Carpal tunnel syndrome

Carpal tunnel syndrome is a disorder in which the median nerve is compressed at the wrist causing symptoms like tingling, pain, coldness, and sometimes weakness in parts of the hand. It is the best known of a class of disorders called repetitive strain injuries.

Treatment and Prevention

There has been much discussion as to the most effective treatment for CTS. There are five basic categories:

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• Wearing immobilizing braces or wrist splints
• Having localized steroid injections
• Soft Tisssue Therapy
• Prioritize activities and Ergonomics
• Carpal Tunnel Release Surgery

Immobilizing braces

Rigid immobilizing braces and wrist splints can help some people, but they are limiting, unsightly and uncomfortable to wear. Over several weeks braces and splints often result in hand and forearm muscle atrophy. For this reason braces should not be worn 24/7 for more than a few days at a time. Instead many health professions suggest one wears them at night, and if possible, during the activity that causes stress on the wrists for best results.

Related Topics:
Brace - Splint

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Localized Steroid Injections

Steriod injections can be quite effective for temporatry relief from the symptoms and pain of CTS for a short time frame while a longterm strategy that fits with one's life style is developed. However, it is not a long-term solution. Ethical medical professionals would only resort to localized steroid injections for a short time until another acceptable treatment option could be identified.

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Soft Tissue Therapy

Many people are turning to soft tissue therapy as a way to prevent pain and avoid sleep loss and work interruption. Soft tissue therapy can result from doing exercises, visits to chiropractors and using a new class of medical device which for many CTS sufferers offers relief from CTS pain and hand tingling in days. These are different from other over-the-counter CTS treatments and are not rigid immobilizing braces. Worn during sleep soft tissue devices gently reshape soft tissue in and around the Carpal Tunnel and eliminates hand pain, numbness and sleep interruption. A particular treatment, known as carpal solution therapy, has been shown to improve CTS symptoms in 80 to 90% of the people that try it. It often allows people to get back to their active life styles with minimal disruption.

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One recommended stretching exercise is:

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• Sit in a chair.
• Place the right elbow into your side, palm side of the hand facing upwards.
• Using the left hand, push the right hand down by applying pressure to the four largest fingers.
• Hold for two seconds.
• Release the stretch by taking the pressure off the fingers and just letting the hand naturally come back.
• Perform 10 repetitions, switch arm configuration and perform 10 more repetitions.

Prioritizing Hand Activities and Ergonomics

Using our hands is a defining characteristic of the human condition. While avoiding activities that cause repetitive stress is an option that can help avoid the pain, it causes people to curtail their careers, forfeit earnings and give up whole segments of their lives. Our self esteem as human beings and contributors at home, at work and at recreation is directly tied to the way we use our hands. Giving up activity is a poor option for most people.

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More frequent rest can be useful if it can be orchestrated into ones schedule, but rest is not very practical in today's active work environment. It has been shown that taking multiple mini breaks during the stressful activity is more effective than taking occasional long breaks. There are two applications available that allow one to set up a proper breaking schedule by blocking input to the computer. The first to appear was a commercial solution called WorkPace, which was followed eventually by a free software alternative known as WorkRave. Both applications have recommended defaults, following the most effective average break configuration which is a 30 sec. pause every 3 to 5 minutes (the more severe the pain, the more often one should take this break). During this break it would be best to perform a stretching exercise or simply let one's arms dangle to the ground. Note that one will find these breaks very disruptive at first, but once adjusted to them, they will make a huge difference in carpal tunnel pain, possibly giving more stress reduction than all other treatments combined.

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Changes in diet relate to providing the body with the nutrients it needs to reduce the flamatory action of the carpal muscles in order to reduce pressure on the nerve, thus allowing it to heal, as well as providing nutrients needed to repair nerves. No specific vitamin or nutrient has been shown to have a noticeable anti-inflammatory effect, but taking a diverse multivitamin can have a noticeable effect on reducing inflammation in the body. Using an over-the-counter anti-inflammatory such as Aspirin or Ibuprofen is very effective as well. Pain relievers (ex: Tylenol) will only mask the pain and only an anti-inflamatory will give the carpal nerve time to heal. Certain vitamins and nutrients can also be taken to repair nerve damage, such as amino acids, vitamin B complex and hypercium (an extract of St John's Wort). A more aggressive option is an injection of cortisone, to reduce swelling.

Related Topics:
Anti-inflammatory - Aspirin - Ibuprofen - Tylenol - Amino acids - Vitamin B - Hypercium - St John's Wort - Cortisone

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More pro-active ways to reducing the stress on the carpal tunnel involve adopting a more ergonomic work and life enviroment such as using an ergonomic keyboard (and perhaps switching from a QWERTY key layout to a more efficient Dvorak Simplified Keyboard layout). Studies have shown ergonomic keyboards reduce wrist stress by 30% or more and Dvorak reduces stress an additional 30%. It's also important that one's body be aligned properly with the keyboard. This is most easily accomplished by bending one's elbows to a 90 degree angle and making sure the keyboard is at the same height as the elbows. Also it is important not to put physical stress on the wrists by hanging the wrist on the edge of a desk, or exposing the wrists to strong vibrations (ex: manual lawn mowing).

Related Topics:
QWERTY - Dvorak Simplified Keyboard

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Carpal Tunnel Relief Surgery

While there is a surgical relief to carpal tunnel syndrome, full recovery is achieved in less than 60% of cases. Often surgeons counsel patient to change their careers and undergo surgery. Downtime and rehabilitation can take up to three months resulting in a significant loss of earnings, depression and loss of self esteem. Also, since carpal tunnel syndrome is a "syndrome", not a disease, if repetitive stress activities are continued, then surgery will likely have to be repeated within a year or two. This makes surgery a choice of last resort for carpal tunnel syndrome treatment. Most insurers and healthcare professionals recommend exhausting all conservative options before resorting to Carpal Release Surgery.

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