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Dear
Doctor: Lately I’ve been experiencing numbness and tingling in my wrist and
a friend said that I might have carpal tunnel syndrome. Would you explain
what this is? S.S. Columbus
The carpal tunnel is a narrow, tunnel-like canal
in the wrist, encased by bone on three sides and a strong fibrous sheath,
known as the flexor retinaculum, on the other. This tunnel is the
passageway for several tendons critical to proper hand functioning. It also
provides a pathway for the median nerve, which runs from the forearm into
the hand. The median nerve controls sensations to the palm side of the
thumb and fingers as well as sending impulses to the smaller muscles in the
hand that allow our fingers to move. Carpal
tunnel syndrome occurs when the median nerve becomes compressed at the
wrist, resulting in pain, tingling or numbness, burning and even weakness
in the hand and wrist, oftentimes radiating to the forearm and shoulder
joint.
Carpal tunnel syndrome
has become a major public health concern. It is the single largest
contributing factor to lost time at work in the United States. This condition
is seen more often in women than it is in men, especially in pregnant and
menopausal women. This is likely due to the hormonal changes which occur
during these times.
Signs and Symptoms
Carpal tunnel syndrome
typically starts gradually, first appearing as an annoying “tingling” in
one or both hands. Usually, these symptoms will first manifest at night, as
many people sleep with their wrists in a flexed position. As symptoms
worsen, this tingling sensation may develop during the day, accompanied by
numbness, commonly in the thumb, index and ring fingers. A sense of
weakness and diminished grip strength may follow, resulting in a tendency
to drop objects. Shaking the hands vigorously may provide relief for brief
periods of time. If this condition is advanced enough, a relentless loss in
feeling in the hand and fingers can occur.
Causes
Simply put, the cause of
carpal tunnel syndrome is pressure on the median nerve. This pressure is
often the result of a combination of factors. Pressure on this nerve can
stem from swelling or thickening of the tendons in the carpal tunnel,
reducing the space for the median nerve to traverse. This swelling can
result from trauma or injury to the wrist, such as sprain or fracture,
repetitive grasping and manipulating activities, or forceful stressed
motions of your hands and wrists. Health conditions can also contribute to
this picture, such as rheumatoid arthritis, diabetes, menopause, or fluid retention
due to pregnancy. Carpal tunnel syndrome often results from overuse or
strain in certain job tasks requiring repetitive and forceful movements of
the wrist. “Research conducted by the National Institute for Occupational
Safety and Health (NIOSH) indicates that job tasks involving highly
repetitive manual acts, or necessitating wrist bending or other stressful
wrist postures, are connected with incidents of carpal tunnel syndrome or
related problems.” It should be remembered that this syndrome is not
confined to any single occupation or pursuit. Activities associated with
this condition include anything involving a combination of repetitive and
forceful movements of the hand and wrist, such as assembly line work,
computer use, sewing, extensive use of power tools and even playing musical
instruments.
Diagnosis and Treatment
Early diagnosis and
treatment is essential to avoid permanent damage to the median nerve.
Diagnosis is generally made through clinical assessment by physical
examination and history. Occasionally, electroneurodiagnostic
testing is conducted to confirm this diagnosis. Once a diagnosis of carpal
tunnel syndrome has been made, treatment should begin as soon as is
possible. Treatment will vary of course, depending on the severity of the
condition. People with mild symptoms of carpal tunnel syndrome may find
relief by taking frequent breaks to rest their hands and applying cold
packs, if swelling is evident. Though immobilizing braces and wrist splints
are often recommended, these can be rigid and uncomfortable, and over time,
can result in muscle atrophy. Physiotherapy treatment has proven highly
successful in the treatment of carpal tunnel syndrome. Deep friction
massage can promote fiber mobility without stress and can help manage swelling
that is often a factor in nerve compression. Deep tissue treatment at the
site of involvement can also induce increased blood flow to tissue that is
deficient in supply. Interferential stimulation may be used to decrease
inflammatory process and edema. Ultrasound therapy causes the resolution of
inflammatory exudates and increases blood flow. There are numerous other
therapies offered by competent chiropractic physicians, physical therapists
and occupational therapists which can aid in the proper medical management
of this condition. Prolotherapy can be helpful for conditions which are
more advanced. In severe cases, surgery may be indicated; however it is advisable to exhaust
all conservative treatment and resources prior to committing to invasive
action.
Keep in mind that dietary
considerations are essential. Proper nutrition provides our bodies with
appropriate nutrients required to repair damage to injured nerves and
reduce inflammation. Certain vitamins, herbals and amino acids are specific
to nerve damage repair, hence nutritional counseling, from a licensed
professional, is essential to offset the effects of this precarious
condition.
Although there are no
proven strategies to prevent carpal tunnel syndrome, certain precautions can
be taken. Modifying your work station layout, with specific attention to
ergonomic considerations, altering your methods for performing certain
tasks, taking frequent breaks and gently stretching and bending your hands
and wrists are just some of the ways to possibly avoid continued repetitive
stress tasks.
Remember, early signs of
carpal tunnel syndrome should not be ignored. If you are experiencing signs
and symptoms of this condition, see your health care professional.
Treatment is available, and relief is within reach.
Yellowstone Naturopathic
Clinic
720 N. 30th St.
Billings, MT 59101
PHONE 406·259·5096/FAX 406·248·5655
ync@180com.net
Dispensary
406·254·9682
dispensary@yncnaturally.com
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