By Dr. Patricia Knott
I recently watched an old movie starring Sandra Dee and Bobby Darin. Sandra Dee actually wore a suit (skirt and top) along with heels to clean an apartment. My, how things have changed! Not only have we changed our approach to our work, but we have changed what work we approach.
More women work outside of the home in a variety of occupations. Some of these occupations contribute to a common condition in the workplace that leads to missed work days. It begins with a tingling in the hands and can eventually lead to surgery.
Carpal tunnel syndrome (CTS) has almost become a household term. It is the first thing considered when someone begins to experience numbness or tingling of the hands. Sometimes that is exactly what it is, but sometimes it may be something entirely different. What exactly is carpal tunnel syndrome, and what can be done about it?
The wrist bones are called the carpal bones. On the palm side of the wrist, a transverse carpal ligament attaches to the medial and lateral arching bones forming a narrow tunnel through which the median nerve and the tendons that flex your fingers must travel. If anything causes swelling or inflammation of these tissues, then the median nerve could become compressed and began to cause symptoms referred to as carpal tunnel syndrome.
Symptoms of CTS include intermittent numbness or tingling to the hand, specifically to the thumb, forefinger, middle finger, and the thumb side of the ring finger. The small finger is not involved though some patients in my experience will say that the symptoms seem to affect "the whole hand." It is especially annoying when driving, holding a telephone, or trying to sleep. Often the person will "shake out" their hands to rid them of the symptoms. This numbness/tingling may become more constant as the disease progresses.
Other symptoms may involve pain in the wrist radiating into the arms or into the hands and fingers, increasing with repetitive activity. Decreased grip strength occurs with inability to hold onto objects. In chronic cases, atrophy of the muscles at the base of the thumb may occur.
Many conditions are thought to cause an increased risk of CTS. People with hypothyroidism are at increased risk to develop this syndrome, as well as people with Diabetes Mellitus or other metabolic diseases that affect the nerves of the body. Pregnant or menopausal women are also at increased risk, but so are females in general. Females are three times more likely to develop CTS as men. The dominant hand is usually affected the most.
Though there is debate about whether repetitive activity such as computer keyboarding can increase risk for CTS versus tendonitis, some research has shown a possible link to CTS from overuse in jobs that require forceful, repetitive hand and wrist movement as well as forceful pinching and gripping. True, CTS is commonly seen in meat or fish packing plants or in workers using power tools such as jackhammers.
Diagnosis of CTS is usually made by the physician after taking a good history and performing an exam that will probably include an attempt to reproduce the symptoms by having the patient flex the wrists to place pressure on the median nerve or tapping the wrist at the area of the tunnel. He or she will want to test hand strength and sensation.
The physician may want to have the patient undergo an EMG/NCV (Electromyogram/Nerve conduction velocity) test to confirm the diagnosis and rule out other causes of similar symptoms such as pinched nerves from the neck. Other consultants will be brought in if the doctor suspects other medical problems are contributing to the symptoms.
Treatment early on may involve simply taking frequent breaks to rest the hands and using cold packs as needed for swelling. Most patients are treated by their physician with a combination of decreasing the amount of repetitive hand/wrist activity, wearing a resting hand splint at night, or using nonsteroidal anti-inflammatory drugs such as Aleve. He or she may order an injection of cortisone into the carpal tunnel to relieve inflammation or prescribe hand therapy.
If symptoms persist more than six months, your physician may recommend surgery to cut the ligament that presses on the median nerve. Though surgery results in marked improvement for most patients, some residual symptoms may continue to occur. Limitation of forceful, repetitive activity is associated with better satisfaction after surgery.
Preventative measures-frequent breaks to rest/stretch the fingers and hands, use of fatter ink pens to write with, or practice of good posture and hand position-are smart to use but are not a guarantee to prevent CTS.
If you are experiencing symptoms of CTS that interfere with your daily activities, it is important to seek treatment with your physician so that he or she can help design a plan that will work best for you and hopefully prevent nerve damage and muscle atrophy.
Maybe Sandra Dee had the right idea after all. In that outfit for work, she was probably equipped with gear to prevent stress to any body parts.