Carpal Tunnel Syndrome, the most common nerve problem affecting person’s hand

people think that carpal tunnel syndrome is

the disease of the information technology age,

if we are working most of the day with computer,

we feel tingling or numbness in our wrist for months,

then a stabbing pain,

it is very likely we have carpal tunnel syndrome

Carpal Tunnel:

image for illustration purpose only.

Carpal tunnel is a narrow and rigid passage way of ligament and bones at the base of the hand that houses the median nerve and tendons, it is about as big as your thumb, carpal tunnel is located at the palm side of your wrist, the wrist [carpus] is surrounded by a band of fibrous tissue that normally functions as a support for the joint, the tight space between this fibrous band and the wrist bone is called the carpal tunnel, the median nerve passes through the carpal tunnel to receive sensations from the thumb, index finger / fore-finger, and middle fingers of the hand.

Carpal tunnel syndrome [CTS]

CTS has become the most significant medical problem affecting workers,

full recovery will only by avoiding stressful situations and changing work habits.

women are three times more likely than men to develop carpal tunnel syndrome,

because the carpal tunnel itself may be smaller in women than in men.

The carpal tunnel is at the base of the palm of the hand and is made of bones, tendons, and a thick ligament that surround the median nerve, any condition that causes swelling or a change in position of the tissue within the carpal tunnel can squeeze and irritate the median nerve which is located just above the wrist [carpus], irritation of the median nerve can due to either inflamed, or pinched which is as a result of sustained activities like typing, hammering, pushing, constant repetitive use of the hand, causes tingling and numbness of the thumb, index finger / fore-finger, and the middle finger, a condition known as carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist, the median nerve controls sensations to the palm side of the thumb and fingers [although not the little finger], as well as impulses to some small muscles in the hand that allow the fingers and thumb to move, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed, the result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm, carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed or traumatized,

Another terminology of Carpal Tunnel Syndromes [CTS] are:

· cumulative-trauma-disorders,

· overuse-syndromes,

· chronic-upper-limb-pain-syndromes,

· repetitive-motion-disorders.

all terminology are associated generally with repetitive and forceful use of the hands that damages the muscles and bones, many people believe that constant repetitive use of the hand and poor computer set-up are the primary causes the carpal tunnel syndrome.

The drastic increase in computer-related carpal tunnel syndrome injuries is due to computer mouse use, largely due to the problem that the generic computer mouse does not properly fit the computer users’ hand, the generic computer mouse results in excessive fatigue, pain and pressure within the carpal tunnel and thus contributes to inflames / injuries that range from cruelly & insensitive hands and wrists to carpal tunnel syndrome, people who have suffered from carpal tunnel syndrome are usually writers or who works at a computer all day, after hours at the keyboard.

Study to determine the prevalence and incidence of possible carpal tunnel syndrome has been conducted to evaluate the contribution of the use of mouse devices and keyboards to user’s risk, but the study found that the occurrence of possible carpal tunnel syndrome in the right hand, which is usually the hand that controls the mouse, was low, the study emphasizes that computer use does not pose a severe occupational hazard for developing symptoms of carpal tunnel syndrome, a study by researchers at the Mayo Clinic, recently received a lot of media attention when it concluded that there is no association between computer use and carpal tunnel syndrome [CTS]. However, the methodology used in the study was not appropriate to evaluate whether or not computer use causes carpal tunnel syndrome, in fact, carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel.

In fact, recent studies by Tech Dyne International Inc, concluded that the use of a generic, poor-fitting, computer mouse for a single four-hour period caused a loss of strength of the arm of up to 60% and caused the muscles being used in these repetitive operations to get overused, causing inflammation and injury, this is considered the number one ergonomic risk factor for developing computer-related carpal tunnel syndrome.

Cause of generic computer mouse in developing computer-related carpal tunnel syndrome are:

• shape of the generic computer mouse: the shape that does not correctly fit the user's hand, requires the user to grip and hold, which over an extended period will cause tendon and muscle fatigue in the hand, wrist and even the elbow and arm.
• overall size of the generic computer mouse: the size of the computer mouse does not properly fit the size of the individual’s hand, this means there is not enough support for the hand, having optimal support and comfort is required to minimize fatigue with computer mouse operations, individuals with smaller hands should use smaller mice, on the contrary, individuals with larger hands should use larger mice
• right and left hand compatibility: the computer mouse is not compatible with the user’s dominant hand, the computer mouse should be compatible with the dominant hand of the computer user, left-handed computer mouse users should use an ergonomic ^[1] [human factor engineering] computer mouse designed for the left hand.
• wrist position: an ordinary, generic horizontal computer mouse requires your forearm to twist away from its natural position, this causes more strain on your carpal tunnel, wrist tendons and ligaments.
• 
  

^[1] Ergonomic is the science of refining the design of products to optimize them for human use, human characteristics, such as height, weight, and proportions are considered, as well as information about human hearing, sight, temperature preferences, and so on. Ergonomics is sometimes known as human factors engineering.

image for illustration purpose only.

Do we think computer and mouse use can cause carpal tunnel syndrome?

carpal tunnel syndrome from repetitive work has been referred to as one of the repetitive stress injuries.

Symptoms of carpal tunnel syndrome:
carpal tunnel syndrome [a painful progressive condition by compression of a key nerve in the wrist] usually starts gradually, there is frequent burning, tingling, itching, numbness in the palm of the hand and the fingers, typical for thumb, the index finger / fore-finger, and the middle finger, the fingers feel useless and swollen, although they do not show any signs of swelling, when carpal tunnel syndrome’s symptoms tend to worsen, someone will feel tingling all the time, and his / her grip strength decreases, in worst cases, he / she is unable to feel between hot and cold by touch.

The symptoms often first appear in one or both hands during the night, since many people sleep with bend / flexed wrists, a person with carpal tunnel syndrome may wake up feeling the need to shake out the hand or wrist, as symptoms worsen, people might feel tingling during the day.

symptoms usually come and go, symptoms may occur with certain activities, like reading or driving, symptoms will then go away when we move the hand or change what we are doing, the numbness and pain tend to become more frequent and last longer as the problem grows worse, in severe cases, symptoms can become constant.

Conditions and diseases that cause carpal tunnel syndrome:

Most often carpal tunnel syndrome is caused by repetitive motion, injury, or inflammatory types of arthritis, for most patients, the cause of their carpal tunnel syndrome is unknown, any condition that causes pressure on the median nerve at the wrist [compression of a key nerve in the wrist] can cause carpal tunnel syndrome, which is often as the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself, tendon inflammation resulting from repetitive work, such as uninterrupted typing can cause deposition of abnormal substances in and around the carpal tunnel, leading to nerve irritation which causes carpal tunnel symptoms, other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture, mechanical problems in the wrist joint, repeated use of vibrating hand tools

Treatment of carpal tunnel syndrome:

There are many differences in carpal tunnel syndrome treatments, somebody with mild symptoms of carpal tunnel syndrome may ease his / her numbness or discomfort by taking more frequent breaks by resting his / her hands, or by applying cold ice packs if swelling occurs, treatment options include wrist splinting, medications or even surgery, but let's not over react, many people, suffering from carpal tunnel syndrome experience effective treatment with non-surgical methods, including:

wrist splinting, try wearing a wrist splint at night and avoid sleeping on our hands to help ease the pain or numbness in the wrists and hands, treatments for carpal tunnel syndrome should begin as early as possible, under a doctor's direction:

[1]. General initial treatments:

1. resting the affected hand and wrist for at least 2 weeks,
2. avoiding activities that may worsen symptoms,
3. im-mobilizing the wrist in a splint to avoid further damage from twisting or bending.
4. if there is inflammation, apply a cool pack to help reduce swelling.

[2]. Non-surgical treatments:

1. Drugs:
• non-steroidal anti-inflammatory drugs [NSAID], such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease symptoms that have been present for a short time or have been caused by hard / strenuous activity.
• orally administered diuretics can decrease swelling.
• corticosteroids [such as prednisone] : to relieve pressure on the median nerve and provide immediate / temporary relief to persons with mild or intermittent symptoms. [caution: persons with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels. corticosterioids should not be taken without a doctor's prescription.]
• Lidocaine [an anesthetic drug] can be injected directly into the wrist to reduce pain.
• Vitamin B₆ [pyridoxine] supplements may ease the symptoms of carpal tunnel syndrome.
2. Exercise:

stretching exercises can be helpful in people whose symptoms have abated / become less strong, these exercises may be supervised by a physical therapist, who is trained to use exercises to treat physical impairments, or an occupational therapist, who is trained in evaluating people with physical impairments and helping them build skills to improve their health and well-being, exercises can decrease symptoms for a lot of people, the aims are to get more blood flowing to the area and to move the nerve so that the part of the nerve that is in the tunnel slips out for a short rest, try fully curling the fingers tightly closed [fist] and bending the wrist toward the palm, then straighten the fingers and stretch the wrist back the other way, repeat those motions about ten times, remember that carpal tunnel syndrome almost always starts gradually, so it has usually been present for a while before you even notice any symptoms, stretches and exercises have to be performed regularly to be effective, try to make it part of the daily routine, perhaps each morning and before bedtime.

3. Alternative therapies:

acupuncture and chiropractic care have benefited some patients but their effectiveness remains unproved, an exception is yoga, which has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome.

[3]. Surgery

surgery is reserved as a last choice, carpal tunnel release is one of the most common surgical procedures, generally recommended if symptoms last for 6 months, surgery involves providing the band of tissue around the wrist to reduce pressure on the median nerve, surgery is done under local anesthesia and does not require an overnight hospital stay, many patients require surgery on both hands, carpal tunnel syndrome usually doesn't come back after surgery, surgery opens the tight carpal tunnel space and takes pressure off the nerve, after surgery, it may take a while for the nerve to wake up and the symptoms to go away, in more severe cases, the recovery after surgery is slower and symptoms may not go away completely

Important Notice:

Information provided on this article is intended for information, scientific, and education purposes only, it is not intended to substitute the medical advice provided by the medical professionals, only the medical professionals can provide the relevant diagnosis and prescribe the medications!!!

How to prevent from Carpal Tunnel Syndrome:

Carpal tunnel syndrome becomes worse by inactivity than by activity, that is why symptoms are common while sleeping, but with a simple stretching and moving it can be of helpful, symptoms often occur when the hand is in one position for too long.

If we have a job or hobby that keeps the hands in one position for a long time, take a routine short breaks to stretch and move the hands and arms, just a few minutes each hour can be enough to prevent from suffering carpal tunnel syndrome, furthermore, if we are regularly in one position, try to make sure our wrist is relatively straight, because bending the wrist either way increases the pressure around the median nerve.

It is important to notice that there are no proven strategies to prevent carpal tunnel syndrome, it is essential to protect the hands with the following steps:

• relax our grip and reduce the force we are using, such as if using keyboard, hit the keys softly; if writing, use pen with free-flowing pen.
• take breaks whenever we need, such as take a break every 20 minutes, stretch the hands and wrists, if we work with equipment that vibrates, especially when using a great force, it is even more important to take a break.

• at the workplace, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, wear splints to keep wrists straight, and use correct posture and wrist position, wearing fingerless gloves can help keep hands warm and flexible, develops an ergonomics programs, the program of adapting workplace conditions and job demands to the capabilities of workers, jobs that include greater wrist or hand utilization, can rotate among workers.

• improve the posture, if we have incorrect posture, it is more likely we will roll our shoulders forward, when shoulders are in this position, it is more likely our neck and shoulder muscles will be shortened and they will be compressing nerves in our neck, which will also influence our wrists, fingers and hands.
• keep our hands warm to prevent from developing hand pain and stiffness if our work is in a cold environment.

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