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Dr. Lipoff: Carpal Tunnel Syndrome: It's all in the Wrists
Hollywood, MD - 4/4/2013
By Dr. Jay Lipoff
“It was on my fifth birthday that Papa put his hand on my shoulder and said,” Remember, my son, if you ever need a helping hand, you’ll find one at the end of your arm.” – Sam Levenson
Everyone has heard of this problem in the wrists. According to the U.S. Department of Labor, Carpal Tunnel Syndrome (CTS) affects some five million Americans and causes almost 50 percent of the workplace injuries and lost production.
The type of workplace isn’t specific but it usually involves jobs with repetitive motions like: bagging groceries, hammering, computer work with regards to the keyboard and mouse, cleaning, sewing or knitting and the list goes on.
The wrist is very complicated in that there are eight small bones that make up a curved structure. The flexor retinaculum tendon passes over it and connects the sides like a roof. Underneath this ceiling are nerves, arteries, tendons and more, all trying to make their way through this tunnel.
Women may be more susceptible to CTS due to a smaller wrist size but the consistent finding is that the dominant hand usually starts to have symptoms first. Of course as we limit the affected hand’s use, the other one starts to get over-worked and can lead to symptoms in it too.
More common symptoms include pain or numbness in the fingers, loss of grip strength, a change in sensation in the hand, radiating pain up into the arm, forearm pain and swelling. Usually the Median nerve gets damaged and numbness will occur in the first three fingers, (thumb, pointer and middle).
Besides work there are some diseases and injuries that could cause CTS-like symptoms. Rheumatoid arthritis, hypothyroidism and diabetes can cause similar wrist symptoms. So can using a jack hammer because of the constant vibration.
Chronic sprains and arthritis can lead to degenerative changes in the wrist bones and form spurs, or calcium deposits, which further limit the amount of space within the tunnel. If the tunnel changes shape, something starts pressing on the structures within, tissues become inflamed, the area becomes compressed and you may start to notice pain and other symptoms.
A pinched nerve in the neck could also cause hand or finger pain. Orthopedic tests can determine what the source of pain is but sometimes doctors use nerve conduction velocity or electromyography tests. This is when they either use pads or put needles in your muscles and then provide some wonderful current to see if the signal gets there in the proper amount of time.
I had it done to my arms and legs to know what the needles felt like before I sent patients for this test and it wasn’t pleasant.
What can you do at home is make sure you don’t sleep with your wrists bent at night. I would also check to see if you wrists are straight when you type, read, play with your phone or game console. Repetitive motion and bad ergonomics can hurt the body over time.
There are splints to keep the patient’s wrist in sort of like a Spider Man web-shooting position, minus the 2 middle fingers, so your wrist is cocked backward slightly.
Stretches to the arm similar to the splinted position may also help relax forearm muscles. Heat also helps to ease any muscle tension in that area, but ice on the wrist could help if the area is inflamed.
A massage therapist can really loosen the forearm if what you are trying isn’t working well enough. Maybe even try doing things differently or take a break from your repetitious habits. Yoga has also been proven helpful to treat CTS symptoms.
We have patients perform some physical therapy exercises to strengthen any weak regions supporting the wrist. Sometimes adjusting the wrist can also make a difference because if the carpal bones are out of alignment they can change the dynamics of the carpal tunnel and cause nerve compression.
At the same time you could try some anti-inflammatory medications to reduce swelling in the tunnel and any nerve irritation. Always listen to your medical doctor before self-medicating. They may recommend some corticosteroids as well. Some studies have shown Vitamin B6 can also help reduce symptoms.
If none of that works or you have dealt with the pain for six months, then surgery may be an option but wait as long as you can. Surgery involves making an incision along the wrist to cut the carpal ligament and create more space for the nerves and blood vessels. Surgery should work but I have had patients who then developed scar tissue and ended up having surgery again.
After surgery, physical therapy is advised to help you heal and regain your movement and strength.
To avoid this altogether practice good biomechanics and alignment of your wrists while working. Maybe switch tasks or don’t do the same thing without a break or a stretch. Possibly you can split the task amongst co-workers or family members. Try to not sleep with your wrists bent and definitely be careful at the computer or with your phone.
Dr. Jay M. Lipoff is the owner of Back At Your Best Chiropractic & Physical Therapy, LLC, which is located in the Wildewood Shopping Center. Dr. Lipoff is also the author of “Back At Your Best; Balancing the Demands of Life With the Needs of Your Body.” It is available in book and Kindle format at Amazon, www.BAYBBook.com and at his office. This is his second edition.
He received his Bachelor of Science degree from Syracuse University in 1990, a Doctorate of Chiropractic (D.C.) from New York Chiropractic College (NYCC) in 1994 and he became a Certified Fitness Trainer (CFT) in 2005.
Dr. Lipoff is an Executive Board Member, International Chiropractic Association Council on Fitness and Sports Health Science; has a radio segment: Back At Your Best in 5 Minutes or Less, Co-Founder, Drug Free Training USA; Member, NY Strength-promoting the importance of physical conditioning; Board Member of Public Relations Committee, Maryland Chiropractic Association; has spoke on nationally broadcasted radio interviews, has articles in print and referenced in over 100 print papers, magazine and on websites, President, Wildewood Business Network-promoting better business relations and community outreach.
For more information, go to www.BackAtYourBest.com or find us on facebook or call 301-863-BEST (2378).
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