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Hurting Hands

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If you work long hours tapping away at a computer or punching the buttons of a cash register, chances are you may already know what it feels like to.

If you work long hours tapping away at a computer or punching the buttons of a cash register, chances are you may already know what it feels like to have carpal tunnel syndrome (CTS) that tingling and painful condition of the wrists and hands that makes you want to rub or shake them to alleviate the discomfort.

In recent years, repetitive motion injuries have risen dramatically. This may be partly due to the prevalence of computers in homes and offices, though people in all kinds of occupations, including typists, manual labourers, assembly-line workers, janitors, waitresses or massage therapists, are also prone to repetitive motion injuries. Although reliable estimates of the actual number of cases is unknown, the Canadian Centre for Occupational Health and Safety has found from studies of specific occupations that CTS is quite common. For example, in one study of 982 supermarket checkers, 614 reported CTS symptoms. And of 700 employees at an electronics manufacturing plant, 52 cases were reported as workers' compensation claims over a five-year period.

This disabling syndrome occurs more often in women than men, by a ratio of three to one, usually occurring between the ages of 30 and 60. Even leisure activities such as knitting, crocheting, rug hooking, playing a musical instrument, painting, woodworking, gardening and lifting weights can lead to CTS. Women who are pregnant, taking oral contraceptives or experiencing menopause seem to have an increased incidence of CTS. People with thyroid gland disorders and diabetes are also at higher risk.

What Are The Symptoms?

CTS affects the hand and wrist because of compression or irritation of the median nerve. Symptoms often first appear as painful numbness or tingling in one or both hands at night, frequently painful enough to disturb sleep. The pain usually involves the first three or four fingers or may be sensed deep in the palm, but may also radiate up the arm to the shoulder or neck region. A feeling of uselessness, clumsiness or swelling may also occur, even though on inspection, little swelling is apparent. A decreased ability and power to squeeze things may follow. Relief may be obtained by hanging the arm out of bed or shaking or rubbing the hand. In advanced cases, weakness and atrophy of the thumb muscles can occur, which results in significant loss of grasping strength.

What Causes CTS?

Carpal tunnel syndrome usually occurs because of conditions that increase the volume of structures within the tunnel or cause a narrowing of the tunnel itself, resulting in median nerve impingement. Examples include fractures of the forearm bones (radius and ulna), dislocation of the carpal bones, arthritic bone spurs, thickening of the transverse carpal ligament, fluid retention (edema), fat disposition (lipoma), gout, and inflammation of the wrist tendon sheaths (tenosynovitis).

Some research has shown that certain CTS sufferers have decreased vitamin B6 levels, which may account for the symptoms. Other cases are due to ligamentous problems in the elbow where nerve compression may occur. Neck-related concerns such as ligamentous laxity, disc degeneration and arthritis can produce CTS-like symptoms. Trigger points in certain forearm muscles may also mimic CTS.

How Is CTS Diagnosed?

Patient description of the symptoms and physical examination are usually adequate for making a diagnosis. Certain physical tests are done to reproduce the tingling of the median nerve. In true CTS, the little finger is usually unaffected. If more information is required, a nerve conduction velocity test is performed, which measures how fast nerve impulses are conducted through the median nerve.

How Is CTS Treated?

Treatment depends upon the stage of the disease and must take the anatomical nature of this condition into consideration. Mild cases may be treated by applying a removable wrist brace, which is usually worn at night to keep the wrist from bending. Resting the wrist allows the swollen tendons to shrink, thereby relieving pressure on the nerve.

A variety of exercises may prevent or control symptoms. Manual manipulation of the carpal bones or gentle separation of the radius and ulna may relieve pressure in the tunnel. Many chiropractors have had success manipulating the elbow, shoulder and neck in CTS patients to provide relief. Workplace ergonomics have long been thought to be a contributing factor, and alteration of the worksite is a must for patients doing any type of repetitive work.

Hydrotherapy provides a simple, efficient way to increase circulation and reduce edema in the area. Immersion in hot water for three minutes followed by immersion in cold water for 30 to 60 seconds repetitively three to five times will improve local circulation, thereby increasing local nutrition, eliminating waste and decreasing pain.

Some studies have also shown a positive response to acupuncture.

Moderately severe cases of CTS may respond to anti-inflammatory medication that helps control the swelling of the tendons, but relief is temporary at best. Naturopathic physicians prescribe natural alternatives such as proteolytic enzymes, the food supplement MSM, botanicals such as boswellia, devil's claw root, curcumin and homeopathic medicines such as Arnica, Ruta and Hypericum, to name but a few.

Several good studies have demonstrated the efficacy of vitamin B6 supplementation in the treatment of CTS. B6 in the amount of 100 to 500 milligrams per day has been shown to help 30 to 70 percent of patients. Some clinicians prefer to use the active form of B6, pyridoxal-5-phosphate, or to combine B6 with other B vitamins, particularly B2 (riboflavin). The therapeutic response may require up to three months of supplementation. Certain compounds such as oral contraceptives, yellow food dyes and Parkinson's medication lower body levels of vitamin B6 and may precipitate CTS.

More aggressive natural treatment includes injection of the median nerve or tunnel with local anaesthetics and/or homeopathic medicines. This is called prolotherapy. Such therapy may de-inflame the area and promote more normal nerve conduction. Injection of the wrist, elbow, shoulder or neck ligaments by an experienced prolotherapist has frequently helped CTS patients. The aim of prolotherapy is to heal lax or inflamed ligaments by the use of non-cortisone solutions, such as 12.5 percent dextrose, which promote new ligament growth and strength. Trigger point therapy injections to the involved muscles of the arm benefit some people.

A Quick Anatomy Lesson

The carpal tunnel receives its name from the eight bones in the wrist called carpals that form a tunnel-like structure. The tunnel provides a pathway for nine flexor tendons, which control finger movement and the median nerve. The top of the tunnel, (palm side), is covered by a strong band of connective tissue called the transverse carpal ligament.

The median nerve originates from branches in the neck, travels down the upper arm, over the elbow region, down the forearm and eventually through the carpal tunnel and into the hand. This nerve supplies sensation to the thumb, index finger, long finger and half of the ring finger. It also supplies a branch to the muscles of the thumb, the thenar muscles. These muscles help move the thumb and allow the thumb to be able to touch each of the other fingers. This motion is called opposition.

Prevention Exercises

You can strengthen your hands and wrists and help prevent CTS with some simple exercises. Do them for five to 10 minutes before you start work and on your breaks.

  1. Extend your arms, and extend your hands and fingers as if they were in a "hand-stand" position. Hold for a count of five.

  2. Straighten wrists and relax fingers.

  3. Make a tight fist with your hands.

  4. Bend wrists down while keeping hands fisted. Hold for a count of five.

  5. Straighten both wrists and relax fingers. Hold for a count of five.

  6. Repeat exercise 10 times, then let arms hang loosely at sides and shake for a couple of seconds.

Source: American Academy of Orthopedic Surgeons

CTS Prevention

  • If computer work is putting you at risk for CTS, purchase an ergonomically designed desk, chair, keyboard, mouse and mouse pad to help prevent strain on your hands and wrists.

  • At work, start an ergonomics committee to review and develop new workstation design if this hasn't already been done.

  • Use ergonomically designed tools that minimize vibration or forceful exertion.

  • Ensure your posture is correct when lifting or bending.

  • Minimize repetitive motions by taking periodic rest breaks or changing tasks.

Source: American College of Occupational and Environmental Medicine, Texas Back Institute

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