Light at the end of the carpal tun­nel

The Star (St. Lucia) - - HEALTH -

Do you suf­fer from pain, numb­ness or tin­gling in your wrist and hand? If you an­swered yes to any of these symp­toms you may be suf­fer­ing from carpal tun­nel syn­drome. CTS is the com­pres­sion of the me­dian nerve as it passes through the wrist and was first de­scribed in 1894. Since then, with med­i­cal ad­vance­ments, CTS is eas­ier to di­ag­nose and that may ac­count for the ris­ing num­ber of peo­ple suf­fer­ing from this painful con­di­tion. It may also be due to change in life­styles and tech­no­log­i­cal ad­vance­ments.

CTS is thought to be ag­gra­vated by repet­i­tive move­ments and more and more peo­ple are now reg­u­larly us­ing com­put­ers and game con­soles, but, as it has been around for many years, we know there must be other causes.

CTS is a nar­row­ing of space on the in­side of the wrist where the me­dian nerve and other struc­tures pass through to the hand. The me­dian nerve pro­vides sen­sa­tion to the thumb, in­dex fin­ger, mid­dle fin­ger and part of the ring fin­ger; also in­ner­vates the mus­cles of the thumb. The on­set of CTS is usu­ally grad­ual, start­ing with symp­toms at night, and on wak­ing the hand needs to be shaken-out and feels “use­less”, pro­gress­ing to symp­toms dur­ing the day as well.

But wait, be­fore you self-di­ag­nose your symp­toms as CTS, it’s im­por­tant to know there are other con­di­tions that are sim­i­lar, like repet­i­tive strain in­jury. RSI can also af­fect the wrist and fin­gers but there are some mi­nor dif­fer­ences. RSI is used to de­scribe pain and ten­der­ness in the nerves, mus­cles and ten­dons caused by repet­i­tive tasks, not com­pres­sion, and can oc­cur at the shoul­der, el­bow or wrist. How­ever, un­like CTS, it does not cause weak­ness in the thumb.

It is best to seek help early and your doc­tor or phys­io­ther­a­pist will un­der­take a thor­ough as­sess­ment to de­ter­mine if you have CTS and rule out other pos­si­ble causes. A thor­ough his­tory of the on­set of your symp­toms and ag­gra­vat­ing move­ments and ac­tiv­i­ties will be taken fol­lowed by a phys­i­cal ex­am­i­na­tion. Do not be sur­prised if the fo­cus moves from your wrist to your el­bow, shoul­der and neck. Some of the ob­vi­ous signs that will be looked for are mus­cle wast­ing around the thumb, re­duced sen­sa­tion, re­flexes and your re­sponse to spe­cial tests. If the re­sults are in­con­clu­sive, or a clearer pic­ture is re­quired, it may be nec­es­sary for you to un­dergo nerve con­duc­tion tests.

The ex­act cause of CTS is still not known but it is more com­mon in women than men, maybe be­cause women have a nar­rower space than men. One of the un­der­ly­ing causes is in­flam­ma­tion and it has been found that peo­ple with cer­tain con­di­tions and life­style habits run a higher risk of de­vel­op­ing this painful con­di­tion, such as: • Di­a­betes • Hor­monal changes that can oc­cur dur­ing preg­nancy or the menopause • Un­der­ac­tive thy­roid • Over­ac­tive pi­tu­itary gland • Arthri­tis • Wrist sprains or frac­tures • High blood pres­sure • Smok­ing • Be­ing over­weight

Hav­ing a job with repet­i­tive move­ments or us­ing equip­ment that vi­brates also puts you at a higher risk of de­vel­op­ing CTS. But it isn’t only work that can be a prob­lem; leisure ac­tiv­i­ties like sail­ing can ag­gra­vate symp­toms—hold­ing the steer­ing wheel or hold­ing on tight to the tiller may seem like sim­ple tasks but not if you have CTS.

The ear­lier the con­di­tion is di­ag­nosed, the bet­ter the chances of a full re­cov­ery with­out need­ing surgery. In the ini­tial stages rest and ice can help re­duce in­flam­ma­tion and pres­sure on the nerve. If you use your hands at work, whether typ­ing, writ­ing or us­ing equip­ment or ma­chin­ery, you should take lots of rest breaks. Wear­ing a splint can also help sta­bilise your wrist and stop ex­ces­sive bend­ing. If these early in­ter­ven­tions are not suc­cess­ful your doc­tor may sug­gest a steroid in­jec­tion into the wrist or, in se­vere cases, surgery.

Of course, the best ac­tion is al­ways pre­ven­tion; pre­ven­tion is al­ways bet­ter than cure. The first step would be to make life­style changes and re­duce the risk fac­tors along­side a stretch­ing and ex­er­cise pro­gramme. Speak to your phys­io­ther­a­pist who will help you de­sign the per­fect pro­gramme for what­ever stage you are at.

Kim Jack­son is a UK-trained phys­io­ther­a­pist with over 20 years' ex­pe­ri­ence. She spe­cialises in mus­cu­loskele­tal pain and dys­func­tion in­clud­ing back pain and sci­at­ica, stroke and other neuro con­di­tions plus sports phys­io­ther­apy, hav­ing worked with lo­cal, re­gional and in­ter­na­tional ath­letes and teams treat­ing in­juries and analysing biome­chan­ics to im­prove func­tion and per­for­mance. She is reg­is­tered with the Al­lied Health Coun­cil and is a mem­ber of PASL. She cur­rently works at Bay­side Ther­apy Ser­vices in Rod­ney Bay, O: 458 4409 or C: 284 5443; www.bayside­ther­a­py­ser­

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