Carpal Tunnel Syndrome is a common complaint

This article submitted by Molly Connors on 12/3/96.

Electricians. Carpenters. Assembly line workers. Anyone who works with a keyboard.

A variety of jobs, but people in these fields can share one common complaint: carpal tunnel syndrome.

Carpal tunnel syndrome is a "repetitious injury" that comes from "grasping or stretching the wrist," said Dr. Randal Jacklitch of Jacklitch Chiropractic Clinic.

Carpal tunnel syndrome is an "overuse injury ... not a blunt trauma," said Dr. Liz Greguson, of Paynesville Chiropractic.

The carpal tunnel itself is the center of the wrist. Here, bones and a ligament form a narrow tunnel. Nine flexor tendons and the median nerve are inside this tunnel. The tendons, ligament, carpal bones and median nerve are all covered by a tough sheath at the bottom of the palm of the hand.

The wrist's neutral position is at a 45-degree angle, according to Greguson. When the wrist is repeatedly tipped up beyond that 45-degree angle, it irritates the area. This causes swelling in the carpal tunnel.

The swelling is contained within the sheath and the carpal tunnel. None of the tissue can expand anywhere, so the swelling compresses the median nerve.

The median nerve runs to all the fingers except the pinky. When this nerve is compressed, the fingers tingle or become numb.

"People drop coffee cups" when the numbness advances, Jacklitch said.

People notice tingling and numbness reoccurring when they perform the aggravating task if they've developed carpal tunnel syndrome. These people also tend to wake up in the middle of the night and find their hand asleep, Jacklitch said.

Both Jacklitch and Greguson urge anyone who feels reoccurring tingling or numbness to seek professional help. Greguson doesn't recommend "self- diagnosis." She's seen patients further injuries through self-treatments.

Professional help is particularly important because what may seem to be carpal tunnel syndrome could be another problem. One example is what Jacklitch calls the "double crunch" syndrome.

The median nerve, which runs through the carpal tunnel, runs all the way to the neck. If the nerve is irritated, the problem can cut off circulation to the neck. Jacklitch sees sheetrockers, and other people who lift their arms often, with double crunch syndrome. Spasms in the neck, shoulder and wrist muscles are common double crunch symptoms.

Carpal syndrome is becoming more common, as more jobs include tasks that irritate the wrist. Keyboards are one of the most common causes of injury. Few businesses operate without computers. Other jobs that include assembly lines and repetitive motions also cause damage.

Abstaining from any irritating activity is the best insurance against carpal tunnel syndrome. Most carpal tunnel sufferers, however, are not able to quit their jobs and cannot abstain from the cause of their carpal tunnel syndrome.

At work, Jacklitch recommends taking frequent breaks. During these breaks, stretch. Write the lowercase alphabet in the air. This puts the wrist through its full range of motion.

Using cold packs and taking supplements that include vitamin B6 can keep the swelling down. Also, Jacklitch said, try to vary worktime activities if possible.

Treatments for carpal tunnel syndrome are covered under workmens' compensation. Most employers don't mind taking steps to prevent the syndrome from occurring.

At home, simple strengthening exercises can help prevent carpal tunnel syndrome. Wrist curls with three to five pound weights help strengthen the wrist. Lift up and down and to both sides, so all areas of the wrist benefit from the exercises.

Avoid "pressing" exercises, like push-ups, which strengthen arms but strain wrists. Instead of push-ups, use free weights or motion weights, Jacklitch said.

Jobs and tasks can usually be modified to reduce wrist stress. Newer keyboards are built more ergonomically, or comfortably, and wrist rests are available, so typing and computer work won't irritate the wrist.

Treatments for carpal tunnel syndrome vary, depending on doctors and the extent of the syndrome. Surgery, however, is the last resort.

"Surgery is the last thing you should go through," Jacklitch said.

Surgery wasn't always successful for carpal tunnel syndrome sufferers. It corrected about 65 percent of all cases.

Surgeons make a small incision in the transverse ligament, or the tough sheath that runs across the palm of the hand. This is the sheath that everything swells against. When it's cut, everything in the carpal tunnel has more area to expand.

In the 35 percent of cases where surgery didn't work, scar tissue formed. Now, orthoscopic surgery is used. Surgeons use a scope, or camera, to make the incision. This helps 90 percent of patients, said Dr Julie Youngs of the Paynesville Area Health Care System.

Youngs tries "conservative treatment first." She uses an EMG, a nerve stimulation test, to find the problem. The test measures how fast electricity moves through nerves. In carpal tunnel syndrome sufferers, the electricity slows down through the carpal tunnel.

Splints, braces, stretches and anti-inflammatory drugs are prescribed. Surgery is only suggested if there is muscle wasting and discomfort continues, Youngs said.

Greguson's treatments are a little different from Youngs' and Jacklitch's. Once Greguson has determined that her patient has carpal tunnel syndrome, she adjusts the wrist area.

She uses ultrasound therapy, electric muscle stimulation and massage therapy to combat the problem. She prescribes wrist braces and tells her patients to stop the activities that irritate their wrists. She also uses homeopathy, or a blend of herbs, to relieve swelling and pain.

She doesn't cure anything, Greguson said. She "adjusts the body, so the body can cure itself."

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