11/3/2009
Dear Shari and Toby,
CARPAL TUNNEL SYNDROME
In 2005, I was diagnosed as having CTS in my right hand. It has steadily progressed for the last five years. Ignoring the symptoms does not make it go away. The pain is also in the right side of my wrist. It feels more like an inflammation in that area than nerve irritation. The periods when it does not hurt much have become few and far between. I have started using a wrist pad with the mouse and this has reduced the pain in the fore-part of the wrist where it rested on the hard table. I have been doing some exercises for two weeks and have noticed no significant improvement. I have tried a wrist brace before with little success.
The problem with my right hand is a three point problem.
1. The right side of the wrist is inflamed due to previous stress from hammer usage.
2. The four fingers vary in symptoms day to day from a light tingling sensation to total numbness and lack of coordination from poor ergonomics at the computer.
3. The thumb (and maybe some of the fingers) are numb most of the time due to my neck and shoulder strain from pinched nerves (neck injury).
The attitude of - I’ll do
something about it when I’m sure what it is and know what to do is being
replaced with --
- If I don’t want to lose the use of my right arm and hand I need to do
something soon.
The wrist surgery is currently a popular decision. Information from people who have had the surgery ranges from it is great to It just came back. Written information states the wrist is usually weakened and usually requires physical therapy afterwards. Surgery techniques range from band aid one hole arthroscopic to two-inch long gashes. Before electing surgery I would prefer to first remove the immediate causes.
1. I am not using the 6 pound hammer daily which produced the original stress and will start using a wrist brace when using the smaller ones.
2. I am starting to use a wrist immobilizer at the computer.
3. I am using a stool to raise my knees even with my hips.
4. I am using a mouse pad in a lower position. The pad is about hip high, allowing my arm and shoulder to hang comfortably.
5. I am moving the key pad to my lap. This allows my hands to be lower than my arms instead of being bent upward. This also removes the strain from my shoulder.
I am starting to provide better nutrition for preventing inflammation.
6. Diet for December 2009
I am starting the following treatments for inflammation.
7. Heated castor oil packs nightly for 20-30 minutes on wrist and neck.
8. I am using the TEMS for pain.
9. For my neck, I am starting the following treatments for inflammation.(see 6)
10. For my neck, I am performing the following neck exercises daily.
11. I am using the TEMS for pain.
12. I am performing these wrist exercises daily after some of the pain is abated.
Carpal Tunnel info
You're working at your desk, trying to ignore the tingling or numbness you've had for months in your hand and wrist. Suddenly, a sharp, piercing pain shoots through the wrist and up your arm. Just a passing cramp? More likely you have carpal tunnel syndrome, a painful progressive condition caused by compression of a key nerve in the wrist.
What is carpal tunnel syndrome?
Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers (although not the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel - a narrow, rigid passageway of ligament and bones at the base of the hand - houses the median nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm. Although painful sensations may indicate other conditions, carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed or traumatized.
What are the symptoms of carpal tunnel syndrome?
Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to "shake out" the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch.
What are the causes of carpal tunnel syndrome?
Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Most likely the disorder is due to a congenital predisposition - the carpal tunnel is simply smaller in some people than in others. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; overactivity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal. In some cases no cause can be identified.
There is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome. Repeated motions performed in the course of normal work or other daily activities can result in repetitive motion disorders such as bursitis and tendonitis. Writer's cramp - a condition in which a lack of fine motor skill coordination and ache and pressure in the fingers, wrist, or forearm is brought on by repetitive activity - is not a symptom of carpal tunnel syndrome.
Who is at risk of developing carpal tunnel syndrome?
Women are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain. Persons with diabetes or other metabolic disorders that directly affect the body's nerves and make them more susceptible to compression are also at high risk. Carpal tunnel syndrome usually occurs only in adults.
The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job, but is especially common in those performing assembly line work - manufacturing, sewing, finishing, cleaning, and meat, poultry, or fish packing. In fact, carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel. A 2001 study by the Mayo Clinic found heavy computer use (up to 7 hours a day) did not increase a person's risk of developing carpal tunnel syndrome.
During 1998, an estimated three of every 10,000 workers lost time from work because of carpal tunnel syndrome. Half of these workers missed more than 10 days of work. The average lifetime cost of carpal tunnel syndrome, including medical bills and lost time from work, is estimated to be about $30,000 for each injured worker.
How is carpal tunnel syndrome diagnosed?
Early diagnosis and treatment are important to avoid permanent damage to the median nerve. A physical examination of the hands, arms, shoulders, and neck can help determine if the patient's complaints are related to daily activities or to an underlying disorder, and can rule out other painful conditions that mimic carpal tunnel syndrome. The wrist is examined for tenderness, swelling, warmth, and discoloration. Each finger should be tested for sensation, and the muscles at the base of the hand should be examined for strength and signs of atrophy. Routine laboratory tests and X-rays can reveal diabetes, arthritis, and fractures.
Physicians can use specific tests to try to produce the symptoms of carpal tunnel syndrome. In the Tinel test, the doctor taps on or presses on the median nerve in the patient's wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs. The Phalen, or wrist-flexion, test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute. Doctors may also ask patients to try to make a movement that brings on symptoms.
Often it is necessary to confirm the diagnosis by use of electrodiagnostic tests. In a nerve conduction study, electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed with which nerves transmit impulses is measured. In electromyography, a fine needle is inserted into a muscle; electrical activity viewed on a screen can determine the severity of damage to the median nerve. Ultrasound imaging can show impaired movement of the median nerve. Magnetic resonance imaging (MRI) can show the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome.
Carpal tunnel syndrome (CTS) as some other similar diseases belongs to the group of so-called overuse injuries. This is a manifestation of nerve and tissue damage from fast, forceful and seemingly harmless repetitive wrist and hand motions (prolong repetitive trauma), which result in swelling, tenderness and pain.
Carpal Tunnel Syndrome Treatment
Shmuel Tatz working on a patient.
Initial treatment includes includes immobilization, ice packs and non-steroidal
anti-inflammatory drugs.
Wrist splints and braces are used for immobilization. Wrist splints stabilize
the wrist in neutral position, protecting the nerve from being compressed and
take the inflammation down. It usually takes from 6 to 8 weeks.
Surgery is performed in the most severe cases, in order to enlarge the Carpal
Tunnel and repair ligaments
Physical therapy is the corner stone in managing carpal tunnel syndrome. The
goal is to avoid the surgery, and in most cases we can do this. Physical
therapy is combination of manual therapy with special modalities, which provide
reduction of swelling and inflammation as well as relieve pain and other
symptoms of carpal tunnel syndrome.
Our experience extends more then 30 years working with string musicians and
pianists. Manual therapy only is not enough to successfully cure the disease.
Because of repetitive chronic microtrauma, physical therapists have to use
various modalities to reduce swelling, pain and other symptoms of carpal tunnel
syndrome and speed up process of healing. Cold laser is most useful among
different modalities.
1. Manual therapy
to the wrist (8-10 minutes) along with massage of neck and shoulders (8-10
minutes) every other day or 3 times a week.
2. Cold
Laser Therapy (e.g. ML 830® Laser) 5-6 minutes 10 times together with
manual therapy.
In the late 1960's, researchers introduced the concept of
laser biostimulation using low-powered laser beams to produce non-thermal
effects in human tissue. The first experimental applications of low-level
energy laser therapy were reported in 1968, when researchers used ruby and
argon lasers on non-healing or slow-to-heal ulcers. Later research
substantiated the efficacy of laser treatment to accelerate the healing of
wounds, attenuate pain, and reduce tissue inflammation in both humans and
animals.
To treat chronic pain with laser biostimulation, one must reach deep
into tissue to irradiate the affected area. Laser wavelengths between 820
nanometers to 840 nanometers have an extremely low absorption rate in human tissue,
thus allowing deep penetration of laser light. The 830 nm laser beam is also
well absorbed in subcellular organelles, causing them to function normally. The
laser's low level of power output also affects the depth of the beam's
penetration, and has been shown to be effective in treating human tissue. The
830 nm laser with a power output between 60 milliwatts (mW) and 90 mW is
reported by experimenting
clinicians to be optimal for treating chronic pain.
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email: mbarbour@microlightcorp.com
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3. Electrical
stimulation of the wrist area 10 times for 6-8 minutes.
4. Short-wave
thermotherapy to the neck and upper back 10 to 12 minutes 10 sessions.
CARPAL TUNNEL SYNDROME.HTM