Coping with Carpal Tunnel Syndrome

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Coping with Carpal Tunnel Syndrome

 

Carpal tunnel syndrome occurs when tendons or ligaments in the wrist

become enlarged, often from inflammation, after being aggravated. The

narrowed tunnel of bones and ligaments in the wrist pinches the

nerves that reach the fingers and the muscles at the base of the

thumb. The first symptoms usually appear at night. Symptoms range

from a burning, tingling numbness in the fingers, especially the

thumb and the index and middle fingers, to difficulty gripping or

making a fist, to dropping things.

 

Some cases of carpal tunnel syndrome are due to work-related

acumulative trauma of the wrist. Diseases or conditions that

predispose to the development of carpal tunnel syndrome include

pregnancy, diabetes, and obesity.

 

Carpal tunnel syndrome is often 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. Most

likely the disorder is due to a congenital predisposition - the

carpal tunnel is simply smaller in some people than in others. Other

contributing factors include trauma or injury to the wrist that cause

swelling, such as sprain or fracture; overactivity of the pituitary

gland; hypothyroidism; rheumatoid arthritis; mechanical problems in

the wrist joint; work stress; repeated use of vibrating hand tools;

fluid retention during pregnancy or menopause; or the development of

a cyst or tumor in the canal. In some cases no cause can be

identified.

 

There is some clinical data to prove that repetitive and forceful

movements of the hand and wrist during work or leisure activities can

cause carpal tunnel syndrome. Repeated motions performed in the

course of normal work or other daily activities can result in

repetitive motion disorders such as bursitis and tendonitis. Writer's

cramp - a condition in which a lack of fine motor skill coordination

and ache and pressure in the fingers, wrist, or forearm is brought on

by repetitive activity - is not a symptom of carpal tunnel syndrome.

 

 

Diagnosis

 

Early diagnosis and treatment are important to avoid permanent damage

to the median nerve. A physical examination of the hands, arms,

shoulders, and neck can help determine if the patient's complaints

are related to daily activities or to an underlying disorder, and can

rule out other painful conditions that mimic carpal tunnel syndrome.

 

The wrist is examined for tenderness, swelling, warmth, and

discoloration. Each finger should be tested for sensation, and the

muscles at the base of the hand should be examined for strength and

signs of atrophy. Routine laboratory tests and X-rays can reveal

diabetes, arthritis, and fractures.

 

Physicians can use specific tests to try to produce the symptoms of

carpal tunnel syndrome. In the Tinel test, the doctor taps on or

presses on the median nerve in the patient's wrist. The test is

positive when tingling in the fingers or a resultant shock-like

sensation occurs. The Phalen, or wrist-flexion, test involves having

the patient hold his or her forearms upright by pointing the fingers

down and pressing the backs of the hands together. The presence of

carpal tunnel syndrome is suggested if one or more symptoms, such as

tingling or increasing numbness, is felt in the fingers within 1

minute. Doctors may also ask patients to try to make a movement that

brings on symptoms.

 

Often it is necessary to confirm the diagnosis by use of

electrodiagnostic tests. In a nerve conduction study, electrodes are

placed on the hand and wrist. Small electric shocks are applied and

the speed with which nerves transmit impulses is measured. In

electromyography, a fine needle is inserted into a muscle; electrical

activity viewed on a screen can determine the severity of damage to

the median nerve. Ultrasound imaging can show impaired movement of

the median nerve. Magnetic resonance imaging (MRI) can show the

anatomy of the wrist but to date has not been especially useful in

diagnosing carpal tunnel syndrome.

 

Before surgery, you may want to consider other less invasive

measures:

 

 

Complete recovery can occur and we can avoid reinjury by changing the

way we do repetitive movements, the frequency with which we do the

movements, and the amount of time we rest between periods when they

perform the movements.

 

Exercise - Stretching and strengthening exercises can be helpful in

people whose symptoms have abated. 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.

 

Many activities outside of work may contribute to carpal tunnel

syndrome: knitting, sewing, or needlepoint; cooking and housework; TV

computer games and home computer work; playing sports or cards; and

hobbies or projects like carpentry or using power tools for extended

periods of time. You should also take frequent breaks and examine the

tools you use at home that could be causing strain on your hands. You

may need to wear a wrist splint at night, while playing sports, or

when working at home. The wrist splint assists in maintaining the

wrist in a neutral or straight position and allows the wrist to rest.

 

 

Consider these exercises:

 

1. Place the right palm at the wall, spreading your fingers equally.

Extend your elbow and press the palm fully into the wall. Wait a few

breaths and then turn your head to the left, bringing the tip of the

right shoulder blade in towards the front of your body. Hold and

breathe.

 

2. Bring your palms together in front of your chest in a prayer

position stretching all the fingers fully. Relax your shoulders.

Slowly stretch the heel of your palms down until they are the level

of your wrists. If you can do this stretch without discomfort you can

increase the stretch by moving the hands over to the right and

holding for a few breaths. Repeat to the left. Stretch slowly and

carefully, observing the sensations of your forearm and wrist.

 

3. Make fists of your hands and place them, thumb up, on the desk

top . Support your lower arm on the desk. Slowly stretch the fist to

the right, without moving your lower arm, and then to the left. Lift

your arms off the desk top and make slow circles with your wrist,

keeping your hands in closed fists. Circle both directions. Release

your fingers and place them, tips up, on the edge of your desk. Press

into the desk with the fingers. Try this first with the fingers

together and then spread apart.

 

4. Place the index finger on the edge of your desk, keeping your

wrists straight. Gently push into the desk and hold for a few

breaths. Repeat with all the fingers except the thumb.

 

5. Place your right palm on the desk top with your wrist straight.

Relax all your fingers. With your left hand slowly stretch the right

thumb away from the forefinger. Hold for a few breaths and then

release and do the other hand.

 

6. Extend and stretch both wrists and fingers acutely as if they are

in a hand-stand position. Hold for a count of 5. Straighten both

wrists and relax fingers. Make a tight fist with both hands. Then

bend both wrists down while keeping the fist. Hold for a count of 5.

Straighten both wrists and relax fingers, for a count of 5. The

exercise should be repeated 10 times. Then we should let our arms

hang loosely at their side and shake them for a couple of seconds.

 

 

Chiropractic - has shown to be effective for carpal tunnel syndrome.

 

Accupuncture - has shown great results for those with carpal tunnel

in some people.

 

Carpal Tunnel and Yoga - Yoga has shown to reduce pain and improve

grip strength among patients with carpal tunnel syndrome.

 

 

Surgery

 

Carpal tunnel release is one of the most common surgical procedures

in the United States. Generally recommended if symptoms last for 6

months, surgery involves severing 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. The following are types of

carpal tunnel release surgery:

 

Open release surgery: the traditional procedure used to correct

carpal tunnel syndrome, consists of making an incision up to 2 inches

in the wrist and then cutting the carpal ligament to enlarge the

carpal tunnel. The procedure is generally done under local anesthesia

on an outpatient basis, unless there are unusual medical

considerations.

 

Endoscopic surgery: may allow faster functional recovery and less

postoperative discomfort than traditional open release surgery. The

surgeon makes two incisions (about ½ " each) in the wrist and palm,

inserts a camera attached to a tube, observes the tissue on a screen,

and cuts the carpal ligament (the tissue that holds joints together).

This two-portal endoscopic surgery, generally performed under local

anesthesia, is effective and minimizes scarring and scar tenderness,

if any. One-portal endoscopic surgery for carpal tunnel syndrome is

also available.

 

Although symptoms may be relieved immediately after surgery, full

recovery from carpal tunnel surgery can take months. Some patients

may have infection, nerve damage, stiffness, and pain at the scar.

Occasionally the wrist loses strength because the carpal ligament is

cut. Patients should undergo physical therapy after surgery to

restore wrist strength. Some patients may need to adjust job duties

or even change jobs after recovery from surgery.

 

Percutaneous balloon carpal tunnel-plasty: is an experimental

technique that can ease carpal tunnel pain without cutting the carpal

ligament. In this procedure, a ¼-inch cut is made at the base of the

palm. The doctor then inserts a balloon through a catheter under the

carpal ligament and inflates the balloon to stretch the ligament and

free the nerve. Patients in one small study of pertucaneous balloon

carpal tunnel-plasty reported relief of symptoms with no

postoperative complications; most of them were back to work within

two weeks. This experimental technique is not yet widely available.

 

Recurrence of carpal tunnel syndrome following treatment is rare. The

majority of patients recover completely.

 

To reduce the inflammation associated with CTS, one or more of the

following fatty acids and herbal extracts may be taken:

 

-Super GLA/DHA contains a balanced blend of essential fatty acids.

Three softgels daily contain 450 mg of GLA from borage oil and 500 mg

of DHA and 200 mg of EPA from marine lipid extract. Up to 6 softgels

may be taken daily.

 

-Mega EPA contains 400 mg of EPA and 300 mg of DHA in each softgel

capsule. Up to 8 softgels may be taken daily for therapeutic

purposes.

 

-Boswella, one 300-mg capsule daily.

 

-Curcumin (from the spice turmeric), 900-1800 mg daily.

 

-Ginger extract, 1000 mg daily in capsule form.

 

-Inflacin topical cream.

 

The proper synergy of vitamins and minerals controls free-radical

damage that increases pain and inflammation:

 

-Gamma E Tocopherol/Tocotrienols (vitamin E), 1 softgel daily taken

with food.

 

-Vitamin B Complex, 3 capsules daily. This dose should provide at

least 75 mg of vitamin B6 in the total daily dose.

 

-Vitamin C, 2000 mg daily in divided doses.

 

-Vitamin A, 10,000-25,000 IU daily. ***Pregnant women should only

take vitamin A under medical supervision.

 

-Vitamin D, 400 IU daily.

 

-Selenium, 200 mcg daily.

 

Protein-digesting enzymes such as protease, bromelain, trypsin,

lipase, pancreatin, and papain have significant anti-inflammatory

effects. One or more of the following nutrients may be considered:

 

-Super Digestive Enzymes containing protease, lipase, cellulase, and

amylase from pancreatin; 2 capsules at the beginning of each meal.

 

-Bromelain Powder enhances protein absorption and turnover, including

protein found in joint tissue. The suggested dosage is 1/8-1/4 tsp

with each meal.

 

-Papain Powder aids in protein digestion and repair. The suggested

dosage is 1/8-1/4 tsp with each meal.

 

-Magnesium is often deficient from the diet. It is important for

arterial health and has a relaxing effect.

 

-Magnesium also helps regulate calcium uptake in the body. The

recommended dosage is 500 mg of elemental magnesium daily.

 

-Phosphatidylserine (PS) improves neurotransmitter functioning and

enhances the metabolism of cellular energy throughout the body. One

100-mg capsule daily is suggested.

 

-D, L-phenylalanine will help boost endorphin levels. Endorphins are

our body's natural painkillers. The suggested dose to achieve

painkilling effects is 1500-3000 mg daily.

 

 

Andrew Pacholyk, MS, L.Ac

http://www.peacefulmind.com

Therapies for healing

mind, body, spirit

 

 

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