Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
15 Coping Techniques
Three paragraphs into the letter to your grandson and the aching tingle in your writing hand makes you put down the pen.
You spent weeks finding the right paint for the kitchen, but after a few short strokes the bothersome pain in your wrist and hand makes you leave the brush in the bucket. At night you wake up with numbness in your hand and wrist for no apparent reason.
If incidents like these are happening to you, chances are you have carpal tunnel syndrome.
Carpal tunnel syndrome isn't something that happens overnight. It's a cumulative trauma disorder that develops over time due to repeated stressful movements of the hands and wrist.
Think of New York City's Holland Tunnel for a moment. Imagine what a pain it is to try to get through it during rush hour; multiple lanes of traffic aiming to get into single file. Well, your wrist, known as the carpal tunnel, is a lot like the tunnel under the Hudson River during rush hour. You don't have trucks and cabs going through your wrist, of course, but you do have a nerve and tendons, and when you use your hand in repeated stressful motions—like writing, typing, or hammering—the tendons swell and compress the median nerve that runs to your hand. The result is a big pain.
In the Holland Tunnel, when traffic swells, horns blare. In your wrist, when the tendons swell, pain flares.
Women are twice as likely as men to suffer from carpal tunnel syndrome, with the average age of onset being between 40 and 60. According to Colin Hall, M.D., professor of neurology and medicine at the University of North Carolina at Chapel Hill School of Medicine, "Symptoms normally affect one hand but can be present in both. Sometimes the affected hand will feel numb or tingle, or feel like it's 'fallen asleep.' The sensation normally is felt in the thumb and forefinger area, but it's possible to feel it throughout the whole hand."
When the feeling comes, it's time to look for relief. Here's how.
Go round in circles. "When the tingling begins," says physical therapist Susan Isernhagen of Duluth, Minnesota, "it's time to begin doing some gentle hand exercises."
One of these is a simple circle exercise that rotates the wrist. Move your hands around in gentle circles for about 2 minutes. "This exercises all the muscles of the wrist, restores circulation, and gets your wrist out of the bent position that normally brings on the symptoms of carpal tunnel syndrome," says Isernhagen.
The B6 Benefit Recent scientific studies are showing that physician-supervised therapy with vitamin B6 can help relieve the symptoms of carpal tunnel syndrome. In a 12-year study conducted in Louisville, Kentucky, Morton Kasdan, M.D., found that 68 percent of his 494 carpal tunnel syndrome patients improved while taking vitamin B6 daily. John Ellis, M.D., a surgeon and family practitioner in Mount Pleasant, Texas, has been using vitamin B6 for many years to treat carpal tunnel syndrome at the Institute for Biomedical Research and in collaboration with the University of Texas at Austin. Dr. Ellis believes that "carpal tunnel syndrome is caused by a deficiency, pure and simple. In a high percentage of cases, the patients are deficient in vitamin B6." Dr. Ellis says that over the past 26 years, he's successfully treated hundreds of patients with large doses of B6 daily and "they've had no side effects," he says. Vitamin B6 treatment doesn't bring about immediate relief, he warns. "You have to be patient." He says it often takes about 6 weeks until the enzyme changes are sufficient enough that the symptoms gradually begin to subside. "From 6 weeks to 12 weeks you will really notice a decided difference in your hands and fingers," he says. "The numbness, tingling, stiffness, and pain in your hand subsides." Dr. Ellis also says that "a number of people have a recurrence of carpal tunnel syndrome when they stop taking the vitamin." Vitamin therapy for carpal tunnel syndrome, however, should be used only under the supervision of a physician. Vitamin B6 can be toxic at high levels. The U.S. Recommended Daily Allowance is 2 milligrams. |
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Raise your hand. Get those hands off the keyboard and up into the air. "Raise your arm above your head and rotate your arm, while rotating your wrist at the same time," says Isernhagen. This gets your shoulder; neck, and upper back in a better position and relieves the stress and tension."
Go on R & R. Take a break from what you're doing. "Rest your hands on a desk or a table and then rotate your head for about 2 minutes. Bend your neck backward and forward," recommends Isernhagen, "then tip your head to either side. Also do some neck turns, looking over your right shoulder, then your left."
Make exercise as routine as eating. It's important to exercise and relax all the muscles that are giving you problems every day, even when you're not in pain, says Isernhagen. Motion exercises, such as the ones described above, should be practiced at least four times a day.
The Straight Facts on Staying Pain-Free The National Institute for Occupational Safety and Health estimates that carpal tunnel syndrome affects 23,000 workers a year. Some workers are affected more than others, especially meat cutters, cashiers, data processors, assembly line workers, truck drivers, and pneumatic-hammer operators—the kind of people who absolutely must use their hands on the job. Those who work at home are at risk, too. Carpal tunnel syndrome has been known to attack homemakers who spend lots of time wringing wet laundry by hand, sweeping with a broom, dicing with a knife, or even shelling peas. Even weekend do-it-yourselfers can do themselves in. Excessive use of a staple gun over a weekend is enough to trigger the disease. But it doesn't have to. If you're faced with a hands-on type of job, it's possible to avoid the problem—and still manage to pat yourself on the back after a job well done. Carpal tunnel results when pressure is constantly applied to the median nerve when the wrist is flexed up or down, explains John Sebright, M.D., head of the Hand Surgery Section and director of the Microsurgery Laboratory at St. Mary's Hospital in Grand Rapids, Michigan. "If the wrist is repeatedly flexed and extended, the pressure is increased. To avoid this," he says, "keep your hands and wrists as straight as possible." It may seem unnatural at first not to bend your wrists when you're typing or driving, for example. But time and practice will get rid of that awkward feeling. |
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MEDICAL ALERT
It Could Be Arthritis Wrist and hand pain is not always the result of carpal tunnel syndrome and could actually be the sign of a more serious illness, cautions physical therapist Susan Isernhagen. In fact, Isernhagen says, "if you get a crackly or crunchy feeling in your wrist when you exercise it, that's not a sign of carpal tunnel syndrome; it may be a symptom of osteoarthritis." You should have it checked out by your doctor. |
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Reach for the aspirin. "To reduce pain and inflammation, take a nonsteroidal anti-inflammatory medication like aspirin or ibuprofen," says Stephen Cash, M.D., an orthopedic surgeon and assistant clinical professor at Jefferson Medical College of Thomas Jefferson University. Don't take acetaminophen, though. Acetaminophen is for headaches, not carpal tunnel syndrome. According to Dr. Cash, "Acetaminophen reduces pain, but it doesn't do anything for inflammation."
Put the pain on ice. "Cold packs will work to bring the swelling down," says Isernhagen. Don't wrap your wrist in a heating pad. That will increase the swelling in the area.
Rise to the occasion. "Avoid having your hand lower than your shoulder when you take a break from work," says Isernhagen. "Sit with your elbows supported on your desk or propped on the arms of your chair. Keep your hands pointed upward. That's a good relief position."
Put the squeeze on your pain. "Getting squeezing motions of the fingers will help relieve the tingling feeling," Isernhagen says. Press your fingers into your palm, then stretch them way back and hold. Repeat.
Stay topside at night. Keep your arms close to your body and your wrists straight while sleeping. "If you let your hand drop over the side of the bed, it can increase the pressure," says Isernhagen.
If you find yourself waking up because of the pain in your hands, Isernhagen recommends doing the same exercises at night that you do during the day. Tingling or pain might also be an indication that a night splint might help.
Go for splint second relief. To relieve symptoms of carpal tunnel syndrome, use a wrist splint to keep your wrist straight. "The splints help take pressure off the nerve," says Dr. Cash. Buying a wrist splint, though, is not as easy as buying a glove. He recommends a splint that has a metal insert and Velcro fasteners. They give support without being totally rigid. "The kind made out of plastic usually are hard and are also hot and sticky," notes Isernhagen. "Whatever kind of splint you get, it should fit into the palm of your hand, leaving the thumb and fingers free," she says.
You might want to consider having the splint tailor-made. "You should really have a professional like a physical therapist or occupational therapist fit you to make sure it fits your hand exactly," notes Isernhagen.
Don't get too tight. You don't want to completely tie up traffic in your wrist. "Don't wrap your wrist with an Ace bandage, because you could wrap it too tight and cut off the circulation," says Isernhagen.
Use the right grip. If you have to carry anything with a handle, be sure the grip fits your hand. If the grip is too small, build it up with tape or rubberized tubing. If it's too large, get another handle, says Isernhagen.
Handle with care. If you find yourself hurting after using the old drill around the house, change the way you hold it. "Don't concentrate pressure at the base of the wrist when using hand tools. Use your elbow and shoulder as much as possible," recommends Isernhagen.
PANEL OF ADVISERS
Stephen Cash, M.D., is assistant clinical professor of orthopedic surgery in the Division of Hand Surgery at Jefferson Medical College of Thomas Jefferson University in Philadelphia, Pennsylvania, and a staff member of the Hand Rehabilitation Center there.
John Ellis, M.D., is a surgeon and family practitioner in Mount Pleasant, Texas, and is on the staff of Titus County Memorial Hospital in Mount Pleasant.
Colin Hall, M.D., is professor of neurology and medicine and director of the Neuromuscular Unit in the Department of Neurology at the University of North Carolina at Chapel Hill School of Medicine.
Susan Isernhagen is a physical therapist and president of Isernhagen and Associates in Duluth, Minnesota. She acts as a consultant to industries to help reduce work injuries and rehabilitate injured workers.
John Sebright, M.D., is head of the Hand Surgery Section and director of the Microsurgery Laboratory at St. Mary's Hospital in Grand Rapids, Michigan, and an associate clinical professor in the Department of Surgery, Department of Human Medicine, at Michigan State University in East Lansing.
