Carpal Tunnel Syndrome

Whether you work at a computer or with tools -- anywhere that requires using your hands for repetitive tasks -- carpal tunnel syndrome (CTS) is a potential hazard. It affects workers in many different industries, from office work to construction to retail. The mechanisms of the wrist and hand are much more complicated and delicate than one might think, and it can be easy to ignore signs of strain or overuse.

Symptoms of Carpal Tunnel

Understanding carpal tunnel syndrome requires understanding the anatomy of your arm and hand. The carpal tunnel is the narrow passageway on the palm side of your wrist that connects your forearm to your hand. The ligaments and bones that connect these two house the median nerve as well as the tendons that bend your fingers. The median nerve controls some of the muscles at the base of your thumb, but primarily is what provides feeling to the thumb and all your fingers except the little finger. When this nerve is squeezed, carpal tunnel syndrome can develop.

CTS is called an entrapment neuropathy, a condition in which too much pressure is placed on a peripheral nerve. The symptoms can somewhat vary in degree and usually begin gradually. They can occur in one or both hands and include:

• Numbness, burning, and tingling in the palm and fingers.
• Burning and aching pain, numbness, and tingling that causes disruptions in sleep: many people sleep with flexed wrists and this can wake you up.
• Weakness and decreased grip strength: difficulty holding objects or performing manual tasks.
• In chronic or untreated cases, thumb muscles may weaken or shrink.
• In chronic or untreated cases, nerve damage may occur, and the loss of ability to feel hot and cold in the hand and fingers.

Causes of Carpal Tunnel: Who's at Risk?

Pressure on the median nerve causes CTS, and this pressure usually comes when the space in for the median nerve within the tunnel shrinks. Typically this is from swelling or thickening in the tunnel lining by irritated tendons, and a single cause can be hard to find. Injuries or actions that can start this process may include:

• Repetitive labor that bends the wrist, such as factory work or certain tools.
• Incorrect hand positioning when using a keyboard.
• Using tools that vibrate for long periods of time, such as a jackhammer.
• Trauma such as a sprain or fracture.
• An overactive pituitary gland.
• An underactive thyroid gland.
• Rheumatoid arthritis.

Other contributing factors may include genetic predisposition, diabetes, obesity, the development of a cyst or tumor, fluid retention during pregnancy or menopause, mechanical problems in the wrist joint, and various forms of work using the hands.

Women are 3 times more likely than men to get CTS, and this may be due to having smaller wrist bones and less space within the carpal tunnel. Many conditions that cause hormonal changes and can contribute to CTS are also suffered more commonly or exclusively by women, such as pregnancy, menopause, and hypothyroidism. Carpal tunnel incidence also increases with age, with people age 45-54 particularly at risk.

Carpal Tunnel in the Workplace

Certain industries have more prevalent rates of CTS. Although it's often associated with secretarial, data entry, and other office work, the highest rates of worker's compensation for carpal tunnel have been found in factories, particularly textile mills and clothing manufacturers. Any assembly line is subject to it, though: assemblers are 3 times more likely to get CTS than even data entry professionals.

Any occupation with these types of tasks may present carpal tunnel risks:

• Repetitive hand motions.
• Awkward hand positions.
• Mechanical stress on the palm or wrist.
• Vibration.
• Strong gripping.

Treating and Preventing Carpal Tunnel

Preferably the best course of action with CTS is to prevent carpal tunnel before it becomes an issue. However, this is most readily available for cases stemming from the workplace and doesn't fully cover complications caused by other health issues. Still, it helps to have guidelines in place to ensure safer work practices. These might include the following:

• Alter your environment: Ensure that your desk and keyboard are at the right height and distance to allow you to comfortably position your hands and sit with good posture. Special products like cushions, ergonomic mouses and keyboards, or soft grip pens may make some work easier.
• Take breaks: A 10-15 minute break every hour from repetitive or stressful hand motions is recommended.
• Vary tasks: Avoid repetitive movements by switching between tasks that use different muscle movements every hour.
• Relax your grip: Practice doing tasks less tightly. Get yourself in the habit of not tensing your muscles when you don't need to.
• Exercises: It can help to flex and bend your hands, wrists, and fingers in the opposite direction of the repetitive motions your work requires.
• Stay warm: Warm muscles are less susceptible to CTS. Wear gloves at work if you have to!

Unfortunately, sometimes you can develop carpal tunnel syndrome despite precautions. Like the gradual onset of the syndrome, treatment is a process. It's dependent on how advanced your symptoms are, and the underlying causes. Treatments are varied and may include:

• Wrist splint: The early stages of CTS may be improved by a wrist splint worn either at night or 24 hours a day.
• Rest and adaptation: Altering your work habits or taking a break from the work that may be causing the strain on your hand and wrist.
• Cold packs: To reduce wrist swelling.
• Over-the-counter drugs: Non-steroidal pain relievers and anti-inflammatory drugs like ibuprofen and aspirin to relieve discomfort.
• Prescription drugs: Taking corticosteroids or injecting lidocaine on a long-term basis to reduce inflammation.
• Physical and occupational therapy: Special exercises to improve hand and wrist strength or to develop better mobility habits.
• Surgery: Carpal tunnel release, which involves cutting a ligament around the nerve to relieve pressure, is one of the most common surgical procedures in the U.S. It's typically an outpatient procedure with local anesthesia.