by Richard Brown, MD, Scripps Memorial Hospital La Jolla
You wake in the night with a painful tingling sensation in your fingers — or no sensation at all. You pick up a pencil or apply lipstick, and it falls out of your grip.
If that sounds familiar, it could be carpal tunnel syndrome.
Picture a tunnel running from your forearm through your wrist. That’s your carpal tunnel. Your median nerve, which supplies feeling and function to your thumb and first three fingers, runs through it. Carpal tunnel syndrome (CTS) occurs when the median nerve becomes compressed, either by a swollen ligament or inflammation of the tendons within the tunnel. Pressure on the nerve may cause numbing, pain or tingling in the wrist, hand or fingers (excluding your little finger).
Early signs of CTS may be as subtle as tingling or mild pain in the hands or wrist, progressing to numbness, increased pain, weakness, loss of manual dexterity and a tendency to drop things. Symptoms can strike even at rest; in fact, pain can wake you from a sound sleep. Severe cases that go untreated may lead to long-term disability.
In 1988, 2.8 million people consulted doctors about CTS symptoms, and that number appears to be growing. Specific causes remain a mystery, but more women experience CTS than men. Fluid build-up in the ligaments during pregnancy, menopause and before menstruation may trigger some cases, while arthritis, diabetes, obesity or, rarely, a hormone disorder also may contribute.
Recent research suggests that people with CTS may have unusually stiff wrists due to abnormal collagen levels, but more studies are needed.
While genetics may be a factor, excessive or repetitive use of the wrist or hand during work, leisure activities such as needlepoint or sports (think “tennis elbow of the wrist”) is often to blame. In the workplace, CTS accounts for nearly half of all repetitive motion disorders; these, in turn, account for nearly half of all work-related illnesses.
Careers that involve intense or repetitive hand and wrist actions, such as word processors, dental hygienists, postal workers, and even musicians, may increase CTS risk.
Treatments range from rest to repair. Resting the affected area for several weeks may be enough to ease inflammation; over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, can help reduce swelling and pain. If pain or numbness are severe or do not improve, or you have trouble using your hands or fingers, call your doctor.
Several other treatments may hold promise for relieving CTS symptoms, including:
- Physical therapy to strengthen the hand and wrist, often coupled with exercises to improve posture.
- Ultrasound, which showers the wrist with painless sound waves.
- Laser light therapy treatments, which penetrate the skin and stimulate cell activity.
- Yoga postures to stretch, strengthen and balance joints in the upper body.
- Acupuncture, which inserts thin needles along the body’s “energy pathways” to relieve pain.
- Corticosteroid injections, which can shrink swollen tissues and relieve pressure on the nerve.
- Carpal tunnel release surgery, the most commonly performed outpatient hand surgery, which releases nerve pressure by cutting the carpal ligament free from the median nerve.
The following tips can help reduce your risk of CTS:
- Have an ergonomics expert evaluate your workstation and make adjustments to promote correct posture and positioning and reduce repetitive stress. As you work, your wrists should be in the same position as they are when you dangle your arms at your sides.
- Take frequent breaks from repetitive tasks and avoid excessive exertion of your hand and wrist muscles. Minimize vibration from machines or tools.
- Stretch your wrists before you start tasks and during breaks. Learn to do isometric and stretching exercises to strengthen the muscles in the wrists and hands.
The simple wrist exercises below are designed to help prevent CTS. Perform them several times throughout the day. However, do not do them if you currently have CTS symptoms such as numbness or pain, as they can irritate existing problems.
- Wrist press: Hold your right hand out, palm up, and make a fist. With your left hand, press down gently against your fist. Resist the pressure with your right fist and keep your wrist straight. Hold for five seconds. Turn your fist palm down and press your left hand against your right knuckles. Again, resist the pressure with your fist and do not bend your wrist. Then, turn your fist so your thumb is facing up, and press down with your left hand, resisting the pressure. Switch hands and repeat.
- Wrist circles: Make fists with both hands, then make circles with your fists. Make 10 circles in one direction, then 10 circles in the opposite direction. Open your hands, extend your fingers, and repeat in both directions.
- Wrist curl: Stand or sit with your elbows close to your waist and forearms parallel to the floor, and your palms facing down. Grasp a one-pound dumbbell in each hand and slowly bend your wrists down. Hold for five seconds, return to starting position, and repeat 10 times.
This Scripps Health and Wellness information was provided by Richard Brown, MD, orthopedic hand surgeon at Scripps Memorial Hospital La Jolla.