“Don't you hate when your hand falls asleep and you
know it will be up all night.” Steven Wright
After I completed my dissertation and defense, I
began to have pain and numbness in my right arm and hand. The pain was so bad
at times that I couldn’t even hold a pen let alone write anything. My hand
would also fall asleep all the time even when I was using it. Talk about
problems. All these things are not good news for someone who works with their
hands for a living. I suspected that I may have carpel tunnel syndrome, and
unfortunately, I was correct. As the hand is not my body area of expertise, I
decided to research more about this syndrome and share my results with you.
Explanation
If not treated early, carpal tunnel syndrome is a
progressively painful condition of the hand and arm caused by a pinched nerve
in your wrist. Several factors contribute to carpal tunnel syndrome including
the make-up of your wrist, underlying health problems and repetitive patterns
of hand use. In many cases, no single
cause can be identified as a combination of risk factors generally contribute
to the development of the condition. The carpal tunnel is a narrow passageway located
on the palm side of your wrist and acts to protect the median nerve to your
hand. The median nerve runs from your forearm through a passageway in your
wrist (carpal tunnel) to your hand. It provides sensation to the palm side of
your thumb and fingers, with the exception of your little finger. It also
provides nerve signals to move the muscles around the base of your thumb (motor
function). Compression or pinching of the nerve produces numbness, pain and,
eventually, hand weakness. Usually with proper treatment, most people who
develop carpal tunnel syndrome can find relief from the pain and numbness and ultimately,
restore normal use of their wrists and hands.
Symptoms
Typical symptoms of carpal
tunnel syndrome which can include, but are not limited to the following:
- Vague aching in your wrist extending to your hand/forearm
- Tingling or numbness in your thumb, index, middle or
ring fingers, but not your little finger
- Pain extending from your wrist up your arm to your
shoulder or down into your palm or fingers
- A sense of weakness in your hands
Risk
factors
- A wrist fracture or dislocation that alters the
space within the carpal tunnel
- Women more commonly present with carpel tunnel as
the area is relatively smaller than in men
- Some chronic illnesses like as diabetes and
alcoholism increase your risk of nerve damage
- Inflammatory illnesses like rheumatoid arthritis or infections
can affect the tendons in your wrist thus exerting pressure on your median
nerve
- Certain conditions like pregnancy, menopause,
obesity, thyroid disorders and kidney failure, among others alter the balance
of body fluids which can increase pressure within your carpel tunnel thus
irritating your nerve
- Working with vibrating tools or on an assembly line
that requires prolonged or repetitive flexing of the wrist may create harmful
pressure on the median nerve, or worsen existing nerve damage
You may have noticed that computer work is not a
proven cause of carpel tunnel syndrome. Scientific evidence shows that there is
little evidence to support extensive computer use as a risk factor for carpal
tunnel syndrome, although it may cause a different form of hand pain.
When
to see a doctor
If your signs and symptoms persist, especially if
they interfere with your normal activities and sleep patterns, see your doctor.
If you leave the condition untreated, nerve and muscle damage can occur (really
not fun).
Tests
and diagnosis
There are lots of physical tests that the doctor can
do to determine whether you have carpal tunnel syndrome. First, he or she will
probably take a history of symptoms. Finding a pattern to your signs and
symptoms may offer clues to their cause. For example, since the median nerve
doesn't provide sensation to your little finger, symptoms in that finger may
indicate a problem other than carpal tunnel syndrome. Another clue is the
timing of the symptoms. Typical times when you might experience symptoms due to
carpal tunnel syndrome include while holding a phone or a newspaper, gripping a
steering wheel, or waking up during the night.
Secondly, the doctor will want to test the feeling
in your fingers and the strength of the muscles in your hand. Pressure on the
median nerve at the wrist, produced by bending the wrist, tapping on the nerve
or simply pressing on the nerve, can bring on the symptoms in many people.
Then, he or she may order an x-ray of the affected
wrist to exclude other causes of wrist pain, such as arthritis or a fracture.
A really fun test that I’ve had twice now is the electromyography,
which measures the tiny electrical discharges produced in muscles. A thin-needle
electrode (yes, a needle) is inserted into the muscles of your hand and arm, and
then an instrument records the electrical activity in your muscle at rest and when
you contract the muscle. This test can help determine if muscle damage has
occurred. Like the electromyography, a nerve conduction study uses two electrodes
are taped to your skin that deliver a small shock through the median nerve to see
if electrical impulses are slowed in the carpal tunnel.
Often times, all these tests are performed together
to get a good overall look at what may be going on and to check for other
conditions that may mimic carpal tunnel syndrome like a pinched nerve in your
neck.
Treatments
If your symptoms are mild, begin by taking
more-frequent breaks to rest hands and apply cold packs to reduce occasional
swelling. If these techniques don't offer relief within a few weeks, additional
treatment options may be warranted.
Nonsurgical
therapy
If diagnosed early, nonsurgical methods should help
improve carpal tunnel syndrome. Wrist splinting is a good idea to try as a splint
will hold your wrist still while you sleep can help relieve nighttime symptoms
of tingling and numbness.
Non-steroidal anti-inflammatory drugs (NSAIDs) can relieve
pain from carpal tunnel syndrome in the short term. However, there's no
evidence these drugs can actually improve the carpal tunnel syndrome.
Corticosteroids, such as cortisone, may be used to relieve
pain. Injected directly into the carpel tunnel area and median nerve, corticosteroids
decrease inflammation and swelling, which relieves pressure on the median
nerve. Oral corticosteroids aren't considered as effective as corticosteroid
injections for treating carpal tunnel syndrome.
Surgery
therapy
If your symptoms are severe or persist after trying
nonsurgical therapy, surgery may be the best option. To relieve pressure on
your median nerve, the ligament pressing on the nerve is cut. Using an
endoscope, your doctor can perform the carpel tunnel surgery through small
incisions in your hand or wrist. In other cases, surgery involves making a
larger incision in the palm of your hand over the carpal tunnel and cutting
through the ligament to free the nerve. Either way, during the healing process,
the ligament tissues gradually grow back together making more room for the
nerve than existed before. Either technique has risks and benefits that are
important to discuss with your surgeon before surgery. You will be encouraged you to use your hand
after surgery, gradually working back to normal use of your hand. Soreness or
weakness may take anywhere from days to months to resolve, and if your symptoms
were very severe before surgery, they not ever go away completely.
I hope you have found this helpful. For more
information, check out these links:
In the next post, I will cover cubital syndrome, yet another fun condition to have when you work with your hands for a living.
