is impossible. If the CTS isn't too severe, it can be treated by placing the wrist in a splint (usually worn day and night) and administering anti-inflammatory drugs, such as ibuprofen or naproxen sodium (Aleve or Naprosyn). In more debilitating cases, injection of cortisone or stronger anti-inflammatory drugs may be necessary.

In very severe cases, surgery may be necessary. This is especially true if thumb weakness is present, because unlike the pain and numbness, thumb weakness can become irreversible. Treating severe thumb weakness requires surgery on the wrist ligaments to relieve pressure on the median nerve, which also relieves the pain, numbness and tingling. Often conducted as day surgery under regional anesthesia (where only the hand and arm are put to sleep), carpal tunnel surgery can be performed by either the \"open\" or the \"endoscopic\" method.

In the open method, a small incision is made in the underside of the wrist, through which the procedure is performed. In the endoscopic method, one or two very small incisions are made in the underside of the wrist, through which very small video and surgical instruments are passed and the procedure performed. Though less invasive than the open method, the endoscopic method also carries a slightly higher risk of damage to the median nerve, so the majority of surgeons still prefer the open carpal tunnel surgical method. Following surgery, the wrist and hand is generally placed in a cast or splint, and you must avoid strenuous use of the wrist and hand for anywhere from one to six weeks.

Preventing CTS starts with a healthy diet, regular check-ups, and monitoring your health to avoid any of the underlying medical conditions that can cause CTS. For CTS caused by repetitive motion activities, there are a number of preventive steps.

If the repetitive activity is work related, it's crucial that you improve the ergonomic setting in which you work. This includes sitting in a chair with armrests (to avoid pressure and a low blood supply to the wrists and hands caused by resting them on the edge of your desk) and using an ergonomically correct computer keyboard. A recent study from the University of California demonstrates that a computer keyboard designed with \"springy\" keys can significantly reduce the hand pain associated with carpal tunnel syndrome.

Since doing your job may make it impossible to eliminate an activity that causes CTS, be sure to take frequent short breaks--three to five minutes every hour or two. Depending on the activity, frequent stretching of the hands and wrists or using a squeeze device before, during, and after the activity is important.