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Help, Half My Hand is Numb!

Carpal Tunnel Syndrome (CTS) Can be Debilitating

Carpal Tunnel Syndrome or CTS refers to a condition when one’s median nerve in the wrist, for various reasons, is crushed or compressed, causing it to function inadequately and causing abnormal sensations such as tingling, numbness and pain.
Occupational Safety and Health Administration reported CTS as the injury with the highest median days away from work, greater than fractures or amputations, as well as being the costliest (costing companies up to $60,000 per incident, factoring in productivity loss, medical and hospitalization cost etc). In the USA, carpal tunnel syndrome results in an average of $30,000 in lifetime costs (medical bills and lost time from work).

Tell-Tale Signs and Symptoms
The primary symptom of CTS is the on-off numbness of the thumb, index, long and the long half of the ring finger closer to the middle finger, which intensifies with prolonged use, overstrain and/or awkward posture. Patients with CTS typically can experience tingling, numbness, weakness, loss of dexterity, cramping and burning in the thumb and fingers innervated by the median nerve (namely, the thumb, index finger, middle finger, and long half of the ring finger closer to the thumb side). The intensity of the pain and cramping can be so painful that it wakes patients up if they’re asleep, or they have to stop whatever they are doing, consciously or unconsciously. Long term CTS leads to permanent nerve damage with constant numbness, loss of muscle mass, leading to muscle weakness and decreased dexterity.

At Risk of  Developing CTS
Those who use their hands most/more, especially in wrist flexion-related movements are most at risk of developing CTS. A list of occupations where CTS is common includes: computer users, assembly-line workers, stock clerks, warehouse workers, drivers, transcriptionists, garment workers, athletes, meat and poultry processors, painters, writers, gardeners, golfers, carpenters, bank tellers, data entry clerks, accountants, bricklayers, secretaries, construction workers, CAD and graphic designers, programmers, silkscreeners, artists, needlepoint hobbyists, draftsmen, gardeners, crafts enthusiasts, sportsmen, musicians, knitters, crocheters, checkout clerks and anyone else who uses their hands continually or forcefully. In addition, pregnant women and certain other conditions, have a higher risk due to fluid retention.

Causes of Carpal Tunnel Syndrome
The carpal tunnel is tightly encased, the median nerve and nine tendons fitting snugly in it. The carpal tunnel too, is snugly surrounded by bones below and around, and the transverse carpal ligament and a thumb muscle on top – all in all, a very snug and tight fit. Due to various reasons, the soft structures/tissues swell, especially the tendons and the protective sheaths that cover them. There are a variety of reasons that cause the swelling – from overuse (RSI), direct trauma and injury, friction, fractures, fluid retention, forceful movement and even injections.
Here’s the main problem: unlike most of our body parts where swelling just protrudes, swelling in the carpal tunnel has nowhere to go/protrude, as it is held in tightly by bones and ligaments. This increases the pressure in the carpal tunnel which then compresses the median nerve, which causes it to not function properly.
The pressure also limits blood flow which impairs healing and aggravates and further degenerates cells. The common symptoms of CTS are fatigue, pain, cramping, numbness, cold, tingling, weakness, stiffness, burning or loss of dexterity.

Diagnosis of CTS
Usually, a thorough subjective and objective examination by a physician or a hand therapist will be able to diagnose the condition. Sometimes, additional tests are required, such as electromyography and nerve conduction testing is done to assess for severity.

Additional Clinical Assessments
• Phalen’s Test. Flex the wrist as far as possible. Hold this position for one minute (60 seconds) and wait to see if any CTS symptoms manifest. If CTS symptoms manifest within 60 seconds, this means it’s a positive Phalen’s Test. The quicker and/or more intensive the symptoms manifest, the more severe the condition.
• Tinel’s Sign. It is performed by lightly tapping the skin over the affected wrist to detect irritated nerves. If there is a sensation of tingling or pins and needles, especially over the area where the median nerve-innervated areas are, it shows that the median nerve is irritated and leans towards CTS diagnosis.

What You Can Do Median Nerve Glide Exercises
Be seated comfortably, and support your affected hand by the resting it on a table. Extend your wrist and fingers. Using your unaffected hand, slowly pull the thumb of the affected hand away from the index finger and stretch. Hold for about five seconds, and repeat 10 times. Do this three times a day.

Lifestyle Changes
Take micro-breaks – Every 30 minutes, take one minute to stop and stretch muscles. Adequate sleep helps your body to heal from injuries, big or small. Exercise at least three times a week to increase your strength, stamina and health.
Plan and prioritize – Schedule your important tasks first, and complete them first.
Improve ergonomics – Can you identify if there is a specific activity, device or pattern you realized is causing you pain? Can you change it, replace it or modify it? Think creatively how you can do things better. An example is if you seem to be getting numbness in your forearm because you realised that you’ve been resting your entire body weight on your forearms as you type, can you bring your keyboard tray forward for you to easily reach and type without resting your forearms and body weight on the edge of your table?

See your doctor or pay a visit to the physiotherapist
If you find that preventative measures aren’t helping, see a doctor or therapist as soon as possible. Prompt attention can mean the difference between a quick recovery and a lifetime of suffering. And, by all means, be sure the physician you choose is familiar with these disorders.

Nigel Chua is the Principal Hand Therapist with special interest in Ergonomics for Urbanrehab Pte Ltd. He practices in The Hand Therapy Clinic, Royal Brothers Building, 22 Malacca Street #03-03, Singapore 048980. Tel (+65) 6533 9133 | SMS (+65) 9774 6535 | Fax (+65) 6534 5086. Visit www.urban-rehab.org for more information on physiotherapy and hand therapy solutions Singapore.
Posted by ezyhealth on Jul 19 2012. Filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0. Both comments and pings are currently closed.

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