Hand Pain and Computer Keyboards

When you touch a keyboard do you have pain in your fingers / hands or arms? Do you feel, if you have to spend one more minute keying on a computer you will scream? Do you feel alone in your pain? If you answered yes to any of these questions, read on.

Typing on a keyboard is a repetitive action which dries up the fluid inside your hands. After years of typing the inside of your hands look like and start feeling like a rotten apple. The more you type on a keyboard or use your hands in any capacity the worse this gets.

Many people go to occupational therapy or hand therapy and this can relieve their hand pain. There are many people who do not have their hand pain treated by therapy. Their hands have rotted on the inside and only surgery or complete hand rest will resolve the problem.

I discovered years ago, after my numerous hand surgeries / hand therapies something by accident. I placed a pad underneath my keyboard. Itave my hands instant relief from pain when typing on a keyboard.

It cushioned my hands and now I can type on a keyboard comfortably. Without it I am in extreme pain. This remarkable pad can help you too. Why suffer in pain everyday?

Thank you for reading my article. Please feel free to read my other numerous articles.

Copyright 2006 Linda E. Meckler

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Doctor – What Can I Do About Carpal Tunnel Syndrome?

Carpal tunnel syndrome occurs when the median nerve, one of the major nerves that provides innervation to the hand, is pinched in the carpal tunnel. The carpal tunnel is a narrow space on the palm side of the wrist. The “floor” of the tunnel is formed by the wrist bones; the roof is created by a tough piece of tissue called the flexor retinaculum. If the carpal tunnel opening becomes constricted for whatever reason, then pressure is exerted on the median nerve. The patient will develop symptoms such as burning, numbness, and tingling in the hand involving mostly the thumb, index, third, and part of the fourth fingers. If the pressure continues without adequate treatment, then the ability to use those fingers to grip will also worsen.

The carpal tunnel can be narrowed as a result of trauma, edema (fluid build-up as occurs during pregnancy), repetitive motion, thyroid disease, acromegaly (growth hormone excess), gout, and various forms of arthritis (rheumatoid arthritis is the most common).

The diagnosis is suspected by taking a careful history. Further corroboration is established through a careful physical examination by a skilled clinician. Nerve conductions tests are also helpful for confirmation.

The initial treatment may consist of splinting as well as anti-inflammatory medications. Rest- staying away from keyboard work if this is what welcomed it on in the first place – is mandatory.

If symptoms persist, then a corticosteroid injection into the carpal tunnel using ultrasound needle guidance is a good option. Data indicates that this procedure may be very helpful in alleviating the symptoms. In the past, patients who did not respond to injection and splinting were probably considered candidates for surgery.

A new technique may make this approach obsolete.

Percutaneous needle release using ultrasound guidance is a minimally invasive approach. Using local anesthetic with ultrasound guidance, a small needle is inserted and fluid is injected at the same time to shred the fibers of the flexor retinaculum, the tough band of tissue that forms the roof of the carpal tunnel. With repeated movements of the needle and further hydrodissection with fluid, the retinaculum weakens and the physician is able to gently break the retinaculum. A splint is applied and the patient is back to normal activities the next day.

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Carpal Tunnel Syndrome

Introduction

Carpal tunnel syndrome (CTS) as some other similar diseases belong 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 movements (prolong repetitive trauma), which result in swelling, tenderness and pain.

Carpal tunnel syndrome occurs mostly in middle-aged women, who does repetitive labor work (eg typing) and mostly in dominant hand. It is also often seen in production and manufacturing workplaces (with repetitive activities such as cutting meat, dressing poultry and assembling automobiles). The condition is very common among musicians, who play string instruments and piano. During last 10-15 years people can get this problem as a result of extensive computer work (computer manufacturers now use warning labels to alert consumers that keyboard use may increase the risk of CTS). This is second most common (after lower back pain) for both males and female reason for seeking for medical attention. According to recent studies, around 1% of population sufferers from CTS. Statistics from the National Center for Health indicate that 2.4 million visits were made to physicians in 1999 because of CTS, of which 1 million were made to orthopedic surgeons. American Academy of Orthopedic Surgeons (AAOS) published data, that approximately 366,000 CTS surgeries were performed in 1999, a 300% increase from 1991.

The carpal tunnel is a narrow tunnel on the inner surface of the wrist where tendons for flexing muscles of the digits travel. It bordered anterioly by transverse carpal ligament, medially by pisiform bone and hook of hamate bone, laterally by the tuberculle of trapezium bone and posterioly by the carpals. Along with these muscles lie medium nerve, which innervate the skin on palmar surface of the palm as well as palmar surfaces of 1,2,3 and half of 4th finger. When a person does repetitive and long (for hours) work with his wrist or fingers, the tendons become inflamed, which causes their swapping and compression of the median nerve. The same symptoms may occur after wrist trauma (eg Colles fracture – fall on extended wrist) or when one of the wrist bones (lunate) displaced (subluxation) and compress medium nerve. This may also occur with osteoarthritis of the wrist, at the last trimester of pregnancy, with hypothyroidism or acromegaly. This is so-called carpal tunnel syndrome.

Symptoms

People usually complain about numbness, tingling or pain in their hands along the median nerve distribution. The symptoms mostly occur at night and aggravate with repetitive hand motion. Thenar atrophy may also be seen. Careful questioning may determine, that little finger is spared (distribution of median nerve). Without treatment hand muscles deteriorate and lose their ability to grip. CTS sufferers may become permanently disabled if they ignore the symptoms.

Diagnosis

Diagnosis is made based on clinical symptoms. Tapping over carpal tunnel reproducing pain within median nerve distribution (positive Tinel symptom). Passive maximal flexion of the wrist for 1 minute cause tingling along median nerve distribution (positive Phalen symptom). Boston questionnaire may be useful to evaluate symptoms of CTS.
American Association of Orthopedic surgeons also recommend wrist X-ray to rule out other things.

Differential diagnosis

There are several similar to CTS conditions. One of them is De Quervian's disease. This problem is usually seen in people who does repetitive forceful sentences together with ulnar deviation. Eg wrist in playing tennis (squash) or repetitive use thumb in work-related situations. Pain localized to the radial aspect of the wrist (inflammation of the tendons of the thumb muscles).

Treatment

The earlier time of diagnosis and treatment will benefit in shorter duration of treatment and in treatment cost.

Initial treatment includes include immobilization, ice packs and non-steroidal anti-inflammatory drugs.

Wrist splints and braces used for immobilization. Wrist splints stabilize the wrist in neutral position, protecting the nerve from being compressed, take the inflammation down. It usually take from 6 to 8 weeks.

Surgery performed in the most severe cases, in order to enlarge the Carpal Tunnel and repair ligaments

Physical therapy is the corner stone in managing CTS. The goal is to avoid the surgery, and in most cases we can do this. Physical therapy includes combine manual therapy along with special modalities, which provide reduction of swelling and inflammation as well as relief pain and other symptoms of carpal tunnel syndrome.
Our experience extends more then 30 years working with string musicians and pianists. Perform the 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 CTS and speed up process of healing. According to our data, we found so-called cold laser is most useful among different modalities.
Laser (Light amplification by stimulated emission of radiation) was produced in the previous century and first experimental applications of low-level laser therapy (LLLT) were reported in 1968, when researchers used ruby ​​and argon lasers on non-healing or slow-to- heal ulcers. Later research substantiated the efficiency of laser treatment to accelerate the healing of wounds, attenuate pain, and reduce tissue inflammation in both humans and animals. One of the human body's reactions to the soft tissue trauma is to “splint” the injury with edema, which is accumulation of the fluid in tissue spaces or cell interstices, causing a swelling. This swelling advances excessive movement of the damaged tissue and results in secondary pain (primary pain is from actual trauma itself). Laser with special wavelengths (820-840 nanometers) have an extremely low absorption rate in human tissue, so allowing deep penetration of laser light. Low-level laser (LLLT) therapy first targets the lymphatic system, because it contains the fluid balance in the body and also improves reabsorbtion of the edema. With LLLT, waving is reduced, allowing movement to return to the treated area.

Evaluation

Subjectively patient will have decreed pain, paresthesia, objectively it'll be increase strength of thenar muscles (electromyography studies), negative Tinel and Phalen signs.

Prevention

Prevention is the corner stone in CTS. Educational programs for patients as well as for employees and employers can help to avoid development of this particular problem. It may be postural education, work site modification, wrist supports for keyboard along with exercises for upper extremity (hand, forearm, shoulder) and neck. Exercises like flexion-extension, rotation and stretchening will provide adequate blood supply and get relief for tensile muscle and tendons. This should help to avoid the development of CTS or speed up the treatment of the condition.

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RSI & Carpal Tunnel Syndrome – Natural Ways for Relieving the Pain

As more and more people become reliant on computers during their day to day routine, so has there been an increase in RSI (repetitive strain defects) such as Carpel Tunnel Syndrome. Many people who suffer from this chronically painful and sometimes debilitating injuries are now turning to alternative methods of treatment including looking for a safe and natural pain relief.

The problems that many company's face because of carpal tunnel syndrome is that it lowers the productivity of its staff and goes along way to company's losing large amounts of work time and the expenses incurred in claims being made by employees each year.

The first signs that some one may possibly be suffering from RSI is that they usually have a burning, tingling or itching numbness in the palm of their hand and the fingers. This especially seems to affect the thumb, index and middle fingers of a person's hand. The usual treatment for such an injury is by the taking of anti-inflammatory drugs such as aspirin, ibuprofen and any other over the counter non-prescription pain relievers that are available. However, because of the side affects that now seems to be associated with the long term ingestion of such medication, people are now looking for a more natural alternative.

One such alternative is a spray, which will help to alleviate the pain that you feel. It works by centering on the bodies electrical pathways which send messages to the brain informing of the pain. Really it works in much the same way as acupuncture, but without the needles, and because it is made only with natural ingredients you will find that it has no side effects. It also means that you do not have to visit the doctor as it is always close at hand for use when required.

So if you are looking for an alternative to the usual over the counter drugs that are available, then you could look no further than by visiting a Chinese medicine shop or one of the many alternative therapy / health foods shops that are open. You can even purchase such products over the internet.

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Relief From Carpal Tunnel Syndrome – Non-Surgical Options Prove Promising

Carpal tunnel syndrome (CTS) is one of the most commonly reported work-related disorders in Dallas, Houston, through Texas, and across the United States. Although studies are still out, those most affected seem to be employees with jobs that require long-term repetitive movements, particularly those working with small hand tools or using computer keyboards on a regular basis.

Women are more likely to be diagnosed with CTS than men, and although it is highly suspect many young people suffer from the condition, those between the ages of forty and sixty are the most commonly diagnosed. Those with health insurance are also more likely to be rented.

CTS is a painful syndrome caused by pressure on the median nerve of the wrist, which runs through a passageway called the carpal tunnel. This syndrome affects the musculoskeletal structures of the upper extremity, and often results in pain, tingling, numbness, and weakness in the hands and / or wrist. Further symptoms include increased tingling or pain at night, a feeling of helplessness or weakness in the fingers, reduced ability to squeeze objects, loss of strength in the muscles at the base of the hand, and shooting pain up the arm, sometimes as far as the shoulder. In several cases, partial paralysis may occur.

It's been difficult to diagnose in the past, and therefore difficult for many in Texas and across the US to get treatment covered by individual health insurance. Cities like Austin, Houston and Dallas, though, now have more easily accessible pain centers, which specialize in diagnosing the syndrome through physical examinations and specialized scans, like MRIs.

CTS is garnering more attention in the medical and business communities in Texas due to its ability to incapacitate valuable workers, not to mention the pain and suffering it causes.

“It's a tough call,” sighed Mike * after a long day. “I hurt all the time now. I have to start considering surgery or something … otherwise, I'm not going to be able to work.”

Mike was diagnosed with CTS several months ago, and is increasingly worried about his ability to maintain his income as a self-employed production artist. “I do not have health insurance, so if I can get out of doing the surgery, I will. It looks so drastic anyway.”

The trouble with carpal tunnel syndrome is that the longer the condition goes untreated, the higher the chances of permanent damage. And like any disease, CTS is statistically less likely to be diagnosed and treated without health insurance coverage. Mike's story is not particularly rare. Over 25% of people in Texas went uninsured in 2005, far exceeding the national average of 15.9%. Rates are higher for the self-employed. What this translates into is 46.6 million Americans going without health insurance, 5.4 million more than in 2001-the recession year. Mike can not afford treatment, but he can not afford not to get treated, either.

Fortunately, there are less expensive options than surgery, and Texas offers a wide variety of choices, particularly in urban centers like Austin, Dallas and Houston. Pain centers specializing in carpal tunnel syndrome are excellent resources.

The first step, of course, is reducing the symptoms of the condition in hopes that, with time, those symptoms may be eliminated. These are free or low-cost measures that do not require individual health insurance policies. High caffeine, tobacco, and alcohol intake are contributing factors; those suspecting they have CTS should eliminate or reduce these as much as possible. Food allergies may exacerbate, or even cause, some of these symptoms as well, and common triggers include dairy, canola oil, and wheat / gluten products.

Some health practitioners believe dehydration also aggravates the problem. The earliest stages of dehydration do not exhibit immediately recognizable signs, and mild dehydration may only cause headaches or fatigue. Many practitioners in Texas predict Americans-with busy lifestyles, caffeine wines, and high stress-go slightly dehydrated on a daily basis. Dehydration impairs body functions, including the ability to supply proper nourishment to the extremities, which, of course, only makes CTS worse. Upping healthy fluid intake alone may reduce the severity of the disease.

Other symptom-reducing measures include stretching or flexing the hands, wrists, and arms before and during repetitive movements, reducing such movements to a bare minimum, using a wrist splint for four to six weeks, modifying tasks to reduce pressure on the wrists, and , whenever possible, using CTS-friendly equipment, such as wrist rests, and adjustable keyboards, tables, and chairs. A study of library managers conducted at Texas A & M found promising results for preventing or reducing symptoms of the condition after modifying work surfaces.

Nutrition is also of utmost importance. In fact, some in the medical community believe carpal tunnel syndrome is actually caused by a deficiency of B-6, made worse by repetitive movement. Positive results have been achieved for those in Texas and across the United States by administrating 100mg of B-6 daily. Other dietary recommendations include taking a high-quality multi-vitamin-which should include antioxidant vitamins A, C, E, and D, and the trace minerals magnesium, calcium, zinc, and selenium. Omega-3 fatty acids, found in fish oils, have been shown to reduce inflammation associated with CTS, as has Methylsulfonylmethane (MSM) and Resveratrol (from red wine).

Green tea, milk thistle, bromelain, turmeric, and cat's claw are excellent herbs for reducing symptoms associated with CTS. Applying a hot castor oil pack for one to five hours at a time may also reduce pain and inflammation.

One of the most promising, non-surgical treatments for CTS available today is acupuncture, an ancient form of Chinese medicine dating back thousands of years. The National Institutes of Health reported promising results for treating CTS with acupuncture as early as ten years ago, and the community of qualified Chinese medical practitioners-who undergo at least four years of intensive training in Chinese medicine-have long attested to its efficiency. Acupuncture is believed to help restore normal nerve function and provide long-term relief of pain associated with this, and other chronic inflammatory syndromes. Common forms of acupuncture treatment include low-beam laser acupuncture, often accompanied by electrical stimulation (a painless administration of low-intensity current).

Finally, an injection of corticosteroid in the wrist may provide temporary relief of pain without surgery for those with moderate symptoms. Dr. Shawn Marshall of the University of Ottawa (Canada) found twelve published studies that confirmed a single injection of the steroid was, on average, more affective than a placebo for relieving pain. Concerns in the medical community over use of the shot have surrounded long-term damage to the nerves. It's still controversial but, at the very least, practiceers recommend only short-term usage, and not to repeat the injection if it is ineffective the first time. Over the long-term, oral anti-inflammatory medications, such as ibuprofen, and using wrist splints, may be just as effective.

If you suspect that you may be afflicted with carpal tunnel syndrome, do not be afraid to check it out with a qualified practitioner. Texas abounds with pain centers, acupuncturists, and other qualified physicians with a growing knowledge of the condition and the ability to help. If it's eaten early, the syndrome is reversible, and, with the proper assumptions and dietary modifications, may never return.

How you treat and maintain your body when you're young will certainly affect your health as you age, and often your wallet. If you're a young individual who tries to keep informed and maintain a healthy condition and lifestyle, you should take a look at the revolutionary, comprehensive and highly-affordable individual health insurance solutions created by Precedent specifically for you. Visit our website, [http://www.precedent.com], for more information. We offer a unique and innovative suite of individual health insurance solutions, including highly-competitive HSA-qualified plans, and an unparallel “real time” application and acceptance process.

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How Do You Treat Carpal Tunnel Syndrome?

Once the diagnosis of carpal tunnel syndrome has been established and underlying diseases associated with the condition have been treated with, then it is time to treat the condition.

Medication such as acetaminophen and non-steroidal anti-inflammatory drugs can be used for symptom relief. Splinting the wrist, especially at night, helps keep the wrist straight during the night and thus decrees the pressure on the median nerve. These splints, which are available in your rheumatologist's office or at many pharmacies, may relay symptoms, especially in milder cases.

A cortisone injection into the carpal tunnel area is often helpful in relieving symptoms for weeks to months and can be repeated. Injections should be done using ultrasound guidance. If there is an underlying disease, such as hypothyroidism (under active thyroid) or rheumatoid arthritis, causing the carpal tunnel syndrome, then treatment of the specific disease may also relieve symptoms.

Carpal tunnel syndrome occurring during pregnancy is often treated with splints and occasional diuretics. These drugs should be used sparingly. Carpal tunnel symptoms usually resolve after delivery.

When the above measures fail to alleviate symptoms, surgical opening of the tunnel to relieve the pressure on the median nerve, known as a carpal tunnel release, is probably indicated. In severe cases, early surgery may be considered. If there is significant muscle atrophy, surgical release is indicated over more conservative measures. However, if the carpal tunnel syndrome is very severe and has been present a long time, even surgery may not work. The surgery may be an open surgical procedure or an endoscopic procedure, and can be often done on an outpatient basis.

A new procedure may make surgical correction of carpal tunnel syndrome unnecessary. Percutaneous needle carpal tunnel release involves the use of a tiny needle that is inserted using local anesthetic and ultrasound guidance. The needle is placed in the flexor retinaculum, the tough piece of fibrous tissue that forms the roof of the carpal tunnel. The flexor retinaculum is pierced a number of times while at the same time, small amounts of fluid are injected to spread the fibers of the retinaculum, in essence, weakening the retinaculum. At the bend of the procedure, the patient's wrist is gently bent and the weakened retinaculum breaks open. A splint is applied and the patient may resume normal activities the next day.

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Carpal Tunnel FAQ

What is Carpal Tunnel?

Carpal tunnel and carpal tunnel syndrome (otherwise know as CTS) is an injury or disease process caused by a pinched or impingement of the nerve (s) in the wrist, resulting in pain and numbness in the thumb, finger (s) and muscle weakness of the hand area.

The name “carpal tunnel” receives its name from the bones in the wrist, called carpals, which form a “tunnel” through which the nerves pass through. Pain, tingling and numbness as well as other hand and wrist problems is known as CTS.

What are the Signs of CTS?

Possible signs and symptoms:

o Pain and / or tingling in one or both hands or fingers, frequently worse during activity or at night

o Feeling of weakness in the fingers, difficulty to squeeze or hold things

o Sensation that fingers are swollen even though little or no swelling is showing

o Loss of strength in gripping or carrying items

o Pain shooting from the hand up the arm as far as the neck or shoulder

It is important, if you believe you are suffering from CTS, to consult a qualified physician and health professionals for treatment options. Not everyone who has carpal tunnel syndrome experiences the condition at the same level, and a treatment that is suitable for one person may not be necessary for another.

What are the causes of CTS pain?

The wrist area is filled with tendons (attaching muscle to bone) that control finger and thumb movement. Tasks requiring highly repetitive and stressful movements of the wrist can cause pinching of the nerve (s) resulting in swelling and inflammation around the tendons, producing CTSl.

Injuries to the neck can damage nerves to the hands and wrists (known as “Double Crush Syndrome”) which also can cause CTS. This is common in “whiplash” injuries such as auto accidents.

Because pathway of the nerves to the hands connect all the way up to neck, any pinching or impingement at the neck (the first “crush”) or along this pathway can actually effect recovery and healing. Such impingement of these nerves can make them more susceptible or vulnerable to carpal tunnel syndrome (the second “crush”).

The double crush phenomenon and is broadly referenced in the scientific and medical research as a consistent finding in patients with CTS and can explain why some patients do not recover with care.

Often times in a sudden injury a patients can suffer double crush syndrome to the neck area. If the patient suffering from double crush syndrome and is just treated for carpal tunnel syndrome only, often times the treatment is not only ineffective, but the symptoms can get worse.

Such advanced stages can become quite serious, involving a loss of sensation, muscle deterioration, and permanent loss of function. It is important for the patient to be check for this syndrome.

Other possible causes include late stage pregnancy, disease processes, or even poor posture. Poor posture problems in particular are often overlooked when patients seek treatment.

What is the Therapy for CTS?

Many doctors and health professionals have access to different types of treatment for carpal tunnel syndrome. Treatments choices range from simple pain relief to long term active patient care. Possible methods of treatment can include rehabilitation, carpal tunnel wrist brace, traction, exercises, stretches, soft tissue massage, medication, injections, physical therapy, chiropractic, acupuncture or other types of care. In advance cases surgery can become an option.

As with any other health condition, it is very important that you talk with your doctor or other qualified health professional about possible carpal tunnel treatment or any other alternative care that he or she can recommend.

Regardless of the treatment, it is important that the carpal tunnel sufferer maintain good communication with their doctor or health professionals on treatment progress. As the patient improves under care, outside care and activities also need to be reviewed and addressed.

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Common Sense Treatment For Carpal Tunnel

Carpal tunnel is an inflammation of a nerve in the hand called the median nerve. The nerve passes through the wrist in a small compartment called the carpal tunnel. If the pressure inside the tunnel increases the nerve reacts by becoming inflamed. Pressure increases can be caused by inflammation of the forearm tendons that also pass through the tunnel or increases in fluid pressure from fluid retention such as in pregnancy.

I have treated many cases of carpal tunnel in my practice and many patients make three big mistakes that really adversely affect their prognosis.

Mistake Number One: Get a Proper Diagnosis

There are a number of conditions that cause hand pain and numbness. For example there is another nerve can not become irritated in the little finger side of the hand called the ulnar nerve. If you've ever stuck the “funny bone” of your elbow what you've felt is the ulnar nerve. Another condition causes pain and swelling in the thumb tendons located in the wrist area. Many times people come to me thinking they have carpal tunnel when in reality they have a different condition. If they attempt to correct it themselves they can make the condition worse. Getting a diagnosis from a competent licensed health care practitioner will go a long way in healing.

Mistake Number Two: Get Treatment Early

This sounds simple but it is surprising how many people wait until the later stages of the disease until getting treatment. They try to wait out the disease in hopes it will resolve on its own. Occidentally it does but many times it continues to progress until it becomes a severe problem that requires a good deal of care.

One of the first signs of carpal tunnel is night numbness. This is a numbness that wakes you up at night and is not affected by changes in position. The numbness is generally in the thumb and first three fingers. If treatment is started during this stage the prognosis is good and many times little treatment is needed. If the problem progresses to constant numbness or pain, more treatment is generally needed. If the problem becomes severe with muscle weakness or wasting and constant pain or numbness then there is less of a chance for success with non-medical intervention.

Mistake Number Three: Eliminate the Cause

This seems like common sense, but many busy practitioners often do not have time to examine a patient's workstation ergonomically or question a patient about things that could have caused the problem. Many times I have seen people have several episodes of carpal tunnel largely because they never eliminated the cause in the first place. For example, there is a coworker of mine who just had several steroid injections over a period of several months for carpal tunnel and elbow tendonitis. I took one look at his workstation and was amazed that he did not have these problems sooner. No one had talked to him about changing his workstation or even mentioned it through his treatment.

Other Mistakes

Almost every time I go to the grocery store I see people working at the checkout wearing carpal tunnel braces. These are called cock-up splints or night splints. The reason they are called night splints is because they are only to be worn at night. The idea is that carpal tunnel is an inflammatory process and the infection tends to build up at night, which is one reason there is night numbness. Also, the splint has a plastic or metal piece embedded in it that holds the wrist in a position to decrease the pressure in the tunnel. Putting stress on the area by working and performing repetitive movements works to increase the pressure in the area.

What You Can Do

What can you do if you have been given a diagnosis of carpal tunnel? There are a number of non-medical ways to treat carpal tunnel. Exercises such as wrist stretches help to reduce tendonitis of the wrist flexor tendons. Certain nutrients have also been found to be helpful. These include:

Vitamin B6 – up to 300 mg per day initially for the first 3 months then decrease the dose to 100 mg.

Magnesium – 250 mg per day. Nerve problems like carpal tunnel are a sign of magnesium deficiency.

Natural Anti-inflammatory substances such as:

Bioflavinoids

Tumeric

Ginger

Boswellia Serrata

Trypsin

Chymotrypsin

Many of the above substances can be found in the local health food store.

Other effective treatments include ultrasound. I use ultrasound in nearly every carpal tunnel case and have found it to be extremely effective. Electrical stimulation such as concurrent current may also help to reduce inflation. Alternative modalities such as chiropractic adjustments and acupuncture have also been found to be effective.

Lastly, really getting at the cause and working to eliminate it will help you to heal and avoid future episodes. If you do a lot of keyboarding it is helpful to adjust your seat so that your feet are flat on the floor, elbows close to your sides, and wrists as straight as possible. One of the worst positions is keyboarding with your wrists bent at the sides. Technically this position is called ulnar deviation and becomes worse as the elbows move sideways away from your body. If you use arm rests to be careful they are not too far apart.

Carpal tunnel can be a serious problem and in some cases surgery or steroid injections are the only options left. However, if you follow the above guidelines you will do your best to avoid a costly and expensive procedure.

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Carpal Tunnel Syndrome Exercises Equal Relief

Carpal tunnel syndrome is a painful condition, with symptoms ranging from numbness, tingling and paresthesia (pins and needles) in the thumb, index and middle fingers. Not all of the listed symptoms have to occur simultanously and can vary from week to week. Severe cases of carpal tunnel are characterized by wrist inflammation and swelling and muscle wasting in the hand, especially the base of the thumb (Thenar eminence).

Carpal tunnel syndrome in most cases is caused by a muscle imbalance between the flexors, extensors, radial and ulnar deviators and supinator and pronator muscles in the hand and forearm that extremely leads to median nerve entrapment at the wrist junction. The entrapment occurs as both weak and strong muscles pull at the bones in a tug-of-war fashion, causing the bones to shift towards the stronger muscle side and resulting in the shifting and misalignment of the bones, which in turn compress the median nerve and other surrounding soft tissues and blood vessels.

It is simply that the weaker stabilizing muscles can no longer do their job and lose the battle as the stronger muscles tighten down further and further and compress under structures. The condition can be exceedingly painful, and it is often associated with decreased strength and coordination in the hand. Although numerous treatments exist, such as cortisone injections and surgery, the most effective are those that address the underlying muscle imbalance that drives the condition.

During an initial doctor visit, patients may be prescribed non-steroidal anti-inflammatory drugs (NSAIDS) to reduce swelling and ease pain. They may also be advised to refrain from movements that place undue pressure on the affected area or wear a brace, which is fine but at nighttime only as daytime use increases the existing muscle imbalance by reducing stimulation and activity to the already weak and imbalanced extensor muscles . However, these are generally short-term treatments intended to provide relief of acute symptoms.

Effective relief and long-term treatment for carpal tunnel syndrome often comes in the form of hand and forearm exercises and stretches that promote muscle balance around the median nerve. These exercises are designed to promote greater equality in muscle strength and length in the wrist and to bolster trapped nerves and tendons. Many occupational and physical therapists used nerve and tendon “gliding” exercises in the early stages of the illness, but fail to take it the next step, which is to create overall balance between all the agonist and antagonist muscle groups in the hand and forearm , the key to fast, effective relief.

Research supports the use of exercises that involve strengthening the extensor muscles and stretching the flexor muscles and tendons in the hand and forearm. The goal is to provide overall balance and stability to the muscles, which in turn provides increased joint integrity and the reduction of median nerve compression.

By eliminating the causative factors of median nerve compression through effective stretch and exercise therapy, the injury simply goes away!

Be sure to consult with your physician prior to beginning an exercise or therapy program.

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What’s The Best Way To Treat Osteoarthritis Of The Hand? Do The Europeans Know Something We Don’t?

Symptomatic osteoarthritis (OA) of the hand affects 20% of those people older than 55 years and has the potential for significantly affecting activities of daily living. Interference with grip and fine precision pinch and dissatisfaction with cosmetic appearance are major concerns.

Current evidence for the management of hand OA is currently based on either expert opinion or what appears to be effective for OA affecting other joints. However, the small size and accessibility of hand joints allow a different range of interventions than in large joint OA.

The European League Against Rheumatism (EULAR) is the American equivalent of the American College of Rheumatology. They formulated guidelines for OA of the hand at their annual meeting in June 2006.

The 11 recommendations were as follows:

o Optimal management of hand OA requires a combination of nonpharmacologic and pharmacologic (non drug and drug) treatment modalities individualized for each patient.

o Therapy of hand OA should be individualized based on the localization of OA; risk factors (age, sex, adverse mechanical factors); type of OA (nodal, erosive, traumatic); presence of inflammation; severity of structural change; level of pain, disability and restriction of quality of life; comorbidity (other concurrent diseases) and comedication (other concurrent medicines) (including OA at other sites); and patient desires and expectations.

o All patients with hand OA should receive education concern joint protection (how to avoid adverse mechanical factors) together with an exercise regimen (involving both range of motion and strengthening exercises).

o Local application of heat (with paraffin wax or hot pack), especially before exercise, and ultrasound are helpful.

o Splints are recommended for thumb base OA, as well as orthoses to prevent or correct lateral angulation and flexion deformity.

o Local treatments are preferred over systemic treatments, especially for mild to moderate pain and when only a few joints are involved. Topical non-steroidal anti-inflammatory drugs (NSAIDs) and capsaicin are safe and effective.

o Because of its efficiency and safety, paracetamol (up to 4 g / day) is the oral analgesic of first choice. It is the preferred long-term oral analgesic for patients who respond. (Paracetamol is an analgesic similar to acetaminophen).

o In patients who respond inadequately to paracetamol, oral NSAIDs should be used at the lowest effective dose and for the shortest duration, and the patient's requirements and response to therapy should be reevaluated periodically. Patients with increased gastrointestinal risk should use nonselective NSAIDs (eg, regular anti-inflammatory drugs like ibuprofen or naproxen) plus a gastroprotective (medicine to protect the stomach lining) agent or a selective Cox-2 inhibitor (eg., Drugs like Celebrebrex) . In patients with increased cardiovascular risk, Cox-2 specific inhibitors are contraindicated, and nonselective NSAIDs should be used with caution.

o Symptomatic Slow-Acting Drugs for Osteoarthritis (eg, glucoasamine, chondroitin sulphate, avocado soybean unsaponifiabetes, diacerhein, intra-articular hyaluronan) may offer symptomatic relief with low toxicity, but effect strains are small, suitable patients are not defined, and clinically relevant structure modification and pharmacacoeconomic benefits have not been established.

Intra-articular injection of long-acting corticosteroid (cortisone shots) is effective for painful flares of OA, especially at the trapeziometacarpal joint.

o Surgery, such as interposition arthroplasty, osteotomy, or arthrodesis, is effective for severe thumb base OA and should be considered in patients with marked pain and / or disability after failure of conservative treatments.

While these guidelines are useful, they are by no means comprehensive nor are they hard and fast rules.

In our clinic we have found many other types of therapy to be helpful. For instance, compressive driving gloves worn inside out so the seams are on the outside at night are helpful for reducing morning stiffness.

We advocate the regular use of the therapeutic paraffin baths.

Steroid injections are very useful but should be done using ultrasound guidance to ensure accuracy.

Symptomatic OA at the base of the thumb that does not respond to injection with glucocorticoids can be treated arthroscopically with debridement followed by an injection of a viscosupplement. (Wei N, Delauter SK, Beard SJ.) Arthroscopic debridement and viscosupplementation: a minimally invasive treatment for symptomatic osteoarthritis involving the base of the thumb J Clin Rheum 2002 Jun; 8 (3): 125-9.

Finally, the role of the hand therapist is key in maintaining functionality in patients.

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Could You Have Developed Arthritis in Your Hands? If So, Do You Know How to Treat It?

Arthritis is a condition which quite literally means inflamed joint. Usually in a joint, you have smooth, cartilage covered bones which move smoothly against each other when they move.

Arthritis generally occurs when those bones become worn down by the smooth surfaces becoming uneven and rubbing together. It is possible for arthritis to appear in any part of the body, although when it appears in the hands and the fingers, it is definitely more noticeable.

Arthritis in the Hands

Overall there are twenty seven bones in our hands and two bones which create the wrist. These include nine main ones and eight smaller ones. If arthritis does develop in the hands it can be extremely painful and often disabling. There are various different types of arthritis in the hand including osteoarthritis, post-traumatic arthritis and rheumatoid arthritis

Rheumatoid arthritis causes problems for the cells which line and lubricate the joints. It can affect the whole body and it can often affect several joints at the same time on both sides of the body. The lining of the joint generally becomes swollen and inflamed, and it typically erodes the cartilage and the bone.

It is also possible for the swollen tissue to stretch the surrounding ligaments which hold the bones together. This usually ends with deformity and instability of the joints. It is also possible in some cases, for the inflammation to spread to the tendons which are used to connect the muscles to the bones. This often ends with ruptured tendons. When a person gets Rheumatoid arthritis in the hand, it is usually most common in either the finger knuckles or the wrist.

The symptoms of Rheumatoid arthritis in the hand include:

Cracking sounds during movement

A little, soft lump on the back of the hand which moves with the tendons which straighten the fingers.

Unstable joints within the fingers or thumb

Any stiffness or swilling within the hand

The above are just some of the symptoms which show once you have arthritis. If you do notice any symptoms you should consult your doctor immediately.

Treatment for Rheumatoid Arthritis

The treatment designed for Rheumatoid Arthritis is aimed towards relieving pain and restoring the hands function. Usually medications are given for arthritis in the hands, which help to reduce any inflammation and to slow the arthritis down so that it does not have much chance to progress. Some treatments include oral steroids and even cortisone injections.

In some cases your physician may suggest that you see a hand therapist in order to exercise the hand as well as providing splints and advice on how you can relieve pain and the pressure on the hand, as well as protect your joints. There are also some devices which could really help with everyday life.

If the arthritis does get to the stage where the tendons rupture, you could find that you end up having trouble straightening or bending the fingers. If the problem is particularly severe, surgery may be the only option. Usually surgery includes removing inflamed joints and giving joint replacements. If the bones are damaged, parts of them may be removed.

The type of surgery will vary depending upon how severe the problem is and where the problem is in the hand. A hand surgeon will be able to give you the best advice possible as to what surgery you do need.

Overall there is no cure for this kind of arthritis, but there are treatments available which can help you to control the condition. It is always better to treat the condition as early as possible in order to stop any permanent deformities and problems from occurring.

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Carpal Tunnel Syndrome

Carpal tunnel syndrome is an entrapment syndrome of the median nerve at the wrist level and can result from many disease conditions. If you have been diagnosed as having carpal tunnel syndrome it is important to exclude other conditions that can cause problems of the peripheral nerves specifically metabolic conditions such as diabetes. The common mechanical cause for initiating the symptoms is repetitive stress injury to the wrist.

When there is carpal tunnel syndrome, the patient usually has symptoms of pain, tingling and or numbness in the thumb, index finger, middle finger and half of the ring finger closer to the middle finger. Many patients however complain of numbness in all the fingers. If the patient has numbness also in the little finger and the ring finger this is an indication that the ulnar nerve is also involved. When there are symptoms in all the fingers, the involvement is not only localized to the median nerve.

The local pressure on the median nerve is usually from thickened and swollen flexor tendons that pass through the carpal tunnel under the ligament of the wrist called the flexor retinaculum. Inflammation of these flexor tendons makes the carpal tunnel tight allowing the tendons to press on the nerve. If the goal of the treatment is to decongest the carpal tunnel using local injections or surgery, the patient's symptoms may not be alleviated. Many patients continue to have symptoms with treatments that are directed only to the median nerve at the wrist level.
To avoid having surgery as the first line of choice, treatments must involve the flexor tendons that pass through the wrist putting pressure on the median nerve. Using the see-saw principle you will now understand that if the flexor tendons are the problem, their actions have been chronically unopposed by the presence of weak or lengthened extensor muscles on the back of the forearm.

Patients with carpal tunnel syndrome especially those who have symptoms also in the last 2 digits have associated spinal nerve root aging at multiple levels. When spinal nerve roots age or are subjected to sudden or insidious trauma, the muscles that they supply become shortened and tight. The most commonly injured nerve roots are C6 and C7 spinal nerve roots. Of all the muscles that these nerves supply, the muscles that will become weakened first are the muscles that are frequently subjected to lengthening contractions.

In the upper limb, the muscles that will weakened first are the posterior deltoid, latissimus dorsi and the triceps muscles. Since these large and powerful muscles are the first ones to be used in prolonging contractions in order to stabilize joints in most activities of daily living, when they become weaker, the smaller muscles of the forearm are used to stabilize the joints. The forearm extensor muscles arise from above the elbow joint and in the presence of weakness of the triceps, will be called into play to help the triceps in motions that require straightening the elbow.
The forearm extensor muscles are primarily used for lifting the wrist upward. When they become weak, the flexor muscles in the front of the forearm become tight and shortened due to the unopposed pull and will initiate not only the development of carpal tunnel syndrome but in maintaining the symptoms by continued pressure on the median nerve at the wrist level .

Therefore, conservative treatment of carpal tunnel syndrome treatment is more complicated than one might think of. To return optimal function to the posterior deltoid, triceps and latissimus dorsi muscles, the tightness and spasm in these muscles have to be released. To allow the strongest and largest muscle provided by the C6 and C7 roots, sometimes the latissimus dorsi, to function better release of muscle spasm and shortening within this muscle must be addressed. In addition, for this muscle to perform optimally, non-invasive electrical stimulation of the motor points with eToims, must involve the entire paraspinal muscles from neck to the lower back, scapular and upper limb muscles as well as muscles of the hip and pelvic girdle .
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The CAUSE of Carpal Tunnel Syndrome

Over the last decade and a half, carpal tunnel syndrome (CTS) became the # 2 surgery performed in the United States. It was the “buzz” phrase that captured headline news in the '90's. Graphic illustrations of people in pain adorned the newspapers and even Gary Trudeau creator of the Doonesbury cartoon series did two cartoons on the subject. OSHA, Occupational Safety and Health Association, set ergonomic standards for companies to help curb the epidemic of CTS. There has been so much research done on this disorder, and labeled a disease, (it is not) and it still surprises me that they do not know the cause of it. Today it is still an issue and a very expensive one, and a surgery I believe, is not necessary in most cases.

If you have these symptoms, does this mean you have carpal tunnel syndrome?

Maybe not!

Symptoms of carpal tunnel syndrome may include:

o loss of sense of touch

o tingling and numbness in your hand and fingers

o pain in your shoulder at night, pain in your elbow, or swelling in your wrist area

o loss of grip strength in your hand

o pain in your wrist when you have it stretched in an extreme position, such as bending your wrist pointing the fingers to the floor.

o dropping objects more often than usual

oa burning sensation in your wrist and hand area

o being unable to unscrew a jar lid

o more difficult to do tasks such as brushing your hair

The loss of your grip strength and not being able to use your hands without pain is a serious matter and should not be taken lightly. But, before you opt for an invasive procedure such as surgery, you may want to consider another alternative – A non-invasive approach with less down time in healing and dealing with the cause and not just the symptoms.

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is the entrapment and compression of the median nerve due to a structural and postural misalignment bought on by the overworked and over strained muscles of the upper body, arm, wrist and hand, which can lead to a muscle-strength problem.

oooAny previous neck injury or injury to the upper body can also further complicate symptoms and healing time.

oooAn additional component could be a systemic or a biochemical factor, which can bring on an inflammatory condition not involving repetitive movement.

Carpal tunnel syndrome causes numbness or tingling in your fingers or hand and may cause a pain from the wrist that seems to shoot into your forearm or palm. The pain may be worse at night. Carpal is from a Greek word that means “wrist” -and the carpal tunnel is just what it sounds like, a passageway or tunnel through your wrist that protects nerves and tendons. The median nerve, which affects feeling in your thumb and all your fingers except your little finger, passes through the carpal tunnel. When the tunnel becomes swollen, your median nerve is compressed. The key to an accurate diagnosis of carpal tunnel syndrome is that the little finger is not affected, because the median nerve is not connected to this finger.

Now that the definition has been said, lets discuss the cause of carpal tunnel syndrome.

A Healthy Body physically moves in space, in gravity, with daily stresses on the physical body. These stresses take the form of micro (small muscle movements) and macro (large muscle movements) and all normal. When it is subordinated to a higher degree of repetitive movements the risk factor increases for a musculoskeletal injury.

A Body that is overworked and over strained begins to weaker as fatigue, soreness, and pain develop in the musculature. Muscles that are becoming functionally weaker, and are feeling the brunt of the work, give out. Normal. Anatomically, when this occurs, the tendon attached to the muscle begins to feel the strain, and as it is attached to a bone, as tension increases, it may slowly begin to pull that bone / joint out of alignment. An inflammatory condition may develop called tendinitis. The result is a reduction in nerve conductivity to the muscle for normal function. And again, this is a normal course of events when you are healthy, and physically active. It is reversible.

The Unhealthy Body which is structurally misaligned, pain in the muscles, developing symptoms listed above, fatigued … and worn down, develops from years of neglect and lack of care.

Reason? Body Maintenance. Why? You were never taught how. You are a mechanical being moving parts that need to be oiled, lubed and grease, aligned and electrically sound. You perform mechanical maintenance on your car, why not your Body! It needs the same tender, loving care, so it will last longer. You can not throw it away or buy a new one when it falls apart. It is never too late to learn Body Maintenance. Learn how, and you can rid yourself of carpal tunnel pain without surgical intervention.

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Carpal Tunnel Syndrome – Stopping the Pain

Carpal tunnel syndrome is a nerve entrapment disorder that is associated with significant pain and functional impairment of the fingers and hand. It is also quite common for this condition to refer pain up the median nerve pathway into the elbow, shoulder, upper back and neck.

Caused by an imbalance of the muscles that open, close, deviate and rotate the hand, results in biomechanical dysfunction and a joint imbalance, affecting the median nerve at the wrist junction. Severe cases of carpal tunnel syndrome can lead to muscle atrophy and deterioration of the median nerve when left untreated. It is the cause of significant disability worldwide and a subject of growing research in the medical and physical therapy communities. With costs to treat this disorder surpassing 60 billion annually, a common sense treatment approach is being taken by both private and federal communities.

There are many pathways to muscle imbalance in the hand, and considerable research has examined the pressure system surrounding the carpal canal. This work has shown that people with carpal tunnel syndrome have markedly increased pressure in the carpal canal in the hand following minor movement in the wrist that involve repetitive and / or static wrist and finger flexion. The longer these types of activities are performed, the greater the muscle imbalance develops and the more severe the symptoms become. As the finger and wrist flexor muscles that close the hand become more developed than their opposition extensor muscles that open the hand, the stronger muscles cause the bones to shift in the direction due to the “pulling” action of the stronger muscles and results in the impingement of the structures between. In this case, the median nerve is impinged. As the median nerve and flexor tendons now have to glide past each other as the fingers and wrist flex and extend while being in a state of impingement, there is increased friction which irritates the tendons and nerve and causes inflammation and swelling of these tissues. The result of this pressure and secondary swapping is a further increase in edema inside the median nerve. (Swelling is often thought of as the “cause” of carpal tunnel, when in fact it is the “result” of being irritated due to its state of being impinged between the flexor tendons inside the carpal tunnel which has also been reduced in size due to the collapse / shifting of the carpal bones.)

This entrapment produces a variety of painful symptoms. Indeed, carpal tunnel syndrome is characterized by paresthesia (also known as a pins and needles), numbness, tingling and a lack of coordination of the fingers along with muscle degeneration if left untreated, but it may also include pain, stiffness, tenderness, and waving, and many people with the condition notice themselves assuming a ginger stance at the computer keyboard or workstation. As symptoms progress and worsen over time, carpal tunnel syndrome generally includes muscle wasting, diminished strength, and a serious loss of overall dexterity and coordination.

Although the disorder is significantly debilitating, effective treatments do exist. Those with the most scientific support target symptoms by restoring muscle balance in the hand. Most often a combination of strengthening and lengthening exercises combined with supporting equipment is enough to improve symptoms dramatically.

By addressing carpal tunnel with conservative modes of treatment (Flextend), people can usually avoid the high failure rates associated with treatments like cortisone injections and surgery. Always be sure to consult with your physician and be sure that you have received a precise diagnosis of your condition, but if you do not agree with your doctor, seek a second or third opinion.

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Carpal Tunnel Syndrome – Low Level Laser Approach

Introduction

A friend of mine, a dentist, came to me, numbness on her right hand as the chief complaint. That is a very specific injury to whatever who uses hand, especially the wrist, rhythmic and for a long time. It usually occurs in people who work as a dentist (like my friend), someone who works a lot using computer, or in Indonesia, during fast month, housewives suffer from Carpal Tunnel Syndrome (CTS) due to their repeated work of making “sambal “using” cobek “. Almost, CTS is one of ladies' disease.

Published data in Minnesota shows the ratio of CTS incidence among male: female = 5: 14. In Cipto Mangunkusumo Hospital, the number of CTS cases found was 238 in the year of 2001 and 149 cases in 2002. The patients' age ranges between 25 – 35 years old. In Washington, the chief complaint reported was tingling and pain.

Pathogenesis:

CTS is caused by impingement of the median nerve inside the carpal tunnel. As tension inside the tunnel increases, perineural edema occurs, and causes damage to the nerve. This event will release serotonin and prostaglandin, and adverse microcirculation. This is the mechanism which stimulate the pain.

Laser therapy:

I gave her diode laser (15 mW for 15 minutes) with trans-cutaneous application. The day after her first visit, she told me that after the treatment she felt an “uncomfortable sensation” in her injured hand. I decided to decrease the dosage of laser therapy to 10mW for 15 minutes. She felt comfortable with this regiment and could work as usual. Orthose also given to fixate the wrist at zero degree position.

Research

A research on CTS has been conducted at the Physical Medicine and Rehabilitation Department in Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The hypothesis was, “Application of plaque of Paris & Low Level Laser Therapy (LLLT) are more effective than plaster of Paris only for pain reduction in Carpal Tunnel Syndrome”. Is there any additional effect to plaster of Paris fixation by LLLT compared with fixation only in reducing Carpal Tunnel Syndrome pain? It was the question tried to be answered.

There were two groups, LLLT combined with plaster of Paris, and the other as control only using plaster of Paris.

The subjects were homogenous among those groups. It was conducted for a period of two weeks, and Visual Analog Scale (VAS) was used as an assessment for pain.

Conclusion: Application of plaque of Paris and Low Level Laser Therapy has an additional effect for pain reduction in comparison to plaster of Paris only

Discussion:

The effect of Low Level Laser Therapy as anti inflammatory and pain reliever worked in this case of CTS.

Acknowledgment:
This story is dedicated to Mrs. Hermina., A friend of mine who is such a beautiful dentist.

(Hi, Mrs Hermina, your visit to my office reminded me to share this kind of problem to others. Thank you)

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