Carpal Tunnel Syndrome: Prevention Is Key

WASHINGTON — More than 28 million Americans use computers each day and, according to officials at the Occupational Safety and Health Administration, many risk coming down with a painful, debilitating condition, carpal tunnel syndrome.

“Carpal tunnel syndrome, or CTS, involves the median nerve and the flexor tendons, which extend from the forearm into the hand through a ‘tunnel’ made up of wrist bones (carpals) and the transverse carpal ligament,” said Army Dr. (Capt.) Matthew Hengy, a family practice physician at the Pentagon. CTS can develop when repetitive wrist motion, fluid retention or acute trauma creates pressure on the median nerve at the wrist.

“Arthritis-related diseases such as rheumatoid arthritis can also cause CTS. These diseases cause pain and swelling in joints and other parts of the body. They can cause swelling of tissues in the carpal tunnel, resulting in pressure on the median nerve,” he said.

Hengy said the source of trouble is unknown with many patients because virtually anything that swells the tendons or pinches the median nerve can lead to CTS or make it worse. Injuries such as a blow to the wrist could cause CTS, for instance, because a carpal bone might fracture, break or otherwise pinch and damage the median nerve.

“The results can be tingling, numbness and, eventually, disabling pain. CTS can strike anyone, and its consequences are serious,” he said. Work-related cases are highest among those ages 20 to 40. Nonwork-related cases are highest among persons in their 50s.

“The condition is treated with steroids, anti-inflammatory drugs, physical therapy, and, in severe cases, with surgery,” Hengy said. The return of hand and wrist functions is often complete, but not always, he added.

Awareness of the problem and its causes are crucial to prevention, as are the proper use of ergonomic aids and attention to your work routine, Hengy said. CTS isn’t limited to computer operators. Other prime candidates include draftsmen, meat cutters, secretaries, musicians, assembly line workers and automotive repair workers, but anyone whose work involves repetitive movement of the hands can be at risk, he said.

“There were 2 million workers’ compensation cases reported in 1995. CTS was the most common and costly cumulative-trauma disorder and accounted for one-third of the cases. Back injuries were second,” said Linda Garrison, a Bureau of Labor Statistics economist in the Labor Department. “Half of all the workers afflicted by CTS lost 30 days or more from the workplace.” Statistics also showed women accounted for 72 percent of the cases.

The exact numbers of CTS cases over the years would be hard to pin down, if not impossible, but they’re clearly on the rise. Garrison said reported computer-related injuries of all types have soared more than 8,000 percent from 23,800 cases in 1972 to 2 million in 1995 — and the 1995 caseload was six times higher than the 332,000 reported in 1994.

CTS workers compensation cases cost up to $65,410 each in lost wages and medical benefits, according to July 1996 statistics published by the National Council of Compensation Insurance. The council’s average 1993 dollar-loss figure was $21,453. The actual cost to the national economy becomes much greater when the costs of lost production, employee rehabilitation, and hiring and training replacements are added in.

Hengy said common CTS symptoms include:

o Pain, tingling and numbness in the thumb, index, middle or ring fingers, or tingling in the entire hand.

o Pain that shoots from the hand up the arm as far as the shoulder.

o A swollen sensation in your fingers, although they may not be visibly swollen.

o You may notice that your symptoms are worse at night.

o Your hands feel weak in the morning.

o You drop objects more than usual.

o You have trouble grasping or pinching objects.

o You have trouble using your hands for certain tasks, such as buttoning a shirt, handwriting or opening a jar lid.

o The muscles at the base of your thumb are smaller and weaker than they used to be.

“At first the symptoms come and go and usually are affected by excessive use of the hand, although there may be no symptoms when the hand is at rest,” Hengy said. “As the condition worsens and pressure on the nerve becomes greater, the person may experience constant numbness.”

If you think you may have CTS, ask your primary care physician to review your medical history and examine your hands and wrists. One or all of the following tests can help confirm a diagnosis of CTS, he said:

o Tinel’s Sign Test. The doctor will gently tap the front of your wrist to see if you feel tingling or pain in your hand or forearm.

o Phalen’s Sign Test. The doctor will ask you to bend your wrist down as far as it will go and to hold this position up to three minutes to see if you feel tingling or pain.

o Nerve Condition Velocity Study. This test measures the nerve’s ability to send electrical impulses to the hand muscles, to see if the electrical impulses slow down in the carpal tunnel.

o Blood tests and X-rays of the hands may reveal whether CTS stems from a medical problem.

“For some patients exercising can temporarily relieve the pain,” Hengy said. He recommends performing the following four-step exercise 10 times a day, especially before starting an activity. Start with your arms outstretched in front of you as if typing:

Step 1: Slowly bend your hands back at the wrists with fingers fully extended. Hold for 10 seconds, then straighten your wrists.

Step 2: Stretch your arms and hands forward with fingers fully extended and hold for 10 seconds. Be careful not to push too hard and cause pain. Return to the starting position.

Step 3: Make a tight fist and hold for 10 seconds. Release.

Step 4: Straighten your wrist and extend the fingers fully for 10 seconds. Return to Step 1; do four or five repetitions.

Researchers in a 1996 study at the Orthopedic and Research Center in Oklahoma City taught these pain-relieving hand and wrist exercises to 81 carpal tunnel syndrome sufferers. They found that just one minute of exercise was enough to reduce the pressure on the victim’s median nerve — and the pain. In some cases, relief lasted several hours.

Step 1: Starting in a typing position, slowly bend your hands back at the wrists with fingers fully extended and hold for 10 seconds. Return to the typing position.

Step 2: Straighten your wrists, stretch your arms and hands forward with fingers fully extended and hold for 10 seconds. Do not cause pain by overstraining your hands and wrists. Return to the typing position.

Step 3: Make a tight fist and hold for 10 seconds. Return to the typing position. Step 4: For the second time, straighten your wrists, stretch your arms and hands forward with fingers fully extended and hold for 10 seconds. Return to the typing position; do four or five repetitions.

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