This is a numbing
disorder of the hand that rarely affects men but is fairly common in
women. The carpal tunnel is a passageway that leads through your
wrist. The area is called a tunnel because it has bones on three
sides and a ligament on the palm side. Feel your wrist. Can you feel
that it has three bony sides and soft tendons on the underside? The
carpal tunnel protects the median nerve that runs inside and
provides sensation to your fingers. Normally you aren't conscious of
that nerve, but when tissues in the tunnel swell, there's less room
in the area and the median nerve becomes irritated. People with
carpal tunnel syndrome (CTS) experience numbness, tingling and pain
in the fingers, wrist and even the arm. It is commonly described as
pins-and-needles tingling or fingers going to sleep, such as when
you've rested on a part of your body for a long time. The pain is
worse at night when your body is warm and blood vessels expand
taking up more space in the carpal tunnel. CTS may be brought about
by activities that involve repeated or strenuous use of the wrists.
Repetitive motions may range from typing all day at a computer to
biking or playing tennis on a regular basis. Staying in one position
for so long that it causes compression on the nerve such as during a
long bike ride may also cause CTS. Swelling and pressure - and
carpal tunnel syndrome - may also be caused by conditions such as
arthritis, diabetes, low levels of thyroid hormones, pregnancy,
hormonal changes associated with menopause and broken or dislocated
bones in the wrist.
When sitting at a keyboard, make
sure your hands are at elbow level or slightly below elbow level to prevent
excess bending or stretching in the wrist. You may also use a wrist rest that is
a foam pad placed at the end of the keyboard for extra support. Take a break
every hour or two or whenever you feel tired, to change your posture. Lean back
and take your hands off the keys. Take a second to bend your wrists the opposite
way from the position they normally maintain. Stretch your fingers and
shoulders, moving them around naturally to get them out of the fixed position.
Take a thick rubber band and place it around the tips of your fingers including
your thumb. Now open and close your fingers. For more wrist exercises, you may
squeeze a tennis ball several times a day or try sports dough called "Power
Putty" If you ride bikes; you should wear properly padded biking gloves and
change positions during a long ride. If you play tennis or handball, take
lessons to learn the proper grip. If you are pregnant, the numbness will
disappear after the baby is born. Treating any of the conditions mentioned above
(arthritis, diabetes, low levels of thyroid hormones, hormonal changes
associated with menopause, broken or dislocated bones in the wrist) should also
bring relief to your CTS.
Aspirin or other over-the-counter
pain relievers such as Aleve, Motrin or Tylenol may relieve the pain. Your
doctor should first prescribe a wrist splint to help hold the wrist in an upward
position. This position is important because it allows the nerve the room it
needs. The splint may be worn round-the-clock or only at night depending on what
gives you the most comfort. Elevate your hands when you sleep so that fluid
drains back down your arm and decompresses the tunnel through which the nerve is
passing. Strap an ice pack to your wrist for 10 - 20 minutes; place your wrists
under a cold running tap or soak in an ice water bath to relieve the
inflammation. You may add a few tablespoons of salt to the water bath. A
therapist may do paraffin or hot wax bath and wrist massage. If you are not
feeling better after a few weeks, your doctor may recommend a cortisone
injection. The purpose of the cortisone is to decrease the swelling around the
tendons. It is like putting the aspirin right into the wrist.
Some people get better after one injection. Others might require a
repeat. Cortisone should not be used frequently because it may cause the tendons
to breakdown. Vitamin B2 (riboflavin) and Vitamin B6 (pyridoxine) supplements
may be helpful especially if you have a deficiency of the vitamin. However
excess doses of Vitamin B6 may also cause nerve damage. If these treatments do
not work, then surgery may be necessary. The procedure called a "release"
involves cutting the ligament forming the roof of the carpal tunnel to relieve
pressure on the median nerve. The operation is usually done on an outpatient
basis and successful in most cases. Before you consider surgery, make sure
you've made changes in the work place and seen a physical or occupational
therapist to learn new ways to work or play. Surgery may not be able to undo
muscle or nerve problems brought on by years of strain. Even after surgery,
these changes will still be necessary if you do not want your CTS symptoms to
come back.
Call your Doctor if making changes in the way
you work or play doesn't seem to help and the pain is sufficient to
keep you awake at night.