Carpal Tunnel Syndrome

People who do repetitive tasks – housewives, secretaries, meat cutters, assembly line workers, carpenters, musicians, computer users and others – may be more likely to develop carpal tunnel syndrome. Fractures, falls on the hand, and poorly designed vibrating hand tools may also damage the palm of the hand and cause carpal tunnel syndrome. Other causes are rheumatoid arthritis or osteoarthritis, Paget's bone disease, multiple myeloma, acromegaly and gout.

Your carpal (wrist) bones form a tunnel-like structure – the carpal tunnel – through which pass nine tendons and one nerve – the medical nerve. Carpal tunnel syndrome (also called occupational neuritis, partial thenar atrophy and median neuritis) occurs when the median nerve is irritated. Carpal tunnel syndrome is so common that it has been called the “occupational disease of the 1990s.”

The relationship between spinal health and carpal tunnel has been documented by a number of individuals who found spinal nerve root irritation in patients who had carpal tunnel or ulnar neuropathy. Others have found that nerve compression in the neck can block the flow of nutrients to the nerves in the wrist, making the wrist more susceptible to injury. This problem is called the “double crush syndrome.” Not surprisingly, when 1,000 cases of carpal tunnel syndrome were investigated, it was found that a large number of those suffering from carpal tunnel syndrome also had arthritis in the neck area.

As a Board Certified Chiropractic Neurologist, I take a different approach to the treatment and prevention of carpal tunnel syndrome. After a thorough neurological examination, I determine which part of the nervous system is not functioning properly.

The right brain controls the left side of the body, and the left brain controls the right side of the body. If a patient is experiencing pain on one side of the body (right or left), the opposite brain may be firing at an abnormally high rate. In order for a patient to perceive pain, an area of ​​the brain must fire at a higher frequency. If the pain is bilateral (on both sides), there may be different central structures involved, such as the brain stem or cerebellum.

{ Comments are closed }

Shoulder, Arm, and Hand Pain

Problems with the neck, shoulder and arm are often called different things by patients: neuritis; bursitis; neuralgia; rheumatism; frozen shoulder; fibrositis; sprained, strained, or sore muscles; Egypt “poor circulation.” Some people may blame their shoulder (or other joint) problems on “old age” even though their other shoulder, which does not have any problems, is just as old.

The brain “talks” with the rest of your body through a vast communications system made up of nerves. Nerves come out of your brain in a large bundle called the spinal cord and travel down your back inside the spinal column.

As the nerves from your brain travel down your spinal cord, they first have to pass through holes (foramina) between the spinal bones (vertebrae). Some nervs go straight to their point of destination, but some first mix with other nerves to form complicated nerve networks that anatomists call a nerve plexus.

The brachial plexus is made up of nerves which come out of the middle and lower neck and upper back. After they connect to form the brachial plexus, they branch off to supply different areas, especially the shoulder, arms, elbows, wrists, hands, and fingers. The most common form of brachial plexus damage is to the nerves that make up the brachial plexus as they exit the spinal column through the foramina plexus. In the foramina, the nerves are surrounded by a ring of bone and meninges (tough coverings), and if the ring becomes smaller, the nerves may become compressed or “pinched.” What causes the nerves to get “pinched?” Many things: long-standing spinal stress; old injuries such as falls from childhood; new injuries such as sports mishaps or car accidents (especially whiplash – a situation where the head and neck are suddenly “snapped” forward and backward); arthritis; being twisted, pulled or shook; or even sleeping in an awkward position, as well as many other stresses and strains of daily living.

The right brain controls the left side of the body, and the left brain controls the right side of the body. If the patient is experiencing pain on one side of the body (right or left), the opposite brain may be firing at an abnormally high rate. In order for a patient to perceive pain, an area of ​​the brain must fire at a higher frequency of firing. If the pain is bilateral, or on both sides, there may be different central structures involved such as the brainstem or cerebellum.

{ Comments are closed }

Could This Be Arthritis In My Hands

Hi Rusty. A few days ago, I slightly injured a finger on my hand. Now my hand is swapping with severe joint pain in the fingers. At first I thought this was a possible sprain in that region, but now my other hand is showing the same sailing of the fingers and pain of the joints. Should I go check this out right away? It does not seem to be getting worse today, but the pain and swelling are persistent. Could this be a sudden arthritis attack? I'm 38 years old and in good health (I just had a check-up at the doctor last week and the blood work came back okay).

Your advice is greatly appreciated.


Ouch, a little sprain is not supposed to do that. Unfortunately some times it does. I am sorry to hear about this. It is not unusual for arthritis to begin in an effected joint. It is not the norm for it to set in so quickly. There are different kinds of arthritis that can effect the hands and feet that can cause swelling. It is possible that arthritis was already beginning but not showing symptoms yet but this triggered a symptomatic response.

I am concerned that the pain is bilateral, effecting both sides. I doubted it is anything extremely serious but it would be good to see your doctor. The sooner the better. If nothing else, your doctor will be able to treat the pain and swelling. But if it is arthritis or one of the other conditions that can cause this type of swelling in the fingers the earlier the diagnosis the better.

I wish you good health.

{ Comments are closed }

Eliminate Agonizing Hand Pain Quickly and Easily!

According to Dr. Nathan Wei, “The hand and wrist are the mirrors of disease.” While the cause of hand pain can be a localized problem, hand pain can also be the presenting sign for other diseases.

The wrist and hand are capable of power and precision. As a result, pain and swelling are often accompanied by weakness of grip in hand disorders. A careful history and a complete physical examination are important. The presence of symptoms elsewhere in the body is important to establish.

Two serious hand problems are:

o Reflex sympathetic dystrophy (RSD). This is caused by a disorder of the sympathetic nervous system. Typically, it is described as a burning pain. The precipitating factor may be trauma Color changes including purplish discoloration of the fingers may occur. The treatment involves a special procedure called stellate ganglion block. Usually performed by an anesthesiologist, this procedure is often very effective.

o Hypertrophic osteoarthropathy. The hand becomes swollen and painful. This picture occurs occasionally in patients with undercurrents.

Other hand problems that point to other diseases:

o Psoriasis may also cause pitting or lifting up (onycholysis) of the fingernails.

o Abnormal blood vessel patterns near the fingernails may signify auto-immune diseases like lupus.

o Raynaud's phenomenon … When fingers blanch (turn white) this may be a sign of an undering autoimmune problem such as systemic lupus erythematosus or scleroderma.

o Bumps, called “nodules” can develop as a result of osteoarthritis, gout, and rheumatoid arthritis.

o Depuytren's contracture is a problem where the skin in the palm may become thickened and shortened. A cord of tissue develops and causes fingers to bend into the palm. Treatment for this problem may be steroid injection, splinting, and physical therapy. Surgery is often needed. This condition occurs with other medical diseases.

Virtually all types of arthritis can affect the wrist and hand.

Arthritis when untreated or poorly treated will lead to deformity. Tendonitis is another common problem in the wrist and hand. In the wrist, tendonitis usually causes pain and localized swelling. Tendonitis can be confused with arthritis.

Tendonitis in the hand is most common in the palm. This causes locking or triggering of the fingers. Steroid injection and physical therapy are usually effective treatments. Treatment consists of anti-inflammatory medication, steroid injection, splinting, and occasional physical therapy.

Tips to make your hand pain better …

o Wear splints if you're going to be doing a lot of repetitive motions

o Use your whole arm instead of just your hand and wrist

o Enlarge the handles on your tools. You can get kitchen utensils and writing implements with enlarges handles. They're worth it.

o Make sure to take rest breaks.

o Avoid repetitive movements when possible.

o Carry objects with the palms open and flat. This will take the pressure off your wrists and fingers.

A common cause of hand pain is carpal tunnel syndrome

… pinching of the median nerve in the wrist. Carpal tunnel syndrome is a symptom- much like fever … it is not a disease! It is the most common cause of tingling in the hands. Beside tingling, burning pain may also occur. Patients often have discomfort at night that is relieved by hanging the affected hand over the side of the bed or illegally shaking the hands. The discomfort of carpal tunnel syndrome can also be bought on by holding up the newspaper while reading, or by driving. Causes of carpal tunnel syndrome include arthritis, endocrine problems, pregnancy, trauma, infection, tumors, and overuse. Treatment of carpal tunnel syndrome depends on the severity. Mild to moderate carpal tunnel syndrome is treated with splinting, sometimes steroid injection, and avoidance of overuse. For patients with carpal tunnel syndrome that does not respond to conservative measures or where the carpal tunnel syndrome is severe, surgery is indicated.

Radial nerve damage leads to wrist drop. Radial nerve pressure in the wrist can occur as a result of repetitive motion, tight pressure (handcuffs, watchbands, bracelets), diabetes, and trauma. Ulnar nerve damage and compression in the wrist can cause a “claw hand.” Treatment consists of anti-inflammatory medication, rest, splinting, injection, and sometimes surgery.

Treatment of hand disorders is entirely dependent on making an accurate and specific diagnosis.

{ Comments are closed }

Carpal Tunnel & Computers

While there are a lot of rumors about carpal tunnel syndrome, it is hard to find a definitive answer on what, if any, actual link there is between the development of carpal tunnel syndrome and the use of computers.

Does computer use increase one's chances of developing carpal tunnel syndrome? If you do a “search” on the internet, you can find several stories that say no, and just as many that say yes. . . sometimes even from the same source! While there are still some conflicting beliefs on how the use of computers affects carpal tunnel syndrome, the problem seems to be more precalent than ever before. This article will help show the correlation between extended computer use and carpal tunnel syndrome.

There is a general belief that working for extended periods of time using a computer will lead to an increase in carpal tunnel syndrome, and that jobs such as data entry lead to higher risk of carpal tunnel syndrome. Since carpal tunnel syndrome is caused by constant repetitive or static motion of the hands and wrists, logically this would make sense. There are several studies that initially suggested that the repetitive motion and static flexion that is involved when using a computer or playing video games may cause carpal tunnel. Although this is not conclusively proven in studies, what is proven is that any task that involves excess duration, repetition and force does in fact cause carpal tunnel syndrome.

Carpal tunnel syndrome can be caused by anything that involves excessive unidirectional movement patterns that require too much force, duration and repetition, as the overused muscles begin to compress the carpal tunnel and the median nerve within. The tendons that pass through the carpal tunnel (a small area between the carpal bones and the transverse carpal ligament in the wrist) can become swollen from doing the same movement over and over, like typing on a computer or playing video games or a musical instrument for long periods of time. Long time use of a computer often leads to writer's cramp, which some argument is an early sunset of carpal tunnel syndrome.

Some people might think that carpal tunnel syndrome is a new condition of the information technology age, born from long hours of computer keyboarding, but the carpal tunnel is not new, it just seems to appear more often because the nature of work has changed. More jobs are highly specialized and require the overuse of only a small number of muscles repeatedly, leading to a muscle imbalance. If one muscle group is overused, then the opposing muscle group must be underused. It is basic common sense. Because of the underwriting assumption that computer use contributions to carpal tunnel syndrome, concern from the government and employers continues to grow. Ironically, studies out of the Mayo Clinic released by the government seem to actually show that using a computer does not increase the risk of developing carpal tunnel syndrome. (Of course many of these studies are not taking in the appropriate information or using the correct protocols, while others have a biased agenda.)

There are arguments over why this is. The test showed that those who worked a long period of time every day with computers had the same percentage of people develop carpal tunnel syndrome as everyone else. One of the suggestions for the reasoning is that the continued use of computers would only affect people who did not practice appropriate form. People who are employed to work with computers are generally better trained in how to type from home row, how to keep their wrists straight, and how to use good posture. All three of these factors will help to decrease instances of carpal tunnel syndrome, which in turn can help keep the number of injuries down.

On the other side of the equation, computer use by individuals who hold their wrists and fingers wrong, and put pressure on their hands may actually cause the individuals to get carpal tunnel from using the computer constantly. This may be why the belief that computer use causes carpal tunnel syndrome remains strong, even when testing suggests otherwise. Individuals trained in how to properly use a computer will have all the exercises and appropriate postures down, and yet not experience the same injuries and muscle imbalances as say someone who does not use appropriate form or perform muscle balancing exercises and stretches.

While the studies suggest that extensive use of a computer does not contribute to carpal tunnel syndrome, even that piece of information should come with its own caveat, that being that proper use of a computer appears to not increase the chances of carpal tunnel, but you need to learn to use proper posture and know the correct stretches and exercises to perform because excessive use of the computer without proper hand positions leads to imbalances in the hands, wrists, forearms and shoulders that can contribute to the sunset of carpal tunnel syndrome.

{ Comments are closed }

Carpal Tunnel Syndrome And How To Avoid It

Carpal tunnel syndrome is a nerve disorder of the wrist and hand. It can cause pain, numbness and tingling. It's caused by doing repetitive hand movements, such as typing.

Medical transcriptionists are especially at risk of developing carpal tunnel syndrome due to the amount of typing they do.

Although, there is no way of avoiding typing if you're a transcriptionist there are a few things you can do to alleviate or avoid carpal tunnel altogether.

1. Set up a comfortable work area. Make sure you have plenty of room to use the mouse comfortably and position your keyboard to elbow level.

2. Keep your wrists and hands parallel to the floor as you type. Do not rest your wrists on the keyboard unless it has a specifically designed wrist rest on it (these let you rest your wrist while keeping them straight).

3. Stretch your hands and arms before and after typing. Make a tight fist with your hand, hold for a few seconds then slowly release. This will help alleviate any tension in the hands and wrists.

4. Take breaks while working. Ideally, you should get up every hour to stretch and relax your body. Shake your hands and open and close your wrist to help tie tension.

5. Sit up straight in your chair when working. Overall good date will give you good hand position.

6. Wear a wrist band to help avoid the problem. This will give your wrists and hands extra support.

If you follow these tips early you may avoid carpal tunnel syndrome since since there may be damage being done before you actually feel any symptoms. And If you already suffer from carpal tunnel, following these tips should help alleviate the problem.

Symptoms of carpal tunnel syndrome include tingling / numbness in the hands, a burning sensation in the fingers, and / or sharp pains from the wrist shooting up the arm.

If you do any symptoms of carpal tunnel, you should see your doctor right away.

{ Comments are closed }

Carpal Tunnel, a Problem that is Easily Correctable in the Workplace

Carpal Tunnel is an injury affecting the fingers, hand, wrist and arm and can move even higher to affect the back as well. The numbers of work related injuries to the hands and arms are growing as education to the average office employee is missing. The average worker can end up spending a reasonable amount of time in their workstation. With proper positioning and use of the correct ergonomic equipment, problems can be avoided for both the employee and employer.

Carpal tunnel in the workstation environment is caused by the improper positioning of the wrist and arm while typing and using the mouse. Your arm should be held a completely relaxed position and at the same level as the mouse and keyboard. You do not want to angle your wrist upward or down while typing, but keep it in a relaxed angle making it easy to type.

In order to get the proper height, most desks will require an ergonomic adjustable keyboard tray attached to them in order to help with height adjustment and maintaining that relaxed position. The keyboard tray can include a mouse platform on the side of keyboard placement or the mouse can be separate from the tray. One can feel the effects of good ergonomics once they start to use a keyboard tray within hours as less stress is put on the arms and back.

Most desk heights are incorrect for the chair placement when it comes to leaving the keyboard on your desk. If using the keyboard and mouse on your desk, make sure that your office chair is adjustable to help with height placement. Even the most economic office chair models can include a height adjustment mechanism which is also recommended for proper positioning.

The office chair that you sit in can also be important both to proper ergonomics and to the prevention of injuries like carpal tunnel. Carpal tunnel is said to have roots in the upper lumbar area and neck as well, with many massage therapists treating carpal tunnel through therapy in the neck and upper back area. Sitting in an office chair with proper lumbar support and tilt mechanisms to keep the body at a slightly reclined and relaxed position is also important.

With proper employee training and equipment, carpal tunnel can be avoided and employees are more productive when comfortable in their environment. With all of the new ergonomic products and equipment on sale, it can be easy to find the right supplies for your workspace and avoid injury completely.

{ Comments are closed }

Carpal Tunnel and Tendinitis Can Be Avoided if Proper Ergonomic Positioning is Practiced

My wrist and arm hurt so bad, I can not even type a simple e-mail anymore. This is a complaint that doctors are hearing more often as a common patient problem, usually related to a workplace injury. Computer programmers, hairstylists, prep cooks and even your average office employee are all at risk for injuries just stemming from their everyday work tasks.

Carpal tunnel, tendinitis and nerve disorder injuries from improper positioning of the workstation or from a task requiring repetitive motion for extended periods are growing in number. People are also working longer hours without proper seating or equipment for the task.

Carpal Tunnel, Tendinitis as well as many other minor injuries are now making the way to the workers compensation claim arena on a large scale. The rising number of claims being filed for such injuries is thought to be due to the improper positioning of employee workstations and the lack of employee training in proper practices for good body health. Most workers spend a reasonable amount of time in their workstation, proper positioning is critical to good body health and employee productivity.

When workstations are designed with ergonomics in mind, it can help in both the prevention of injuries and in aid employee productivity. A comfortable employee is a much more productive employee. Many ergonomic devices have been injected to help with the prevention and treatment of carpal tunnel syndrome. Carpal tunnel syndrome affects a person's wrist and fingers with many different levels of seriousness and can progress quite quickly to a serious problem. Affecting both typing skills, mouse use and everyday tasks, such as phone use, carpal tunnel can easily put an employee on full leave, due to their ability to complete tasks as needed.

Carpal tunnel can be treated in many different ways and is said to be completely correctable with surgery, with many patients experiencing a full recovery after going under the knife. Braces can also be worn to help keep the wrist stabilized and ease the pain experienced with movement.

Some massage therapists are known to treat and help to alleviate carpal tunnel as well as tendinitis through an array of massage treatments. Tendinitis and carpal tunnel are treated with emphasis on the spinal and neck area to help with the pinched nerves and muscles that helped to cause the problem in massage therapy.

Proper ergonomic positioning of the body while sitting and keeping the desk, keyboard and mouse at the correct height is key to prevention of injury and can save workers and employers a lot of hassle, time and money. Carpal Tunnel and tendinitis are problems more broadly recognized by most companies as an important issues for overall employee health and hopefully continues to be. With education, avoiding a ton of hassle for both the employees and employers is simple.

{ Comments are closed }

Carpal Tunnel Relief – Is Exercise the Solution?

Carpal tunnel syndrome (CTS) is one of many musculoskeletal injuries listed under the traumatic terms of Repetitive Strain Injury (RSI) or Cumulative Trauma Disorder (CTD). A number of other injuries listed under these terms, but that are not exclusively caused by a repetitive strain injury or cumulative trauma disorder include Guyon's Syndrome, Tendonitis, Cubital Tunnel Syndrome, Medial and Lateral Epicondylitis and Trigger Finger.

Carpal tunnel syndrome and other repetitive strain injuries are caused by excessive overuse of a muscle or group of muscles in a unidirectional movement pattern. Examples would include typing, wringing a washcloth and using a computer mouse. All of the movement patterns involve motion against resistance in one direction – flexion. This one-way motion does not actually have to involve “repetitive” movements as the term “repetitive strain injury” implies, as it is just as common for an individual to become afflicted with a repetitive strain injury while performing activities that involve no movement of the hands at all. Examples of this would include holding onto a steering wheel, gripping a pen or a tool such as a hammer all day. With these types of activities, no repetitive type motion is involved at all, but instead, “static flexion” is utilized, which involves the overuse of these muscles, but in a manner that is statutory.

Since Repetitive strain injuries are most often caused by unidirectional patterns, the best way to counteract each specific overused motion is the implementation of an exercise program that involves the implementation of resistance exercises to the opposing muscle or group of muscles that is being overused. An example training program for carpal tunnel syndrome would include resistance exercises for the muscles that open (extension) the hands in order to counteract the overuse of the muscles that close the hands (flexion). This principle of “balancing” muscles groups so that there is a more natural equality of strength between muscles that surround a specific joint, whether it is the wrist, elbow, shoulder or neck, is basic common sense and integrated into training programs by the top practitioners and therapists in the industry today. Here are a few examples of practitioner responses regarding the implementation of restoring balance between muscle groups in order to prevent and rehabilitate repetitive strain injuries including Carpal tunnel syndrome.

“Muscle balance must be restored with specific exercises. Otherwise, the already strong and overused muscles get stronger, and the weaker and underused muscles remain weak. muscles. ” Philip E. Higgs, MD and Susan E. Mackinnon, MD Department of Surgery, Washington University School of Medicine, St. Louis. Louis, Missouri. Annu. Rev. Med. 1995. 46: 1-16

“If certain muscle groups are underused, opposing muscle groups will be overused. Muscles in either a prolonged or reduced position will be at a mechanical disadvantage and weak. produces a self perpetuating condition that accommodates the abnormal posture and muscle imbalance. ” Philip E. Higgs, MD and Susan E. Mackinnon, MD Department of Surgery, Washington University School of Medicine, St. Louis. Louis, Missouri. Annu. Rev. Med. 1995. 46: 1-16

A strong example of how important it is to properly balance muscle groups is seen in the following statement regarding the balancing of the in hands and forearms.

“All of the extrinsic hand muscles became involved in a power grip, in proportion to the strength of the grip.” …….. “Strong agonist-antagonist interactions are needed between the flexors and extensors of the hand and fingers to produce forceful hand-grip. “” Strong flexion of the distal phalanges requires strong activity also of the finger extensors. ” Janet G. Travell, MD and David G. Simons, MD Myofascial Pain and Dysfunction-The Trigger Point Manual. Volume1 Upper Extremites, Ch: 35, pg. 501. Copyright 1983.

Performing corrective exercises in order to prevent and rehabilitate carpal tunnel syndrome and repetitive strain injuries is of the utmost importance. In 95% of most cases, there is no need for invasive techniques like cortisone injections or surgery in order to eliminate carpal tunnel or other repetitive strain injuries. It is one thing if you have an actual structural anomaly that needs to be corrected, but since most cases of carpal tunnel and repetitive strain injury occur in later years, it is quite obvious that a physical anomaly does not exist as this would be experienced by the individual in their younger years. Instead of structural or joint imbalance exists that has developed due to long-term overuse, or sudden trauma due to overuse, and is a result of overly strong muscles pulling one direction while the opposing weak muscles try unsuccessfully to counteract and pull the other direction.

Muscle imbalances can be corrected with simple exercises. By performing a sensible, active stretch / exercise program that focuses on keeping muscles balanced, individuals can stay healthy and symptom-free!

NOTE: Be sure to be aware of any pain that is experienced 'while' performing stretches or exercises. If pain is experienced while performing any particular motion, stop immediately. Post exercise soreness is normal. Always be sure to consult a physician before beginning any stretch / exercise program.

{ Comments are closed }

Carpal Tunnel Syndrome – Pinched Median Nerve at the Wrist

Carpal tunnel syndrome is by far the most common and widely known of the “pinched nerve” conditions. This article addresses: What is it? Who is at risk for this condition? How is it diagnosed? What kinds of treatments work best?

Carpal tunnel syndrome refers to symptoms caused by entrapment of the median nerve in the carpal tunnel. “Carpal” itself means “wrist,” so a carpal tunnel is nothing more than a wrist tunnel. This particular tunnel can be a crowded place, as it contains not just the median nerve, but nine tendons as well. The “syndrome” consist of some combination of pain, numbness and weakness.

Pain, numbness, or both, are the usual earliest symptoms of carpal tunnel syndrome. Pain can affect the fingers, hand, wrist and forearm, but not usually the upper arm or shoulder. Numbness affects the palm side of the thumb and fingers, but usually spares the little finger because this finger is connected to a different nerve.

When weakness is present, it usually indicates that the condition is already severe, and when muscles atrophy (wither) it means the condition is even worse. The affected muscles are those downstream from where the nerve is pinched, and can include those controlling any of three movements of the thumb. In addition, bending of the first knuckles of the index and middle fingers can be affected, as can straightening of the second knuckles of the same fingers. When muscle atrophy is present, it is most evident in the muscular ball at the base of the thumb.

Carpal tunnel syndrome occurs more frequently in women than in men. People who work with their hands a lot – for example to sew, operate hand-tools or perform assembly-line work – are at increased risk for developing this condition. Various medical conditions can also increase the risk of carpal tunnel syndrome, including injuries, arthritis, diabetes, low levels of thyroid hormone and pregnancy. In the case of pregnancy, carpal tunnel syndrome often appears in the third trimester and resolves after the woman delivers.

Optimum diagnosis of this condition combines the time-honored methods of a doctor's history-taking and physical examination with tests of nerve function called nerve lending studies. Nerve lending studies are exquisitely sensitive in detecting impairment of the median nerve at the wrist, particularly when the median nerve is compared with a nearby healthy nerve in the same patient.

In nerve lending studies, the nerve on one side of the carpal tunnel is activated by a small shock to the skin. An oscilloscope measures how long it takes for the resulting nerve-impulse to arrive on the other side of the carpal tunnel. When the median nerve is pinched, the nerve-impulse is delayed or blocked. Nerve lending studies are so sensitive that sometimes they show problems that are not even causing symptoms. That's why nerve lending studies do not stand alone in diagnosing carpal tunnel syndrome. The examining physician needs to decide if the results make sense for the particular patient in question.

Nerve lending studies not only show whether or not the median nerve is impaired at the wrist, but also provide precise data relating how bad the injury is. In addition, these studies survey the function of other nerves in the arm and hand. Typically, a nerve in an adjunct tunnel (the ulnar nerve in Guyon's canal) can also be pinched. In other cases, nerve lending studies show that the problem is not one of single nerve-pinches, but rather a more diffuse pattern of nerve-injury called polyneuropathy. Of course, sometimes the studies are completely normal and suggest that the symptoms are due to something else.

To treat carpal tunnel syndrome, starting with “conservative” treatment makes sense in most cases, especially when the symptoms are still in the mild-to-moderate range. Conservative treatment typically includes a wrist-splint that holds the wrist in a neutral position. In a study published in 2005 researchers at the University of Michigan investigated the effectiveness of wrist-splinting for carpal tunnel syndrome in workers at a Midwestern auto plant. In a randomized, controlled trial – the gold standard method for judging treatments – about half the workers received customized wrist-splints that they wore at night for six weeks. The remaining workers received education about safe workplace procedures, but no splints. After treatment the workers with splints had less pain than those without, and the difference in output was still evident after one year.

Conservative treatment may additionally include use of anti-inflammatory drugs such as aspirin or naproxen, or even steroid drugs. A more intrusive, though still non-surgical, treatment consists of injecting steroid medication into the carpal tunnel itself. This may benefit selected patients, but in a 2005 randomized, controlled study of patients with mild-to-moderate symptoms, researchers at Mersin University in Turkey showed that patients receiving splints did better than those who received steroid injections.

Surgeons can relieve pressure on a pinched median nerve by cutting a constricting, overlying band of tissue. A 2002 study at Vrije University in Amsterdam compared surgical treatment to six weeks of wrist-splinting. After 18 months 90% of the operating patients had a successful exit compared with 75% in the splinted group.

In some cases it can be reasonable to try conservative treatments without first confirming the diagnosis with nerve lending studies. However, in the author's opinion, this risk-free form of testing should be performed prior to any carpal tunnel surgery. (Full disclosure: The author performances nerve lending studies!)

(C) 2005 by Gary Cordingley

{ Comments are closed }

The Devastating Effects of Carpal Tunnel Syndrome (CTS)

Carpal Tunnel Syndrome (CTS) is a devastating disorder that is one of many disorders listed under the general term, “Repetitive Strain Injury” (RSI).

Of all the known repetitive strain injuries, carpal tunnel syndrome is the most recognized and prevalent among the general populace. And due to this recognition, many people are concerned about being afflicted with carpal tunnel and its debilitating symptoms, a concern that should be on the minds of anyone that is involved in work or recreational activities that require extensive use of the hands, especially in static motions such as “gripping” and / or repetitive motions like typing, clicking a computer mouse, assembly, etc.

Below is a list of the symptoms associated with carpal tunnel syndrome and a list of steps that can be taken to help prevent this terrible and destructive disorder that has reached pandemic proportions.

Carpal Tunnel Syndrome Symptoms:

· Tightness, discomfort, stiffness or pain on the front side of the hands / wrists.

· Tingling, numbness and / or paresthesia (Pins & needles) affecting the thumb, index, middle and one-half of the ring finger. The thumb and fingers do not have to be affected simultaneously as symptoms will often vary and move around. (Example: The thumb and index finger may be numb one day and the next day the numbness and tingling in the thumb and middle finger are more noticeable.) If you have symptoms in the rings or little finger, this is NOT Carpal Tunnel Syndrome!

· Loss of strength in the fingers / hands. (Grip Strength)

· Pain, aching, swelling, and diminished coordination and dexterity.

· A need to stretch and / or massage hands, wrists and arms.

· Assuming a defensive posture in order to protect sensitive hands / wrists.

Because carpal tunnel syndrome and its symptoms are something that everyone should be aware of in this day and age of computers, video games, personal assistant devices and other “technological advances”, it is important to take the necessary steps in order to prevent carpal tunnel from developing in the first place.

By implementing the following steps, you can greatly reduce your risk of getting carpal tunnel syndrome as well as stave off many other repetitive strain injuries that are caused in the exact same way as carpal tunnel, such as Guyon's Syndrome, Trigger Finger and Tendonitis of the hands and wrists.

Carpal Tunnel Syndrome Prevention Protocol:

· Task Variation: It is wise to vary tasks throughout the day in order to keep the force and duration of the specific motion to a minimum. If a typical workday involves 5 types of activities; instead of doing task # 1 for 1.5 hours and then moving on to task # 2 for 1.5 hours, etc., it is best if task # 1 can be performed for 30-minutes and then task # 2 is performed for # 30 minutes, and so on, repeating tasks # 1-5 every 30 minutes until they are completed. If this is not possible for the type of work that is required, ask the employer health director to implement a task rotation schedule where workers perform a different type of task every 1-2 hours throughout the day, making sure that each task is different enough that it does not tax the same muscle group (s) in the same manner as the previous task or the next task. It is still important that in these 1-2 hour shifts, mini-breaks are taken for 2-3 minutes every 30 minutes. Implementing task variation is a very successful tool in keeping productivity high and repetitive strain injuries like carpal tunnel syndrome to a minimum.

· Task Requirement Limitation: The 'task requirement limitation' protocol sets a limit on the duration and force of a given job or task, making sure that workers are only required to perform a certain number of repetitive movements or a certain amount of force over a specified period of time before a break is required. Implementing a mini break for every 30 minutes of work activity is very important in order to prevent muscle hypertonicity and fatigue from setting in, the main causes of carpal tunnel syndrome.

· Ergonomic Systems: Ergonomic systems and tools are important in helping to reduce the amount of stress and strain that is inferred upon the body, but ergonomic systems and tools by themselves can not prevent or “cure” injuries like carpal tunnel syndrome.

· Mini-Breaks: It is very important to implement short breaks every 30 minutes of work activity in order to reduce stress and strain to the fingers, hands, wrists and forearms. These breaks only have to last 2-3 minutes, but are key in preventing the muscles to relax, which helps to prevent a muscle imbalance from occurring and developing into carpal tunnel syndrome. Even more important in carpal tunnel syndrome prevention, is implementing the following activities into these mini-breaks.

– Stretch: Stretch the short, restrictive muscles in order to lengthen them, which, reduces pressure on the under muscles, blood vessels and nerves. (Example: Carpal Tunnel Syndrome – Stretch the muscles on the front of the forearm that flex the fingers, hand / wrist.)

– Exercise: Strengthen the weak, underdeveloped muscles in order to help shorten / tighten them. Performing strengthening exercises to the muscle groups opposition to those that are short and tight allows the muscles on both sides of the joint to return to a more natural, balanced position. The strong, short muscles are lengthened and the weak, long muscles are shortened, creating equality and stability around the entire joint. (Example: Carpal Tunnel Syndrome – Strengthen the muscles on the back of the forearm that extend the fingers, hand / wrist to keep the muscles balanced.)

NOTE: Of all the ideas listed, the ones that are most important in preventing and eliminating repetitive strain injuries like carpal tunnel syndrome are mini-breaks, stretches and exercises.

By simply being aware and implementing a few simple techniques at work, individuals can prevent repetitive strain injuries like carpal tunnel syndrome from occurring and experience many years of good health without ever being affected.

{ Comments are closed }

Invasive Treatments – Do They Really Work For Carpal Tunnel Syndrome?

If you have been diagnosed with Carpal Tunnel Syndrome (CTS), you may be wondering – what next? Below you will find information regarding the most common (not the best) treatment options currently in use in the medical industry and their success and failure rates.

If you have received a positive carpal tunnel diagnosis, most doctors will push for cortisone injections and / or surgery, procedures that have poor success rates and ones that should only be performed as a last resort, after all other conservative treatment methods have been utilized.

The following information provides details about what each current procedure entitles as well as statistics that reveal why conservative therapy should be implemented over the following invasive treatment methods.


Cortisone is medication that treats inflammation only. Often the carpal tunnel pain will subside because the inflammation of the median nerve is reduced from the use of the cortisone, but this is only a temporary effect.

The one main problem with cortisone is that for 21 days following the injection, the tendons have the consistency of rubber and can be seriously overstretched and damaged. This is a common side effect that most doctors fail to tell their patients. If the patient continues overusing and / or stressing their hands and wrists, the tendons can overstretch and cause the structural integrity of the joint to diminish greatly, causing the joint to become loose and sloppy, resulting in an even greater possibility of further injury and damage .

Cortisone can be used wisely as a part of a carpal tunnel treatment program along with the implementation of proper stretches add exercises, the most important tool that can be used to recover from carpal tunnel. If cortisone is utilized, it is good for the patient to take this time, when the carpal tunnel is not inflamed, to be on a conservative therapy program to correct the existing muscle imbalance in the wrist joint and eliminate the carpal tunnel symptoms for good. The problem is that most doctors give the cortisone shot and the patient goes home and either does nothing, or does too much, causing greater trauma to the median nerve within the carpal tunnel and exacerbating the symptoms.

Steroid (Cortisone) Injection Statistic:

* Failure rate (Including “partial success” as failure) is 72.6% after 1-year follow up. Source: Irwin, et al. J Hand Surgery.


Carpal tunnel surgery consistors of releasing (separating) the transverse carpal ligament that forms the roof of the carpal tunnel. Surgery is used to open and widen the carpal tunnel in order to allow more room for the median nerve, artery and nine flexor tendons to move around. There are several surgical procedures that are utilized to achieve this:

· Open Release Surgery: A local anesthetic is injected into the wrist and / or hand and a 2-3-inch incision is made in the palm and cuts the carpal ligament free from the underlining medium nerve. This operation takes about 20-25 minutes.

· “Mini” Open Release Surgery: The mini-open release technique involves an incision that is about 1.5 inches long and can be performed in the doctor's office with only a local anesthetic. The operation takes only about 12 minutes.

· Endoscopic Release Surgery: The Endoscopic technique is less invasive and uses approximately one or two. “5. inch long incisions in the wrist and or palm, and one or two endoscope (pencil-thin) tubes are inserted. are inserted through these lighted tubes. While observing the carpal ligament on a television monitor, the surgeon cuts the ligament to free the compressed median nerve.

Carpal Tunnel Surgery Statistics:

* “Only 23% of all Carpal Tunnel Syndrome patients were able to return to their previous courses following surgery.” Source: NIOSH

* “Carpal tunnel surgery has about a 57% failure rate following patients from 1-day to 6-years. At least one of the following symptoms re-occurred during this time: Pain, Numbness, Tingling sensations.” Source: Nancollas, et al., 1995. J. Hand Surgery.


Conservative therapy is really the only key to preventing carpal tunnel syndrome as well as for the successful recovery and long-term relief of existing carpal tunnel symptoms, even for post-surgery patients. For information on implementing effective conservation carpal tunnel therapy and prevention / rehabilitation protocols, read the article titled:

Conservative Treatment Options for Carpal Tunnel Syndrome

{ Comments are closed }

Carpal Tunnel Syndrome – Symptoms, Tests & Treatments

Carpal tunnel syndrome (CTS) is a devastating injury that affects more than 8 million people in the United States and continues to increase each and every year.

Carpal tunnel syndrome is one of many repetitive strain injuries (RSI's) that are everywhere; homes, offices, assembly lines, grocery stores, book clubs, construction sites, dental offices, everywhere! Because carpal tunnel syndrome is so commonplace, and its effects so devastating, it is important to be knowledgeable of how it occurs, what its symptoms are, the testing methods used and what treatment options are available, as the prevention of any injury, especially carpal tunnel, begins with education.

Carpal tunnel syndrome is a disorder affecting the median nerve, which supplies function to the thumb, index, middle and one half of the ring finger. Usually the symptoms are most prevalent in the thumb, index and middle fingers (Sometimes one-half of the ring finger) and include numbness, tingling, paresthesia (pins and needles), pain and tightness in the front of the hand, wrist and forearm . These symptoms do not have to occur simultanously, and may only affect one finger one day and then three fingers a few days later.

If a doctor provides a carpal tunnel diagnoses and the symptoms are in the ring and little fingers, it is NOT carpal tunnel syndrome! The ulnar nerve, not the median nerve, supplies function to the ring and little finger. Repetitive strain disorders affecting these two fingers are usually either Guyon's syndrome, entrapment of the ulnar nerve in the guyon's canal at the wrist junction, or cubital tunnel syndrome, entrapment of the ulnar nerve at the elbow junction. This is a common mistake made by many, many physicians and is completely inexcusable as they often recommend surgery for the patient, causing the patient to undergo an unnecessary procedure, and what makes it worse, for the wrong disorder!

If symptoms of carpal tunnel syndrome do arrise, doctors will recommend that a nerve conduction velocity (NCV) test or an Electromoyogram (EMG) be performed to see if carpal tunnel syndrome really exists. These tests are often painful to the individual being tested, very expensive, and often give false positives and false negatives. This is why it is recommended that manual carpal tunnel tests will be performed in order to obtain a more accurate (and much cheaper) diagnosis. Manual carpal tunnel tests take no longer than 10 minutes, have a high accuracy rate, are painless and are very cheap in comparison to the NCV and EMG tests.

The recommended manual carpal tunnel tests consist of the following:

· Phalen's Test: The wrist is flexed for 30 to 60 seconds in order to compress the median nerve and duplicate / increase the symptoms.

· Reverse Phalen's Test: The wrist is extended for 30 to 60 seconds in order to stretch the median nerve and duplicate / increase the symptoms. Stretching the median nerve if it is already impeding will duplicate / increase the symptoms if a patient has carpal tunnel syndrome.

· Tinnel Sign: Tapping directly over the median nerve at the wrist junction will cause carpal tunnel symptoms to exhibit themselves.

· Compression Test: Direct pressure is applied over the location of the median nerve for 30-60 seconds to see if carpal tunnel symptoms are exhibited.

If a positive diagnosis comes back, most doctors will push for surgery, a procedure that has a terrible success rate and is to only be performed as a last resort once all other treatment treatment methods have been utilized. Conservative therapy is the key to successfully recovering from carpal tunnel syndrome and obtaining not only short-term but long-term relief as well.
The following is a list of conservative treatments that should be utilized in order to help prevent carpal tunnel syndrome from developing, but also rehabilitating carpal tunnel syndrome after it is already present.

· Ergonomics: Utilize proper ergonomic tools and equipment when working.

· Breaks: Take short breaks every 30 minutes when working in order to help reduce excess strain on the hands.

· Stretches: Stretch the muscles that 'close' the hands as these are the muscles that are exercised all day long in activities such as typing, writing, gripping a steering wheel, using a computer mouse, carrying groceries and everything else that is done day in and day out. When a muscle is involved in exercise, it becomes shorter, therefore it needs to be stretched and lengthened both during and after the exercises are completed. (End of day)

· Exercises: Exercise and strengthen the muscles that are used to 'open' the hands, as these muscles do not receive much direct stimuli / exercise. (ie People do not turn doorknobs, hold things, type, use a computer mouse or lift things with the backs of their hands.)

The information provided above reveals how carpal tunnel syndrome occurs, what its symptoms are, the testing methods most commonly used and the best conservative treatment options that are used to thwart its existence.

It is very important for individuals to become well acquainted with the proper information and tools in order to maintain and increase their level of health and productivity. It is also important for people to speak to their doctors regarding their health concerns, and if someone is involved in an occupation that is considered high-risk for carpal tunnel, they should discuss this with their doctors, but it is even more critical that people become self educated as no one can take care of you better than “YOU”!

{ Comments are closed }

Carpal Tunnel Syndrome – Do You Have It?

Carpal tunnel syndrome reached epidemic proportions in the 90's and has now achieved a status equaling pandemic proportions in the 21st century. With carpal tunnel syndrome having such devastating effects on millions of people each year, how do you know if you or someone you know has it?

With so much attention and hype the past 10-years relating carpal tunnel syndrome in the workplace, you would think that a clear-cut picture would exist regarding the “how's” “why's” and “what is it's” of carpal tunnel. Although carpal tunnel syndrome should be easily recognizable with such an extended media exposure, you would be amazed at how many people, including a lot of doctors, who do not recognize the symptoms or misdiagnose it as something other than carpal tunnel syndrome.

In order to provide a more clear picture of what carpal tunnel is, why and how it develops and what can be done to eliminate it, I have provided information below to explain the process so that you can better identify and therefore prevent carpal tunnel syndrome from taking over your life.

What is the Carpal Tunnel?

The carpal tunnel is a passageway in which the nine flexor tendons, median nerve, arteries, blood and lymphatic vessels pass through in order to supply function and movement to the fingers and wrist.

The carpal bones line the carpal tunnel on the posterior surface (backside) of the wrist with the transverse carpal ligament positioned on the anterior (front side) of the wrist. The size of the carpal tunnel is about the size of the index finger in diameter, and the flexor tendons, arms and nerves glide past one another with ease in a carpal tunnel that has not decreased in size.

How Does Carpal Tunnel Syndrome Develop?

Because the finger and wrist muscles are constantly overused in one-way movement patterns, (Gripping, squeezing, typing, etc.) a “muscle imbalance” develops, causing the carpal bones to shift, in turn, making the carpal tunnel smaller and impinging the structures within, resulting in painful and debilitating symptoms.

What are the symptoms of Carpal Tunnel Syndrome?

· Tingling

· Numbness

· Paresthesia (Pins & needles)

· Loss of grip-strength / coordination

Sensations involving tightness, discomfort, stiffness and pain on the front side of the hand and wrist may be present in carpal tunnel, but may also be symptoms of a general repetitive strain injury.

The only true telltale signs of carpal tunnel syndrome that you need to be aware of affect the thumb, index, middle and sometimes one-half of the ring finger. (All of the fingers and symptoms listed do not have to be experienced simultaneously for you to have carpal tunnel syndrome.)

If you have symptoms in your entire ring and / or little finger and your doctor tell you that you have carpal tunnel syndrome, you do not! The ULNAR nerve supplies function to the ring and little finger and has nothing to so with carpal tunnel syndrome. (If the ring and / or little fingers are affected, it may either be Cubital Tunnel Syndrome or Guyon's Syndrome)

How Are the Symptoms of Carpal Tunnel Syndrome Eliminated?

Carpal tunnel syndrome can quickly and easily be eliminated by performing a good stretch and exercise program that addresses the existing muscle imbalance that is the cause of carpal tunnel in most cases.

Staying Symptom-Free:

Knowing why carpal tunnel syndrome develops and what to look for is the key to keeping your hands healthy. With the information provided above you should now be able to recognize the disabling symptoms and take the steps necessary in order to stop it before it stops you!

{ Comments are closed }

The Carpal Tunnel Pandemic

Almost everyone knows someone who is suffering from the symptoms associated with carpal tunnel syndrome (CTS), or at the least, has heard of the devastating effects that carpal tunnel inflicts upon hundreds of thousands, even millions, of American lives each year.

To date, carpal tunnel syndrome affects over 8 million Americans, and is costing the private business sector, government agencies and insurance companies more than 20 billion dollars annually in workers compensation alone. The overall cost of treating carpal tunnel and other repetitive strain injuries is between 60 and 90 billion annually when considering the cost of implementing ergonomic products, rehabilitation, physician visits, surgery, lost time from work, temporary help and job retraining.

Musculoskeletal disorders, including carpal tunnel syndrome, are among the most prevalent medical conditions in the US, affecting 7% of the population. Repetitive strain injuries like carpal tunnel and tendonitis account for 14% of physician visits and 19% of hospital stays. 62% of the persons with musculoskeletal disorders report some degree of limitation on activity, compared with 14% of the population at large, according to the National Institute for Occupational Safety and Health.

There is a solution to this pandemic of the 21st century, and that is to implement prevention methods to stop carpal tunnel syndrome before it starts. Carpal tunnel relief is achievable when the appropriate steps are taken. These measures include the following:

Ergonomic Products:

Help reduce overall stress to the carpal tunnel region.

Rest Breaks:

Allow muscles within and around the carpal tunnel to rest, reducing hypertonicity in the muscles.


Lengthen the flexor muscles inside and around the carpal tunnel; reducing compression of the underlying medium nerve and blood vessels.


Strengthen the underused extensor muscles which helps to counteract the compressive forces of the flexor muscles on the carpal tunnel.

Once preventative measures are implemented, carpal tunnel syndrome and its effects will be greatly reduced. Take the appropriate steps today to keep yourself healthy and carpal tunnel free. If your employer will not do it for you, do it yourself. Implement the steps listed above and you will keep yourself from becoming just another carpal tunnel statistic. It's your choice – your health is in your hands!

{ Comments are closed }