When you sit in an awkward position for any length of time,
your feet or legs might 'go to sleep.' It happens to everyone
at some time or other. Hands and arms turning numb is also
common, especially in women, and might occur in one or both
hands. Particularly susceptible are people whose work
requires repeated forceful movements with the wrist extended,
such as the use of a screwdriver, prolonged use of computer
keyboards, grocery check-out clerks and even violinists.
However, the condition was reported more than a hundred years
ago, before computers and electronic tills came on the scene,
and is known as carpal tunnel syndrome.
The carpal tunnel is a narrow tunnel formed by the bones and
other tissues of your wrist, on the palm side. This tunnel
protects your median nerve, the nerve which provides feeling
to the thumb and first three fingers. When some of these
tissues are swollen or inflamed, they press on the median
nerve.
A girl is working at her desk, trying to ignore the tingling
and numbness she has felt in her hand for months, when
suddenly a sharp piercing pain shoots through her wrist and
up her arm. She flexes her hand but it feels like a swollen
lump, although there is no swelling to be seen. The pain
passes, and she thinks it must have been a passing cramp.
That night she wakes up again with the same sharp pain right
up her arm. This time it lasts much longer, and although the
pain has gone by the morning, her hand feels useless. She
cannot even butter her toast.
Women are three times more likely than men to develop carpal
tunnel syndrome. The above is a typical history of its onset.
Symptoms usually start gradually, with tingling or numbness
in the fingers and hands. This often happens when holding a
book, or a telephone, or on waking up in the morning. There
might be a sense of weakness in the hands, with a tendency to
drop things. Then after a while, there is severe pain either
starting in the shoulder and coming down to the wrist, or
starting in the wrist, on the palm side, and radiating up to
the neck and shoulder.
If the condition is advanced, there might be a constant loss
of feeling in the fingers, (not the little finger). It is
only when there is repeated pain that sufferers visit the
doctor. This is a mistake, as early intervention can prevent
permanent damage to the median nerve.
When the doctor examines the patient, he will have to rule
out other conditions, which might have the same symptoms as
carpal tunnel. He will carry out several tests, to verify
that a person really has this treatable syndrome. For
example, a pinched nerve in the neck, or rheumatoid
arthritis, or even diabetes, might all mimic the syndrome. He
might then suggest that you see a rheumatologist, neurologist
or hand surgeon.
A doctor will suggest treatment to alleviate the symptoms,
and then will try to cure the condition. The affected hand
might be put into a splint for at least two weeks, in order
to rest the hand and to avoid further damage, which will
occur if the wrist is bent or twisted. He will prescribe
Brufen or other NSAID (non-steroid anti-inflammatory drug) to
decrease the pain and as a last resort, he might inject some
cortisone directly into the affected area. This last course
of treatment might relieve the pain for a while, but is no
cure.
As with acute back pain, some people swear by a particular
chiropractor, and claim he cured them. Others go for
acupuncture, and are equally vociferous about the efficacy of
the treatment. Osteopathy, and hydrotherapy have frequently
been cited as the ideal cure. There is no doubt that these
alternative therapies have benefited many patients, but there
is no scientific evidence about the true value of the
treatment.
Although conventional medicine does not give credence to
alternative medicine, if people can be helped, or even cured
without having to resort to surgery, they have nothing to
lose. Yoga is the one exception in this case, of alternative
therapy, which has been shown to be useful both in improving
grip strength among patients with carpal tunnel syndrome, and
in reducing pain.
Surgery is the last resort for most people, although when the
condition is already advanced, there is little option. Carpal
tunnel often presents itself in pregnancy, so that if a woman
has had an operation, the condition might well recur.
Surgeons do try to postpone the procedure until a woman is
older, and less likely to have more children. (For the same
reason, they do not like to operate on the varicose veins of
younger women.)
Findings published in the U.S.A about ten years ago reported
that surgery on the carpal tunnel was one of the ten most
common surgical procedures in the United States. 75% of all
the patients reported that they felt better after the
operation, but 25% suffered complications. Surgery involves
cutting the band of tissue round the wrist to reduce pressure
on the median nerve. It is done under local anesthetic, in
the outpatient clinic. The complications range from
infection, nerve damage, stiffness and pain at the site of
the scar.
The wrist and hand might lose strength, because the carpal
ligament has been cut. Recovery for the 75% of the patients
who had no complications, usually took many months. Patients
need physical therapy after surgery, to restore strength to
the wrist as do those who recover spontaneously, without
surgery.
One can take precautions to reduce the risk of carpal tunnel
syndrome.
1. Use less force when hitting a cash register or keyboard.
For writing by hand, use a thick pen which has a soft grip
adaptor and free flowing ink, so that you do not have to grip
so hard, nor press so hard on the paper.
2. Take a short break every half hour or less, to allow your
hands and wrists to relax.
3. Correct posture and height of the keyboard is of utmost
importance. The forearms should be level with the
keyboard.
If you are one of the thousands of sufferers, you are in good
company. If you are one of the many who "has no time for
doctors," in this case it is not wise to ignore the symptoms,
if they persist over several weeks, and if they deteriorate,
as there may be permanent, irreversible, muscle damage, and
even partial paralysis.
Early intervention in this condition is almost always
successful.
