The tunnel of pain
Carpal tunnel syndrome is a common condition that causes pain, numbness and tingling in the hand and arm.
LONG hours of sitting in front of a computer screen at the office is known to be detrimental to blood circulation and our overall health.
There is also another condition many of us may have experienced, but are unaware is a condition that has become increasingly common in the modern workplace.
Known as carpal tunnel syndrome (CTS), it affects our wrist, hands and fingers, causing discomfort and stiffness.
We do not know exactly why CTS starts. The pain or discomfort that you feel in your wrist, the palm of your hand and fingers, particularly in your index finger and thumb, is usually caused by extreme pressure in your wrist and inflammation.
It appears that the more extreme the use of wrists and fingers – such as repetitive manoeuvres and constant use of drills and vibrating hand tools – the greater the likelihood of someone developing CTS.
More likely is that it is brought about by other health conditions, such as hypothyroidism, or an underactive thyroid; menopause; oedema or fluid retention from pregnancy; diabetes; dislocation or fracture of the wrist; an overactive pituitary gland; rheumatoid arthritis; or an overactive pituitary gland.
Testing and treatment for CTS
Symptoms of CTS include an urge to shake off a feeling of numbness and/or achiness.
The longer you neglect tending to this symptom, the more likely you will lose the use of your hand muscles and will be unable to hold anything with a firm grip.
So, when you feel a recurring discomfort in your hands, there are a few ways to test if you may potentially be afflicted with CTS.
You can tap your wrist gently and see if you have a tingling of numbness in the fingers. You can also stretch your wrist above your head or flex your wrist to see the result.
Self-testing, however, is not a foolproof method. Your next step should be to follow up with a doctor for more conclusive tests, like below:
Tinel’s test: The physician lightly strikes the median nerve at the wrist to check for numbness or tingling in any of the fingers.
Phalen’s test: A patient bends his wrists by pressing the backs of his hand against one another, to check for numbness or tingling.
Nerve conduction study: Minor shocks are delivered by electrodes attached onto the hands and wrists. The test measures the speed at which the nerves transmit impulses to the muscles.
Electromyography: Electrical activity is revealed on a screen by inserting a fine needle into the muscle, allowing doctors to check for nerve damage.
Blood test: A blood test does not reveal CTS per se, but it will detect other health conditions that may be the underlying cause of CTS symptoms.
Because it may take a while to determine the root cause of CTS in any given individual, you shouldn’t delay too long in seeking treatment. If the problem is due to physical stress from your occupation or from an activity in which you use your hands regularly, then lifestyle changes are necessary right away to correct the problem.
In treating CTS, physical therapy is the first course of action that will likely be prescribed. Stretching is a key part in the beginning of therapy, followed by resistance-type exercises.
During the day, when you are at work, a cold compress and a wrist brace will help to ease the discomfort.
Apart from manual therapy, the use of deep friction tools may also be used to reduce pressure from your wrists and hands.
Other methods include postural workups, ultrasound and electrical stimulation, and kinesiotaping techniques.
Your joints and muscles will require periodic rest throughout the time that you undergo therapy for CTS.
This can be facilitated by wrist splints or braces, which reduces movement, to allow your joints and muscles to rest properly.
Usually, this is applied at night, but in some cases, you may be advised to wear it all day.
There may be cases where your doctor may recommend drugs like painkillers and even botox injections, which have been known to improve CTS.
There is also potential, as a study published in the Journal of Clinical Rehabilitation suggests, that yoga, laser, ultrasound and NSAIDs (non-steroidal anti-inflammatory drugs) may help quell CTS.
One particularly effective drug is a corticosteroid injection, applied directly to the carpal tunnel, to lower inflammation.
You may feel an increase in pain right after, but it should subside in a few days.
Follow-up doses may be administered if you find the symptoms returning.
With corticosteroids, however, long-term use is discouraged, as there are side effects, like the risk of infections, thinning of bone mass, suppressed adrenal hormone production, a spike in blood sugar levels, and even cataracts.
Surgery is usually the last option, after all others have been exhausted. Carpal tunnel decompression surgery is an outpatient procedure with no nights spent in the hospital.
The carpal ligament, which is the roof of the carpal ligament, is cut in surgery to lower pressure on the median nerve.
Success rates have been high, with the Cleveland Clinic reporting that 90% of CTS surgeries have solved the condition for its patients.
Can CTS be prevented?
In some cases, CTS may be prevented, although the body of research has yet to substantiate the effectiveness of various massages, hand movement exercises, and even yoga.
There is the benefit of improving dexterity by incorporating those activities into your daily routine, especially if your work primarily involves the use of your hands.
If the position of your work space is awkward, causing any strain on your hands from long-term use, reposition your desk setting to reduce unnatural wrist positions.
Other measures should include:
● Avoiding prolonged flexing and extending of the wrists.
● Keeping your wrists straight when possible.
● Keeping your hands at a comfortable temperature, as the cold can cause your hands to tense.
● Preventing unnecessary strain on the wrist and hands, and not bending it in any unnatural manner.
● Taking frequent breaks from prolonged hand-related movements.
● Avoiding tensing and gripping things too hard for long periods of time.
● Treating or controlling other health conditions that may be causing CTS symptoms if you have them.
Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician and gynaecologist. For further information, visit www.primanora.com. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.