Carpal Tunnel Syndrome

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Heavy computer use can lead to compression of the nerves in the carpal tunnel

Everyone worries about his or her health. Today, cancers and heart attacks are commonplace and randomly strike friends and relatives. Anyone who suddenly develops a tingling, shooting pain radiating down the left arm, severe enough to wake up the person in the night, cannot be blamed for thinking it is a heart attack!

But such symptoms are typical of carpal tunnel syndrome, a condition common during middle age.

The carpal tunnel is actually a narrow, rigid box-like area in the wrist which forms a passageway for the ligaments and nerves at the base of the hand. If the nerves are compressed as they pass through this canal, they respond to the pressure with pain, a tingling sensation and numbness. Sleeping with the wrist in a flexed position aggravates the problem and the sufferer often wakes up at night with a numbing pain in the arm that needs to be shaken for relief. If this occurs on the left side, it can be mistaken for a heart attack.

Eventually, as the compression progresses, the tingling decreases but is replaced by weakness of the fingers and obvious wasting of the thumb muscles. Grasping small objects, making a fist and distinguishing between hot and cold may be difficult.

Compression of the nerves in the carpal tunnel may occur as a result of —

A fracture or sprain of the wrist which disrupts the normal relationship between the various structures in that area

Repetitive stress injury as a result of continual movement of the wrist. People working as butchers, fishermen and tailors are particularly susceptible. Heavy computer use or typing for seven hours or more a day is also implicated

Diseases like diabetes and hypothyroidism (it may be the first symptom)

Fluid retention as a result of kidney or liver disease

Obesity and pregnancy

The symptoms are three times commoner in women than in men. This is because women have smaller carpal tunnels than men. However, the carpal tunnel syndrome is not seen in children even though their wrists are small as the structures are more pliable.

The diagnosis is made on the basis of the symptoms. The tingling sensation can be reproduced by tapping on the carpal tunnel area. The symptoms are aggravated if this is done with the wrist in a flexed position. If the diagnosis is uncertain then nerve conduction studies can be done.

Permanent damage to the entrapped median nerve can occur if the compression is not relieved sufficiently early.

Treatment involves the following —

Diagnosis and correction of any underlying metabolic disorders such as diabetes and hypothyroidism

Using a splint to maintain the wrist in a neutral position for two weeks

Using wrist supports while typing. Some computer keyboards are designed to prevent the carpal tunnel syndrome

Medications, especially the NSAID group (non-steroidal anti-inflammatory agents), can relieve pain and swelling. But they should be used only on a short-term basis

Vitamins, particularly pyridoxine (B6), can bring temporary relief.

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Injections — usually a combination of a steroid and local anaesthetic — can be given into the carpal tunnel

Surgery, open or laparoscopic, can be done to remove any compression from bands of bone or tissue. This is done if there is no improvement after six months of conservative treatment.

Physiotherapy provides sustained long-term relief without invasive procedures or medications. The exercises are simple and not time-consuming. Accrued benefit disappears within three days if the exercises are not continued.

Straighten the wrists and relax the fingers

Make tight fists with both hands

Bend the wrists down while keeping the fists. Hold for a count of five

Straighten the wrists and relax the fingers, again for a count of five

The exercise should be repeated 10 times. Finally, let your arms hang loosely at the sides and shake them for a few seconds. Many alternative treatments like acupuncture and massage have been tried. Studies, however, have not shown any proven benefits. Regular practice of yoga provides sustained and long-term relief.

In India, there is usually no compensation for work-related incapacitating injuries. Workers have to maintain their health to remain efficient and productive. Occupational carpal tunnel syndrome can be prevented by —

Providing frequent breaks to workers

Teaching them corrective exercises and stretching

Designing furniture ergonomically for the workplace so that the hands are kept in a natural position.

Unfortunately, even among the educated, blue-collar workers, regular exercise and prevention of injures is not taken very seriously until it is too late.

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Source:The Telegraph (Kolkata, India)

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