How ergonomics helps

Ergonomics may prevent musculoskeletal injuries (such as back strain or carpal tunnel syndrome) by reducing physical and mental stress caused by the workstation setup. By focusing on the physical setup of your workstation and the tools you use, you can reduce your chances of injuries. It also is important to evaluate the work process, including job organization, worker rotation, task variety, demands for speed and quality, and the social aspects of work structure and supervision.
Working intensely over long periods of time without taking breaks can greatly increase your risk for musculoskeletal injuries. Taking regular breaks from your work and doing stretching exercises may reduce the risk of repetitive motion injuries. Try taking 3- to 5-minute breaks-or changing tasks-every 20 to 40 minutes.

Office Ergonomics - Home Treatment for Injuries Related to the Workstation

If you have a musculoskeletal injury such as back or neck strain or carpal tunnel syndrome, try home treatment for a few days when you first notice symptoms. These steps are usually helpful in relieving discomfort caused by stress and overuse. Home treatment includes:
Resting the painful area and avoiding or modifying activities that aggravate your pain or discomfort. Return to some daily activities as soon as possible to help maintain flexibility and general well-being. Be aware of any tingling, numbness, weakness, or pain that may indicate an injury.
Using ice to reduce pain and inflammation. Place an ice pack or cold pack over the painful area for 10 to 15 minutes at a time, as often as once an hour. This will help decrease any pain, muscle spasm, or swelling.
Using nonprescription pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen sodium (such as Aleve), can help relieve pain and reduce inflammation. Acetaminophen (such as Tylenol) can also help relieve pain. People younger than age 20 should not take aspirin because of the risk of Reye's syndrome (a central nervous system complication in children).
Doing gentle stretching exercises to keep flexible and prevent stiffness. These exercises include stretches for your wrist and arm, shoulder, neck, and back.
Examining your workstation setup and workstation tools. Apply the ideas of ergonomics to make sure your workstation and tools fit you and the activity you are doing, and try making changes that will limit any injury.
Maintaining good health habits. Exercise regularly (including aerobic, muscle strengthening, and flexibility exercises), eat a balanced diet, don't smoke, get enough sleep, and lose weight if needed. If possible, reduce stress and tension at work and at home.
Home activities may contribute to workplace injury. For example, doing an activity at home that requires the same repetitive movements as at work may not allow your body time to recover. Also, driving long distances to and from work may contribute to workplace injury. Using special seat covers for added comfort (such as those made of wool or beads), carpooling, or using public transportation may help reduce this added stress.-webmd.com

Best position for your hands while typing

The best position for keying is with your wrist neutral. Your wrist should not bend to tilt your hand up or out to the side.

About laptops and ergonomics

Many people use laptop computers as secondary workstations. You should not use a laptop as your primary computer. Using a docking station that provides an adjustable keyboard can help keep your wrists in a neutral position to reduce stress and strain. If you use a laptop often, try the following to improve ergonomic factors:7
· Take a short break every 20 to 30 minutes. Resting and stretching for 3 to 5 minutes or changing tasks gives your body a chance to recover from working a long time in one position.
· Keep your head and neck in a neutral position and about 18 to 30 inches away from the monitor screen.
· Position the keyboard so that it is at elbow height, and try to keep your wrists relatively straight and your fingers slightly curved while you are working. You may need to use a pillow under your elbows to support your arms if you are sitting on a couch or chair while keying.
· Use an external mouse instead of the small touch pad or trackball that is on the laptop keyboard.
· When you have to carry your laptop with you:7
o Carry only what you need with you.
o Use a carrying case with a padded strap and handle. It's best to put the strap over the opposite shoulder to help distribute the load you are carrying, or to switch hands regularly.
o Use a luggage cart with wheels when possible.
Parents can apply all these ideas when children use a computer. To adjust a workstation for a child, you may want to:
· Make sure the seat is high enough so your child can see the monitor without looking up and so your child's shoulders are relaxed when he or she types. You may want to have your child sit on a thick book, a firm pillow, or a booster seat.
· Use a footstool (or a thick book or a backpack) to support your child's feet if they don't rest comfortably on the floor.
· Use a firm pillow behind your child's back to scoot him or her toward the front of the chair.
· Adjust the keyboard and mouse or other input device to keep your child's wrists straight.
· Avoid glare on the monitor screen.

Ways to improve your workstation

o Many keyboards and keyboard trays have wrist supports to help keep your wrists in a neutral, almost straight position. However, wrist pads are just there for brief rests. They are not meant to be used while you are typing, but some people find they help even during keying. When you type, try raising your wrists from the support so your wrists are in a neutral position. You may want to alternate between resting your wrists on the supports and raising them up. See an illustration of proper hand and wrist positioning for keyboard use.
o You can adjust the tilt of the keyboard. Some people find it more comfortable if the keyboard is flat or tilted slightly down at the top. Try different tilt angles to see what is most comfortable for you.
· A computer mouse or pointing device that does not require a lot of forearm movement or force, such as a trackball mouse or touch pad, is more comfortable than a standard mouse for some people. Other types of pointing devices are also available. See an illustration of proper hand and wrist position for mouse and trackball use for examples.
· A document holder that holds your papers level with your computer monitor, so that as you look back and forth between paper and monitor, your eyes do not need to continually refocus.
· A comfortable room temperature, a relatively quiet area, and sufficient lighting without glare from office lights, sunlight, or the computer screen.
· A telephone headset or speaker phone, so you avoid awkward positions while talking and doing other tasks, such as typing.
· A location for any reference manuals that is close to the center of your workstation, for easy access.

Office ergonomics- tips

· A chair that maintains normal spinal curvature. A supportive chair:
o Is adjustable, so that you can set the height to rest your feet flat on the floor. Keep your feet supported on the floor or on a footrest to reduce pressure on your lower back. Some people like to sit in a slightly reclined position because it puts less stress on the back, although this may increase stress on the shoulders and neck when you reach for items.
o Supports your lower back.
o Has adjustable armrests that allow your elbows to stay close to your sides. If you are not comfortable with armrests, move them out of your way. It is still important to keep your arms close to your sides even if you choose not to use armrests.
o Has a breathable, padded seat.
o Rolls on five wheels for easy movement without tipping.
· A computer keyboard and keyboard tray that allow comfortable typing or keying.
o Your keyboard should be at a height that allows your elbows to be open (bent no more than 90 degrees) and close to your sides.
o There are many variations for keyboard design, including split, curved, or rotated keyboards. A small scientific study has shown that using alternate keyboard designs can reduce tendon stress in the fingers and wrist. If you notice hand, arm, or neck discomfort, your employer may have different keyboard styles for you to try; different people find different styles work best for them.

Let's improve our workstations...!

To improve your workstation , choose workstation tools that fit your personal physical and comfort needs, such as:
· A desk or work surface:
o Large enough to accommodate papers, reference manuals, and other workstation tools, but arranged properly to access items easily.
o At a height that allows enough space for your knees and thighs to comfortably fit under the desk.
o That is not shiny.
· A computer monitor that is:
o Clear and easy for you to see without leaning forward or looking up or to one side.
o At a height where the top of the screen is at eye level, or within 15 degrees below eye level.
o Less than an arm's length away from you.
o Protective against eyestrain, which may lead to vision problems and headaches. For example, glare guards are available either as part of the monitor or to be placed over the monitor screen. Plasma screens also have less glare than other monitors.

Musculoskeletal injuries

Ergonomics may prevent musculoskeletal injuries (such as back strain or carpal tunnel syndrome) by reducing physical and mental stress caused by the workstation setup. By focusing on the physical setup of your workstation and the tools you use, you can reduce your chances of injuries. It also is important to evaluate the work process, including job organization, worker rotation, task variety, demands for speed and quality, and the social aspects of work structure and supervision.
Working intensely over long periods of time without taking breaks can greatly increase your risk for musculoskeletal injuries. Taking regular breaks from your work and doing stretching exercises may reduce the risk of repetitive motion injuries. Try taking 3- to 5-minute breaks-or changing tasks-every 20 to 40 minutes.

Carpal Tunnel

“The treatment for Carpal Tunnel Syndrome in its early stages is often directed at decreasing the inflammation of the tendons. The most common treatment without the use of drugs or injections is a “cock up” night splint which keeps the wrist in a neutral position during sleep, to prevent the normal bent position which often occurs during dreaming which puts pressure on the nerve.

This helps a CTS sufferer sleep better. Symptoms often worsen at night because the position of the hand is at the same level of the heart while lying down and fluid accumulates in the soft tissues within the canal. Patients do NOT wear a splint 24 hours a day —-this is another fallacy and can cause other physical problems. We DO encourage them to change their routine in the future and rest from repetitive activities. “Other options to treat mild symptoms include the use of non-steroid anti inflammatory drugs (NSAIDS) like Ibuprofen or Advil.

“There is a small amount of medical data that suggests high doses of Vitamin B6 may be helpful, acting as a physiological diuretic to decrease the swelling of the tendon sheaths. This shouldn’t be confused with other diuretics, such as those taken by heart patients. “An injection of corticosteroids such as cortisone within the carpal tunnel itself can relieve pain quickly by reducing tendon swelling. This “frees up space” to allow more room for the median nerve in the carpal tunnel and frequently, that resolves the problem.

However, this is a limited treatment option, and I recommend no more than two injections, about 6 months apart. “For patients whose symptoms don’t respond to these conservative treatments and those with a significantly positive nerve conductive study I recommend a minor surgical procedure called endoscopic carpal tunnel release to relieve the pressure on the nerve. This is a painless and very effective treatment.

Tips to improve your workstation:

· Arrange your work so you can sit or stand comfortably in a position that does not put stress on any specific area of your body. You should be able to keep your neck in a neutral position and minimize the need to look up or to the sides continuously while you are working.
· Eliminate most movement from your waist. Keep the workstation and workstation tools within reach without having to lean, bend, or twist at the waist frequently.
· Vary postures if possible.
· Take 10- to 15-second breaks frequently throughout your task. For example, look away from your computer monitor, stand up, or stretch your arms. Short breaks reduce eyestrain and buildup of muscle tension.
· Stretch your body by getting up out of your chair and stretching your arms, shoulders, back, and legs. When you are sitting, shrug and relax your shoulders.
· Maintain good health through regular exercise, proper nutrition, not smoking, and following prescribed treatment for any other health conditions you may have. Exercise has been proven to be an effective method of preventing back and neck pain.
If you do similar work or activities at home, be sure to apply these principles there as well to eliminate any cumulative effect of repetitive motions.

What kinds of injuries occur in the office?

Most problems that occur in the office are caused by physical stress, such as prolonged awkward positions, repetitive motions, and overuse. These injuries can cause stress and strain on muscles, nerves, tendons, joints, blood vessels, or spinal discs. Symptoms include fatigue and hand, wrist, arm, shoulder, neck, or back pain. You may also be at risk for conditions such as tendinopathy and bursitis, which are caused by overuse and repetitive motions. Ultimately, physical stress decreases your overall well-being, may cause chronic health problems, and uses up your sick time.
You may be at greater risk for workplace injuries if you have other health conditions, such as arthritis or mental or emotional stress.

Purpose of Office Ergnomics

Injury and illness are common in the workplace and costly to both you and your employer. Not only do they reduce your quality of life, but they also reduce your ability to be efficient and productive. In one study, over half of employees who used computers for at least 15 hours per week in their first week of a new job reported musculoskeletal problems.Most job-related injuries are caused by falls, repetitive movements, awkward postures, reaching, bending over, lifting heavy objects, applying pressure or force, or working with vibrating tools. Office ergonomics can help you be more comfortable at work while reducing stress and injury caused by awkward positions and repetitive tasks.
Office ergonomics focuses on your workstation arrangement-the placement of equipment such as your desk, computer monitor, chair, computer keyboard, mouse, and telephone. An ergonomic evaluation examines:
Your workstation setup, relative to your posture, length of time in a position or doing a particular task, types of movements, or repetition of movements.
Your job surroundings, including the work surface, lighting, noise level, temperature, and humidity.
Your job tools. This includes any device used to perform your job duties, such as a computer mouse or scanning machines.

What is ergonomics?

Ergonomics is the study of how your body interacts with your environment when you perform a task or activity. Ergonomics often involves arranging your environment-including equipment, tools, lighting, and how you do a task-to fit you and the activity you are doing. Office ergonomics focuses on arranging your work environment to fit your needs while you do your job.
When your workstation is set up properly, you may be less likely to have problems such as headaches or eyestrain, possibly reduce neck and back pain, and perhaps prevent conditions such as carpal tunnel syndrome that can be related to repetitive activities. Whether or not your workstation is causing physical problems, a workstation that is properly set up can increase your productivity and quality of work life.

Using Computer Doesn't Increase Risk Of Carpal Tunnel Syndrome, Study Finds

Using a computer at work doesn't increase your chances of developing carpal tunnel syndrome, according to a study published in the June 12 issue of Neurology, the scientific journal of the American Academy of Neurology.

"We wanted to do this study because conventional wisdom says that using a computer increases your risk of developing carpal tunnel, but few studies have been done to see how often carpal tunnel actually occurs in computer users," said study author and neurologist J. Clarke Stevens, MD, of the Mayo Clinic in Rochester, Minn.
Stevens said most of the studies showing that repetitive motion causes carpal tunnel involve workers in meatpacking plants or other industrial jobs, not computer users.

This study examined 257 employees at the Mayo Clinic in Scottsdale, Ariz., who used a computer frequently in their jobs. "Many of the computer users in the study had experienced feelings of numbness or 'pins and needles' in their hands, but the percentage who actually met the medical criteria for carpal tunnel syndrome was similar to other estimates of how often carpal tunnel occurs in the general public," Stevens said.

For the study, researchers sent a questionnaire to employees who used computers for much of their jobs, such as secretaries and transcriptionists. They reported using the computer for an average of six hours per day. Of the 257 people studied, 30 percent said they had experienced pins and needles sensations or numbness in their hands.
Those people then completed a questionnaire on carpal tunnel symptoms and a diagram to show where their symptoms occurred to determine whether they met the clinical criteria for carpal tunnel syndrome. Twenty-seven people met the criteria, or 10.5 percent of the original study group.
Stevens said those who had symptoms of numbness or tingling but did not have carpal tunnel had mild symptoms that occurred briefly. Some may have had problems with another nerve in the arm, the ulnar nerve. Carpal tunnel affects the median nerve.
The researchers then tested the nerves of those who met the criteria to see if electrodiagnostic laboratory tests would confirm the diagnosis.

The nerve conduction studies confirmed the diagnosis in nine people, or 3.5 percent of the 257 study participants.
"These percentages are similar to percentages found in other studies looking at how often carpal tunnel occurs in the general population -- not just computer users," Stevens said.
The researchers also found no significant differences between the computer users who had carpal tunnel and those who did not.

"They had similar occupations, number of years using the computer and number of hours using the computer during the day," Stevens said. "So there were no differences that might point to computer use as a factor in causing carpal tunnel." Stevens said the results shouldn't be interpreted to mean that the repetitive motions involved in using a computer can never lead to problems for people.

"There are a lot of aches and pains associated with using a computer," he said. "We just found that, at least in this group, frequent computer use doesn't seem to cause carpal tunnel syndrome." Additional studies with large groups of people should be done to see if these results can be confirmed, Stevens said.

Organizations that can help with work related illnesses

Occupational Safety and Health Administration (OSHA), U.S. Department of Labor
200 Constitution Avenue, N.W.
Washington, DC 20210
Phone:
(202) 693-19991-800-321-OSHA (1-800-321-6742)
TDD:
1-877-889-5627
Web Address:
http://www.osha.gov

The Occupational Safety and Health Administration (OSHA) provides information on hazards at the workplace and worker safety.

National Institute for Occupational Safety and Health (NIOSH)
200 Independence Avenue, S.W.
Suite 715-H
Washington, DC 20201
Phone:
1-800-35-NIOSH (1-800-356-4674)
Fax:
(513) 533-8573
Web Address:
http://www.cdc.gov/niosh

The National Institute for Occupational Safety and Health (NIOSH) conducts research and makes recommendations for the prevention of work-related injuries and illnesses. NIOSH also provides information to the public.

American Physical Therapy Association
1111 North Fairfax Street
Alexandria, VA 22314
Phone:
1-800-999-2782(703) 684-2782
Fax:
(703) 684-7343
Web Address:
http://www.apta.org

The American Physical Therapy Association provides information and education to the public about physical therapy and how it is used to treat certain conditions.

What is carpal tunnel syndrome?

Carpus is a word derived from the Greek word "karpos" which means "wrist." The wrist is surrounded by a band of fibrous tissue which normally functions as a support for the joint. The tight space between this fibrous band and the wrist bone is called the carpal tunnel. The median nerve passes through the carpal tunnel to receive sensations from the thumb, index, and middle fingers of the hand. Any condition that causes swelling or a change in position of the tissue within the carpal tunnel can squeeze and irritate the median nerve. Irritation of the median nerve in this manner causes tingling and numbness of the thumb, index, and the middle fingers, a condition known as "carpal tunnel syndrome."

Key points to preventing CTS

Many health conditions and diseases make you more likely to get carpal tunnel symptoms. But if you exercise, maintain a healthy weight, control other health conditions such as arthritis and diabetes, and avoid smoking, you can help prevent carpal tunnel syndrome.
Arranging your activity and work space using ergonomic guidelines can help prevent carpal tunnel syndrome. Office ergonomics focuses on how a workstation is set up, including the placement of your desk, computer monitor, paperwork, chair, and associated tools, such as a computer keyboard and mouse. The same ideas can help you arrange your position for other daily activities.
Proper body mechanics are key to preventing carpal tunnel syndrome.
Evaluate your daily routine for activities that increase your risk of carpal tunnel syndrome.
Take frequent breaks from activities to rest, stretch, change positions, or alternate with another activity.

Carpal Tunnel Syndrome Overview

Carpal tunnel is a disease of the hand characterized by numbness, tingling, pain, and weakness. The disease typically affects the thumb, index, and middle fingers and is often particularly troublesome at night. A major nerve, specifically the median nerve, travels down the arm and enters the hand through the carpal tunnel, which is located in the central part of the wrist. In people with carpal tunnel syndrome, pressure in the carpal tunnel is higher than in unaffected people, and median nerve irritation occurs.

Many conditions can cause increased pressure within the carpal tunnel and lead to carpal tunnel syndrome. Carpal tunnel syndrome was first described with broken wrists. A broken wrist can cause bleeding and swelling within the carpal tunnel leading to increased pressure within the carpal tunnel. Most people with carpal tunnel syndrome have no identifiable cause. It affects almost 5% of the population and is most common in middle-aged women. Carpal tunnel syndrome is diagnosed based on the complaints of the individual combined with physical tests and often electrical studies. No single test is definitive for diagnosis of carpal tunnel syndrome. Instead, the person's complaints and test findings together lead to its diagnosis.

How Is It Diagnosed and Treated?

Did you ever wake up and your hand is still asleep — all numb and giving you pins and needles? That's what it can feel like to have CTS. One way to tell if you have CTS is to check if your pinky is also numb. It won't be in a person with CTS. A doctor who suspects CTS will listen to the person's symptoms and then do a wrist examination. By tapping on the person's wrists, the doctor is often able to tell whether the problem is CTS.

A brace or splint can help mild cases of CTS. It is usually worn at night and keeps a person's wrists from bending. Keeping the wrist straight opens the carpal tunnel so the nerve has as much room as possible. Resting the wrist will allow the swollen tendons to shrink. Medicines like ibuprofen can also help reduce the swelling.

In more severe cases, your doctor may recommend cortisone to reduce inflammation and swelling in the carpal tunnel. This medicine is given by a shot, or injection. When the symptoms of CTS have improved, the doctor may suggest the person do wrist exercises and make changes that can prevent further problems, such as repositioning the computer and keyboard.

If none of these treatments help, the person may need surgery to release the pressure on the median nerve. This surgery takes less than an hour and usually doesn't require a stay overnight in the hospital. Very few people are permanently injured by CTS. Most can get better and take steps to prevent the symptoms from returning.

· Many health conditions and diseases make you more likely to get carpal tunnel symptoms. But if you exercise, maintain a healthy weight, control other health conditions such as arthritis and diabetes, and avoid smoking, you can help prevent carpal tunnel syndrome.
· Arranging your activity and work space using ergonomic guidelines can help prevent carpal tunnel syndrome. Office ergonomics focuses on how a workstation is set up, including the placement of your desk, computer monitor, paperwork, chair, and associated tools, such as a computer keyboard and mouse. The same ideas can help you arrange your position for other daily activities.
· Proper body mechanics are key to preventing carpal tunnel syndrome.
· Evaluate your daily routine for activities that increase your risk of carpal tunnel syndrome.
· Take frequent breaks from activities to rest, stretch, change positions, or alternate with another activity.

Simple steps is all it takes

If you spend a lot of time doing activities that involve forceful or repetitive finger or wrist movement or use of vibrating equipment, you have an increased risk of developing carpal tunnel syndrome (CTS). These activities can include driving, using a keyboard, working with small instruments, knitting, or using a sander. You can reduce your risk, as well as any hand pain or weakness you may already have, by taking a few simple steps. In some of my older posts I mention many exercises that are meant to prevent CTS.

What Tests Help Diagnose Carpal Tunnel Syndrome?

Two useful clinical tests for diagnosing carpal tunnel syndrome are the Tinel and Phalen maneuvers. Tingling sensations in the fingers caused by tapping on the palm side of the wrist is a positive Tinel test, whereas reproduction of symptoms by flexing the wrist is a positive Phalen test. (Dr. Phalen created this maneuver many years ago when he was a hand surgeon at The Cleveland Clinic.)
If needed, an electromyogram, which includes nerve conduction studies, is done to document the extent of nerve damage. An electromyogram is a test that measures the electrical activity in your nerves and muscles. Nerve conduction studies measure the ability of specific nerves to transmit electrical impulses or messages.
The nerve conduction studies, however, will not become positive until there is significant nerve damage. In addition, the severity of a person's symptoms is often not correlated with the findings of a nerve conduction study.

Interesting Info

What Happens in Severe Cases of Carpal Tunnel Syndrome?
When chronic irritation occurs around the median nerve, it becomes constricted and is continually pushed against the ligament above it. When the nerve is continually constricted, it can become compressed to the point that it begins to deteriorate. This results in a slowing of nerve impulses, which may cause a loss of feeling in the fingers and a loss of strength and coordination at the base of the thumb. If the condition is not treated, it could result in permanent deterioration of muscle tissue.
Do Certain Medical Conditions Make People More Likely to Develop Carpal Tunnel Syndrome?
People with rheumatoid arthritis, diabetes or other metabolic conditions like thyroid disease may be more likely to develop carpal tunnel syndrome. These conditions affect the nerves directly, making them more vulnerable to compression.

The Symptoms

What Are the Symptoms of Carpal Tunnel Syndrome?
Usually, people with carpal tunnel syndrome first notice that their fingers "fall asleep" and become numb at night. They often wake up with numbness and tingling in their hands. The feeling of burning pain and numbness may generally run up the center of the person's forearm, sometimes as far as the shoulder. As carpal tunnel syndrome becomes more severe, symptoms are noticed during the day.

CTS from WebMd

The carpal tunnel is the passageway in the wrist and is made
up of the arching carpal bones (eight bones in the wrist) and the ligament
connecting the pillars of the arch (the transverse carpal ligament). The median
nerve and the tendons that connect the fingers to the muscles of the forearm
pass through the tightly spaced tunnel.
Carpal tunnel syndrome occurs when
the median nerve becomes pinched due to swelling of the nerve or tendons or
both. The median nerve provides sensation to the palm side of the thumb, index,
middle fingers, as well as the inside half of the ring finger and muscle power
to the thumb. When this nerve becomes pinched, numbness, tingling and sometimes
pain of the affected fingers and hand may occur and radiate into the
forearm.

While there are many possible causes of carpal tunnel
syndrome, the vast majority of people with the condition have no known
cause.
However, we do know that excessive repetitive movements of the arms,
wrists or hands can aggravate the carpal tunnel bringing out the symptoms of
carpal tunnel syndrome. Untreated, this can become chronic, but when detected
early, carpal tunnel syndrome can be treated and recovery is possible in a few
months. Severe carpal tunnel syndrome can also be treated, but recovery may take
up to a year or longer and may not be complete.

source- webmd.com

Great CTS Information

Carpal tunnel is due to a compression of the median nerve as it crosses the wrist and enters the hand. At that point there is a fibrous band (flexor retinaculum ) which is non elastile and wrist swelling results in median nerve compression against the band.
It is frequently seen in females and is often worse in the morning on waking up. Other occupational causes are described including computer mouse / typing . Some diseases may present with it - especially hypothyroidism and Rheumatoid arthritis. It may be seen post pregnancy.
It is characterized by numbness / tingling / weakness in the fingers. Usually the first three fingers are affected the most , but the whole hand can be affected. It can occur bilaterally. It is worse in the morning and may be relieved by shaking the wrists.
The problem can be confirmed by a nerve conduction study - which a neurologist would do.
The therapy is : Treat the cause -ie- repetitive stress syndromes / hypothyroidism / Rheumatoid etc.. A wrist splint may be of benefit. I use the futuro wrist splint. A short course of a diuretic may help including hydochlorthiazide 12.5mg / day . If that doesn’t help...some people inject around the band - but I don’t personally recommend this. At this stage I’d rather recommend surgery, where the band is divided by a incision over the front aspect of the wrist and slightly into the palm. It is a relatively small operation and may be done under a regional anaesthetic block. A neglected severe carpal tunnel may produce wasting of the muscles in the hand and therapy can be less than perfect regarding final outcome.


What about Carpal tunnel in Rheumatoid Arthritis ?
This is a common problem in RA, and in fact often preceeds the initial presentation of the arthritis itself. The swelling of the synovium -the joint lining - at the wrist - causes the median nerve compression. Therapy of the swelling - by treating the arthritis - frequently resolves the carpal tunnel symptoms and therefore avoids the need for surgery.
Frequently asked questions of Rheumatoid arthritis patients :
If I do nothing, what is the possible scenario?
Answer -IF the CARPAL TUNNEL (CT) causes ongoing pain and weakness and it is not sorted out - ie for months to years -( the length of time varies depending on the severity of the compression and symptoms ) - permanent pain and weakness can follow as the nerve becomes permanently damaged despite release. However if your symptoms are mild and there are no signs of neurological benefit.... then you can observe progress without an urgent need for surgery.
Can I simply learn to live with it?
Answer - as long as you dont have WEAKNESS in the fingers from paralysis or numbness - suggesting significant compression to the nerve. If its ONLY symptoms of discomfort - you can.
Will the RA make it worse
Yes - the cause -IS the swelling at the wrist obstructing the nerve.
CAN I USE ANY OTHER THERAPY: (I know you meant to ask this)
YES- YOU CAN : If a splint and medications haven't helped - Ask your doc about a wrist joint injection of corticosteroid and local anaesthetic. That will usually get the swelling down and thereby help the carpal tunnel.

source-arthritis.co.ca

At a glance... CTS

Carpal Tunnel Syndrome At A Glance

Carpal tunnel syndrome is caused by irritation of the median nerve at the wrist. Any condition that exerts pressure on the median nerve can cause carpal tunnel syndrome. Symptoms of carpal tunnel syndrome include numbness and tingling of the hand. Diagnosis of carpal tunnel syndrome is suspected based on symptoms, supported by physical examination signs, and confirmed by nerve conduction testing. Treatment of carpal tunnel syndrome depends on the severity of symptoms and the underlying cause.

CTS treatment

How is carpal tunnel syndrome treated?

The choice of treatment for carpal tunnel syndrome depends on the severity of the symptoms and any underlying disease which might be causing the symptoms.
Initial treatment usually includes rest, immobilization of the wrist in a splint, and occasionally ice application. Patients whose occupations are aggravating the symptoms should modify their activities. For example, computer keyboards and chair height may need to be adjusted to optimize comfort. These measures, as well as periodic resting and range of motion stretching exercise of the wrists can actually prevent the symptoms of carpal tunnel syndrome that are caused by repetitive overuse. Underlying conditions or diseases are treated individually. Fractures can require orthopedic management. Obese individuals will be advised regarding weight reduction. Rheumatoid disease is treated with measures directed against the underlying arthritis. Wrist swelling that can be associated with pregnancy resolves in time after delivery of the baby!
Several types of medications have been used in the treatment of carpal tunnel syndrome. Vitamin B6 (pyridoxine) has been reported to relieve some symptoms of carpal tunnel syndrome, although it is not known how this medication works. Nonsteroidal anti-inflammatory drugs can also be helpful in decreasing inflammation and reducing pain. Side effects include gastrointestinal upset and even ulceration of the stomach. These medications should be taken with food and abdominal symptoms should be reported to the doctor. Corticosteroids can be given by mouth or injected directly into the involved wrist joint. They can bring rapid relief of the persistent symptoms of carpal tunnel syndrome. Side effects of these medications when given in short courses for carpal tunnel syndrome are minimal. However, corticosteroids can aggravate diabetes and should be avoided in the presence of infections.
Most patients with carpal tunnel syndrome improve with conservative measures and medications. Occasionally, chronic pressure on the median nerve can result in persistent numbness and weakness. In order to avoid serious and permanent nerve and muscle consequences of carpal tunnel syndrome, surgical treatment is considered. Surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. This surgical procedure is called "carpal tunnel release." It can now be performed with a small diameter viewing tube, called an arthroscope, or by open wrist procedure. After carpal tunnel release, patients often undergo exercise rehabilitation. Though it is uncommon, symptoms can recur.

CTS glossary-part 3

Chronic: This important term in medicine comes from the Greek chronos, time and means lasting a long time.
Condition: The term "condition" has a number of biomedical meanings including the following:
An unhealthy state, such as in "this is a progressive condition."
A state of fitness, such as "getting into condition."
Something that is essential to the occurrence of something else; essentially a "precondition."
As a verb: to cause a change in something so that a response that was previously associated with a certain stimulus becomes associated with another stimulus; to condition a person, as in behavioral conditioning.
Diabetes: Refers to diabetes mellitus or, less often, to diabetes insipidus . Diabetes mellitus and diabetes insipidus share the name "diabetes" because they are both conditions characterized by excessive urination (polyuria).
Diagnosis: 1 The nature of a disease ; the identification of an illness. 2 A conclusion or decision reached by diagnosis. The diagnosis is rabies . 3 The identification of any problem. The diagnosis was a plugged IV.
Disease: Illness or sickness often characterized by typical patient problems (symptoms) and physical findings (signs). Disruption sequence: The events that occur when a fetus that is developing normally is subjected to a destructive agent such as the rubella (German measles) virus. Elbow: The juncture of the long bones in the middle portion of the arm. The bone of the upper arm (humerus) meets both the ulna (the inner bone of the forearm) and radius (the outer bone of the forearm) to form a hinge joint at the elbow. The radius and ulna also meet one another in the elbow to permit a small amount of rotation of the forearm. The elbow therefore functions to move the arm like a hinge (forward and backward) and in rotation (outward and inward). The biceps muscle is the major muscle that flexes the elbow hinge, and the triceps muscle is the major muscle that extends it. The primary stability of the elbow is provided by the ulnar collateral ligament, located on the medial (inner) side of the elbow. The outer bony prominence of the elbow is the lateral epicondyle, a part of the humerus bone. Tendons attached to this area can be injured, causing inflammation or tendonitis (lateral epicondylitis, or tennis elbow). The inner portion of the elbow is a bony prominence called the medial epicondyle of the humerus. Additional tendons from muscles attach here and can be injured, likewise causing inflammation or tendonitis (medial epicondylitis, or golfer's elbow).

Who is at risk of developing carpal tunnel syndrome?

Women are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain. Persons with diabetes or other metabolic disorders that directly affect the body's nerves and make them more susceptible to compression are also at high risk. Carpal tunnel syndrome usually occurs only in adults.

The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job, but is especially common in those performing assembly line work - manufacturing, sewing, finishing, cleaning, and meat, poultry, or fish packing. In fact, carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel. A 2001 study by the Mayo Clinic found heavy computer use (up to 7 hours a day) did not increase a person's risk of developing carpal tunnel syndrome.

During 1998, an estimated three of every 10,000 workers lost time from work because of carpal tunnel syndrome. Half of these workers missed more than 10 days of work. The average lifetime cost of carpal tunnel syndrome, including medical bills and lost time from work, is estimated to be about $30,000 for each injured worker.

CTS glossary-part 2

Chronic: This important term in medicine comes from the Greek chronos, time and means lasting a long time. See the entire definition of Chronic
Condition: The term "condition" has a number of biomedical meanings including the following:
An unhealthy state, such as in "this is a progressive condition."
A state of fitness, such as "getting into condition."
Something that is essential to the occurrence of something else; essentially a "precondition."
As a verb: to cause a change in something so that a response that was previously associated with a certain stimulus becomes associated with another stimulus; to condition a person, as in behavioral conditioning.
Diabetes: Refers to diabetes mellitus or, less often, to diabetes insipidus . Diabetes mellitus and diabetes insipidus share the name "diabetes" because they are both conditions characterized by excessive urination (polyuria). See the entire definition of Diabetes
Diagnosis: 1 The nature of a disease ; the identification of an illness. 2 A conclusion or decision reached by diagnosis. The diagnosis is rabies . 3 The identification of any problem. The diagnosis was a plugged IV. See the entire definition of Diagnosis
Disease: Illness or sickness often characterized by typical patient problems (symptoms) and physical findings (signs). Disruption sequence: The events that occur when a fetus that is developing normally is subjected to a destructive agent such as the rubella (German measles) virus. Elbow: The juncture of the long bones in the middle portion of the arm. The bone of the upper arm (humerus) meets both the ulna (the inner bone of the forearm) and radius (the outer bone of the forearm) to form a hinge joint at the elbow. The radius and ulna also meet one another in the elbow to permit a small amount of rotation of the forearm. The elbow therefore functions to move the arm like a hinge (forward and backward) and in rotation (outward and inward). The biceps muscle is the major muscle that flexes the elbow hinge, and the triceps muscle is the major muscle that extends it. The primary stability of the elbow is provided by the ulnar collateral ligament, located on the medial (inner) side of the elbow. The outer bony prominence of the elbow is the lateral epicondyle, a part of the humerus bone. Tendons attached to this area can be injured, causing inflammation or tendonitis (lateral epicondylitis, or tennis elbow). The inner portion of the elbow is a bony prominence called the medial epicondyle of the humerus. Additional tendons from muscles attach here and can be injured, likewise causing inflammation or tendonitis (medial epicondylitis, or golfer's elbow). See also: Elbow bursitis ; Elbow pain ; Nursemaid's elbow. See the entire definition of Elbow
Electromyogram: A test used to record the electrical activity of muscles. When muscles are active, they produce an electrical current that is usually proportional to the level of muscle activity. An electromyogram (EMG) is also called a myogram. See the entire definition of Electromyogram
Extremity: The extremities in medical language are not freezing cold or scorching heat but rather the uttermost parts of the body. The extremities are simply the hands and feet. See the entire definition of Extremity
Foot: The end of the leg on which a person normally stands and walks. The foot is an extremely complex anatomic structure made up of 26 bones and 33 joints that must work together with 19 muscles and 107 ligaments to execute highly precise movements. At the same time the foot must be strong to support more than 100,000 pounds of pressure for every mile walked. Even small changes in the foot can unexpectedly undermine its structural integrity and cause pain with every step. See the entire definition of Foot
Forearm: The portion of the upper limb from the elbow to the wrist. See the entire definition of Forearm
Gastrointestinal: Adjective referring collectively to the stomach and small and large intestines. See the entire definition of Gastrointestinal
Hormone: A chemical substance produced in the body that controls and regulates the activity of certain cells or organs. See the entire definition of Hormone
Hypothyroid: Deficiency of thyroid hormone which is normally made by the thyroid gland which is located in the front of the neck:
Inflammation: A basic way in which the body reacts to infection , irritation or other injury, the key feature being redness, warmth, swelling and pain . Inflammation is now recognized as a type of nonspecific immune response . See the entire definition of Inflammation
Joint: A joint is the area where two bones are attached for the purpose of motion of body parts. A joint is usually formed of fibrous connective tissue and cartilage. An articulation or an arthrosis is the same as a joint. See the entire definition of Joint
Leukemia : Cancer of the blood cells. The growth and development of the blood cells are abnormal. Strictly speaking, leukemia should refer only to cancer of the white blood cells (the leukocytes) but in practice it can apply to malignancy of any cellular element in the blood or bone marrow, as in red cell leukemia (erythroleukemia). See the entire definition of Leukemia
Median: The middle. Like the median strip in a highway.
Medication: 1. A drug or medicine. 2. The administration of a drug or medicine. (Note that "medication" does not have the dangerous double meaning of "drug.")
Mouth: 1. The upper opening of the digestive tract, beginning with the lips and containing the teeth, gums, and tongue. Foodstuffs are broken down mechanically in the mouth by chewing and saliva is added as a lubricant. Saliva contains amylase, an enzyme that digests starch. 2. Any opening or aperture in the body. The mouth in both senses of the word is also called the os, the Latin word for an opening, or mouth. The o in os is pronounced as in hope. The genitive form of os is oris from which comes the word oral.
Multiple myeloma: A malignancy of plasma cells (a form of lymphocyte) that typically involves multiple sites within the bone morrow and secretes all or part of a monoclonal antibody . Also called plasma cell myeloma.

CTS glossary

Abdominal: Relating to the abdomen, the belly , that part of the body that contains all of the structures between the chest and the pelvis . The abdomen is separated anatomically from the chest by the diaphragm , the powerful muscle spanning the body cavity below the lungs . See the entire definition of Abdominal
Abnormal: Not normal. Deviating from the usual structure, position, condition, or behavior. In referring to a growth, abnormal may mean that it is cancerous or premalignant (likely to become cancer ). See the entire definition of Abnormal
Amyloidosis : A disorder that results from the abnormal deposition of a particular protein, called amyloid, in various tissues of the body. Amyloid protein can be deposited in a localized area, and not be harmful, or in can cause serious changes in virtually any organ of the body. See the entire definition of Amyloidosis
Analogous: In anatomy, similar in appearance or function but otherwise different. Two structures may be analogous if they serve the same purpose but differ evolutionary in origin as, for example, human and insect legs. As compared to homologous.
Analysis: A psychology term for processes used to gain understanding of complex emotional or behavioral issues. See the entire definition of Analysis
Anatomy: The study of form. Gross anatomy involves structures that can be seen with the naked eye. It is as opposed to microscopic anatomy (or histology) which involves structures seen under the microscope. Traditionally, both gross and microscopic anatomy have been studied in the first year of medical school in the U.S. The most celebrated textbook of anatomy in the English-speaking world is Gray's Anatomy, still a useful reference book. The word "anatomy" comes from the Greek ana- meaning up or through + tome meaning a cutting. Anatomy was once a "cutting up" because the structure of the body was originally learned through dissecting it, cutting it up. The abbreviation for anatomy is anat.
Ankle: The ankle joint is complex. It is made up of two joints: the true ankle joint and the subtalar joint: See the entire definition of Ankle
Arthritis: Inflammation of a joint. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of arthritis. (see osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout, pseudogout).
Arthroscope: A thin flexible fiberoptic scope which is introduced into a joint space through a small incision in order to carry out diagnostic and treatment procedures within the joint. An arthroscope is about the diameter of a drinking straw. It is fitted with a miniature camera, a light source and precision tools at the end of flexible tubes. An arthroscope can be used not only for diagnostic procedures but a wide range of surgical repairs, such as debridement, or cleaning, of a joint to remove bits of torn cartilage , ligament reconstruction, and synovectomy (removal of the joint lining). All are done without a major, invasive operation, and, since arthroscopy requires only tiny incisions, many procedures can be done on an outpatient basis with local anesthetic. See the entire definition of Arthroscope
Atrophy: Wasting away or diminution. Muscle atrophy is wasting of muscle, decrease in muscle mass.

Blood: The familiar red fluid in the body that contains white and red blood cells, platelets, proteins, and other elements. The blood is transported throughout the body by the circulatory system. Blood functions in two directions: arterial and venous. Arterial blood is the means by which oxygen and nutrients are transported to tissues while venous blood is the means by which carbon dioxide and metabolic by-products are transported to the lungs and kidneys, respectively, for removal from the body.
Blood sugar: Blood glucose. See also: High blood sugar; Low blood sugar.
Bone: Bone is the substance that forms the skeleton of the body. It is composed chiefly of calcium phosphate and calcium carbonate . It also serves as a storage area for calcium, playing a large role in calcium balance in the blood.

Carpal tunnel release: A surgical procedure to relieve pressure exerted on the median nerve within the carpal tunnel (the carpal tunnel syndrome). The median nerve is pinched in the wrist as it passes through the carpal tunnel. The buildup of scar tissue inside the carpal tunnel leads to this problem. Treatment options include splinting, anti-inflammatory agents, and surgery. The surgical release is performed via a small incision using conventional surgery or a fiberoptic scope (endoscopic carpal tunnel repair).
Carpal tunnel syndrome: A type of compression neuropathy (nerve damage) caused by compression and irritation of the median nerve in the wrist. The nerve is compressed within the carpal tunnel, a bony canal in the palm side of the wrist that provides passage for the median nerve to the hand. The irritation of the median nerve is specifically due to pressure from the transverse carpal ligament. See the entire definition of Carpal tunnel syndrome

This is how it feels

How does a patient with carpal tunnel syndrome feel?Patients with carpal tunnel syndrome initially feel numbness and tingling of the hand in the distribution of the median nerve (the thumb, index, middle, and part of the fourth fingers). These sensations are often more pronounced at night and can awaken patients from sleep. The reason symptoms are worse at night may be related to the flexed-wrist sleeping position and/or fluid accumulating around the wrist and hand while lying flat. Carpal tunnel syndrome may be a temporary condition that completely resolves or it can persist and progress.

As the disease progresses, patients can develop a burning sensation, cramping and weakness of the hand. Decreased grip strength can lead to frequent dropping of objects from the hand. Occasionally, sharp shooting pains can be felt in the forearm. Chronic carpal tunnel syndrome can also lead to wasting (atrophy) of the hand muscles, particularly those near the base of the thumb in the palm of the hand.

Protecting your wrists at home

At The Factory or Home
Rest your hands frequently, especially when any tingling, numbness, pain, etc. occurs.
If a repetitive job is awkward, try to find a better way to accomplish it.
When using vibrating tools, try to insulate the vibration from your hands with gloves, padding, etc.
Alternate easy and hard tasks that use your hands.
Keep your wrist in a neutral position as much as possible, not bent or twisted.
Use your whole hand to grasp objects, not just your thumb and index finger.
Give your hand and wrist time to recover after forceful movements.
Don't carry heavy objects for long periods. Use jacks, carts, dollies, etc. whenever possible.
Increase the diameter of the handles of tools and equipment with tape, foam or other materials to help reduce the force of your grip and to spread the pressure more evenly over the hand.
Keep your hands warm to promote circulation.
Avoid sleeping on or with your hands bent at the wrist. If you experience CTS symptoms at night due to this, wrist splints may help.
Cut back or discontinue the use of tobacco products.

Ergonomic Tips

At the Office
Rest your hands frequently, especially when any tingling, numbness, pain, cramping, etc. occurs.
Try and control your mouse with the lightest possible grip.
Rest your palms, not your wrist, on a wrist-rest or the desktop.
When using a keyboard/mouse, your hands should be even or slightly lower than your elbows. An adjustable keyboard tray mounted under the desktop may be necessary.
Keep your hands in-line with your forearms as much as possible, not bent in/out or up/down at the wrist.
Rest your elbows on your chair's armrests and adjust them so the weight of your arms is supported by the armrests, not supported by your shoulders.
Use a foot rest if your feet aren't flat on the floor.
The top of your monitor should be about eye level so you aren't bending your neck up or too far down.
Sit upright so your head is above your shoulders. Don't slouch forward.
Take frequent breaks and do stretching exercises to replenish blood flow which is restricted by continuous muscle use, especially involving your hands.
Alter your posture from time to time but keep within the guidelines of correct sitting most of the time.
Sit so the natural hollow stays in your lower back. A good adjustable chair should allow this.
Position your monitor and keyboard in front of you, not to the side.
Use larger barreled pens (1/2"+ diameter) to make them easier to grasp.
Don't wear wrist splints for extended periods during the day. Some muscles may atrophy.
Don't type with long fingernails.
Cut back or discontinue the use of tobacco products.
source-thehelpinghand.com

A useful Glossary Related to CTS

Glossary of Terms

Median Nerve
a major nerve to the hand that controls the thumb, index and middle fingers
Carpal Tunnel
a passage in the wrist through which the median nerve and tendons travel to the hand, much of it located at the base of the palm
Transverse Carpal Ligament
a tough but elastic structure which holds the bones of the Carpal Tunnel together, often surgically cut to relieve pressure on the median nerve
Repetitive Strain Injuries (RSI), Cumulative Trauma Disorder (CTD), Repetitive Motion Syndrome (RMS), Occupational Overuse Syndrome (OOS)
synonymous terms for disorders caused by prolonged, repetitious tasks
Carpal Tunnel Syndrome (CTS)
pressure (or compression) on the median nerve that may cause pain, numbness, weakness, etc.
Tendonitis
inflammation of a tendon, the structures that link muscles to bones
Tenosynovitis
inflammation of a tendon's sheath which causes it to swell and may also retard proper lubrication of the tendon inducing more injury
Carpal Canal
sometimes used interchangeably with Carpal Tunnel
Ulnar Nerve
another main nerve to the hand which controls the last two fingers, it passes outside the carpal tunnel but can be affected by tennis elbow or displacement

In advanced cases of CTS

In very advanced cases, a procedure called a Carpal Tunnel Release Operation is performed. It involves cutting the Transverse Carpal Ligament and letting it heal back together. This gives more room for the soft tissues and therefore lowers the pressure. Surgery is expensive, usually requires many weeks to recover, and is far from being a guaranteed cure. However, there is another approach. Even though the transverse carpal ligament doesn't automatically stretch to accommodate swelling, it can be stretched externally. This technique can be used a preventative method, as well as, a way to help relieve symptoms before they spiral out of control.

What To Do, What To Do....

The most common first aid is to treat the cause of the swelling with drugs. By trying to reduce the swelling, the pressure is decreased and if the median nerve is not damaged, it's function can be restored. However, many times the tissues are so enlarged that drugs can't reduce their size. Another approach is to use braces. Braces keep the hand in a position that prevents the wearer from causing even more damage due to bending or twisting at the wrist with the hopes that the pressure will subside in time. Braces are often used in conjunction with drug therapies. In addition, changing the way you use your hands can be beneficial. See this Ergonomic Tips page for suggestions. Just minor changes such as lowering your keyboard height can significantly raise the threshold of effort needed to make the symptoms arise.

How CTS Happens

The Carpal Tunnel is made up of several bones connected by ligaments. The largest of which is the Transverse Carpal Ligament. These structures form the perimeter of a passage through its center called the carpal tunnel (also called the carpal canal). Through this tunnel run nerves, tendons, blood and other soft tissues. For a variety of reasons some of these soft tissues swell, especially the tendons (red) and the protective sheaths that cover them. Overuse (Repetitive Strain Injury or RSI), injuries such as sprains, friction between the tendons and their protective sheaths, fractures, fluid retention, forceful movements and infection are a few of the more common causes. However, unlike most of your body where swelling simply protrudes, this swelling has no place to expand since it is encircled by bones and ligaments. Consequently, because the swelling is contained, pressure builds in the tunnel. This pressure then crushes the main nerve to your hand called the Median Nerve, causing it not to function properly. The pressure also obstructs blood flow which retards healing and causes further cell degeneration until the cycle spirals out of control. The results are the symptoms listed above and most victims are amazed by the swiftness mild symptoms can progress into a major problem.

Carpal Tunnel

It causes sensory conduction changes in the nerves, so people perceive that their hand is numb. Sometimes, they perceive it as pain," said Dr. Peter Murray, a surgeon at the Mayo Clinic.
Murray says it may also cause weakness.

"If I was using a wrench or something, it would just slip out of my hands," Mendez said.
The treatment you choose will likely depend on the severity of your symptoms. If you've had the condition for less than 12 months, splinting, injections and time may help resolve the problem.

If symptoms have lasted longer than a year, surgery may be necessary.
During carpal tunnel release surgery, doctors make a small incision through which they cut the tight carpal ligament. This releases pressure off the nerve.
Some studies show up to 99 percent of people who have carpal tunnel surgery gain relief from symptoms.

But, Murray has shown in a recent study that results of surgery may not be as good if you're over 75 years of age, or have had carpal tunnel for a long time.
Older people may also have other conditions, such as diabetes or arthritis, that cause overlapping symptoms.
However, Mendez, who's only 58 years old, says surgery has allowed him to return to work in full force.
"
I'm back in action now," he said.
About 250,000 carpal tunnel release operations are performed each year, and almost half of those patients say their conditions are work-related.

Phalen's Maneuver

A common test for CTS is Phalen's Maneuver. Put the backs of your hands together while keeping your arms parallel to the floor and your fingers pointing down. Hold your hands together firmly. If within a minute, you experience one, or a combination, of the symptoms, you probably have the disorder. Don't hold this position for more than a minute or after any symptoms occur.

What happens if I have CTS?

Fatigue, Pain, Tingling, Weakness of Grip, Loss of Dexterity, Stiffness, Cramping, Numbness, Cold, Burning. They may often occur during or after periods of rest or sleep. In advanced cases, you may feel pain or cramping around the base of the thumb or your thumb may become nonfunctional.These symptoms often characterize the common disorder. By the time you feel any of them in your hand, wrist or arm, cell degeneration is in process and should be taken seriously. It often progresses rapidly if ignored and doesn't take years to develop as many think. Often, just a few mild instances suddenly never go away or are brought on by ever decreasing effort.

What happens if I have CTS?

Fatigue, Pain, Tingling, Weakness of Grip, Loss of Dexterity, Stiffness, Cramping, Numbness, Cold, Burning. They may often occur during or after periods of rest or sleep. In advanced cases, you may feel pain or cramping around the base of the thumb or your thumb may become nonfunctional.These symptoms often characterize the common disorder. By the time you feel any of them in your hand, wrist or arm, cell degeneration is in process and should be taken seriously. It often progresses rapidly if ignored and doesn't take years to develop as many think. Often, just a few mild instances suddenly never go away or are brought on by ever decreasing effort.

Where the name come from

Carpus is a word derived from the Greek word "karpos" which means "wrist." The wrist is surrounded by a band of fibrous tissue which normally functions as a support for the joint. The tight space between this fibrous band and the wrist bone is called the carpal tunnel. The median nerve passes through the carpal tunnel to receive sensations from the thumb, index, and middle fingers of the hand. Any condition that causes swelling or a change in position of the tissue within the carpal tunnel can squeeze and irritate the median nerve. Irritation of the median nerve in this manner causes tingling and numbness of the thumb, index, and the middle fingers, a condition known as "carpal tunnel syndrome."

Research being done on CTS

Much of the on-going research on carpal tunnel syndrome is aimed at prevention and rehabilitation. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is funding research on carpal tunnel syndrome.

Medications or Surgery?

Medications:NSAIDS (Nonsteroidal anti-inflammatory drugs) are commonly used to treat CTS. Available over the counter or by prescription, they fight inflammation or swelling and relieve pain. Cortisone injections into the area may lessen the swelling and ease pressure on the nerve.Vitamins:In some studies deficiencies of vitamin B6 have been associated with CTS. One study supported this association and, furthermore, reported that high levels of vitamin B6 were associated with fewer CTS symptoms. Further studies are needed.

Surgery:In more severe cases surgery to widen the carpal tunnel may be needed. Surgery consists of releasing the ligament that forms the tight roof of the carpal tunnel. This opens and widens the carpal tunnel allowing plenty of room for everything in it and relieving pressure on the nerve. There are several methods to do this. The standard surgery has involved a 2-3 inch incision. The newer endoscopic procedure uses a small 3/4 inch incision through which tiny instruments are inserted to perform the needed surgery. Other methods are used less often and with decreased success.

Support and exercise

Opinions vary on the use of splints and support as a CTS treatment. Working and resting splints used to be common in early, conservative treatment. Except for anecdotal reports, no evidence exists that these supports actually help. Some experts believe that wrist supports may actually increase the problem by reducing circulation and restricting movement so that the shoulder muscles tense up.

A supervised hand and wrist strengthening exercise program offered by physical or occupational therapists may be beneficial. One study found that most people with CTS felt improvement after two months of physical therapy that included exercises to improve balance and posture.

This is critical

It is critical to begin treating early phases of CTS before the damage progresses. If possible the person should avoid activities at work or home that may aggravate the condition. Conservative treatment seems to work best in men under 40 and least well in young women.The affected hand and wrist should be rested for at least two weeks; this allows the swollen, inflamed tissues to shrink and relieves pressure on the median nerve. Ice may provide relief.

CTS Diagnosis

There are many conditions that can cause symptoms similar to carpal tunnel syndrome. It is important to be examined by an orthopaedic surgeon or a neurologist, to make sure you do have carpal tunnel syndrome and not something else. A test called a nerve conduction study may be done to evaluate the flow of electricity through the median nerve. Magnetic resonance imaging (MRI) has been found to be accurate in determining the severity of CTS.There are two very simple tests that most doctors do during the initial exam. About two-thirds of individuals with CTS will have an electrical sensation when the doctor taps over the median nerve at the wrist. Another test that is more specific for CTS is reproduction of the symptoms on flexion of the wrist with the forearm held vertically.

CTS symptoms and treatment

Symptoms of carpal tunnel syndrome usually progress gradually over weeks and months and, in some cases, years. The most common symptoms are pain, numbness, and tingling in the wrist, hand, and fingers (except the little finger, which is not affected by the median nerve). There may also be a sense of weakness and a tendency to drop things.

CTS can range from a minor inconvenience to a disabling condition, depending on its cause and persistence. Many cases of CTS are mild, and some resolve on their own. Treatment will be dependent on the severity of each individual case.

What causes CTS?

Anything that causes swelling or irritation of the synovial membranes around the tendons in the carpal tunnel can result in pressure on the median nerve. Some common causes are repetitive and forceful grasping with the hands, repetitive bending of the wrist, broken or dislocated bones in the wrist, obesity, rheumatoid arthritis, thyroid problems, diabetes, hormonal changes of pregnancy and menopause.

What is CTS again?

There is a nerve called the median nerve that travels from the forearm into your hand through a "tunnel" in your wrist. Wrist bones form the bottom and sides of this tunnel; a ligament covers the top of the tunnel. This tunnel also contains nine tendons that connect muscles to bones and bend your fingers and thumb. These tendons are covered with a lubricating membrane called synovium, which may enlarge and swell under some circumstances. This swelling may cause the median nerve to be pressed up against this strong ligament which may result in numbness, tingling in your hand, clumsiness or pain.

CTS stats

Approximately 260,000 carpal tunnel release operations are performed each year and 47 percent of these are considered to be work-related.

A 1999 study reported that 14% of the population surveyed complained of symptoms such as pain, numbness, and tingling in the hands, but only one in five of these people actually had CTS.
source- arthritisinsight.com

This is why cts exercises are important

Carpal tunnel exercises should be performed at the start of each workday and after each break. These exercises decreases the amount of pressure on the median nerve in the carpal tunnel.
Workers with hand-intensive jobs should do a five-minute exercise warm-up before starting work, just as runners stretch before a run to prevent injury. In some older posts I have a lot of exercises that are to prevent carpal tunnel. I will post some more when I learn of new ones.

A single injection!

A single corticosteroid injection in the wrist can offer at least a month of relief to people suffering from severe carpal tunnel syndrome, according to an updated review of studies by Canadian researchers.Local injections are the most effective nonsurgical remedy for carpal tunnel, said Shawn Marshall, M.D., a specialist in physical medicine and rehabilitation at the University of Ottawa and lead author of the review. "One of the goals is to avoid surgery," he said.The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.Carpal tunnel syndrome is irritation of the nerve that passes from the wrist to the hand by way of the carpal tunnel. Repetitive stress commonly causes the syndrome, especially in industrial or manufacturing settings with vibrating tools. The most frequent symptoms are pain and numbness in the fingers. Severe carpal tunnel syndrome can cause permanent loss of feeling and partial paralysis in the thumb.This is the second update that Marshall and his co-authors have made since the initial publication of the review in 2000, which comprised three studies. Since then, there have been many more studies. For this update, the authors looked at a dozen studies with 671 participants.They found that a single local corticosteroid injection provided clinical improvement in symptoms at one month when compared to a single systemic injection. In two studies, patients showed significant improvement in less than one month after receiving a local corticosteroid injection when compared to receiving a placebo. Another study that compared receiving a local corticosteroid injection to taking an oral corticosteroid found greater improvement among those who received the injection as long as three months after treatment."There's building evidence to suggest that it works beyond one month," Marshall said.Injections to treat severe carpal tunnel syndrome are more common in Europe than in North America, Marshall said.Sometimes patients with very severe carpal tunnel syndrome receive corticosteroid injections although they also require future surgery. "It can work immediately," Marshall said.However, although they were more effective than oral medications, after two months, injections were no more effective than anti-inflammatory medicine, wrist splints or helium-neon laser therapy.For many years, physicians avoided local corticosteroid injections for fear of causing nerve damage, said Robert Werner, M.D., chief of physical medicine at the Ann Arbor Veterans Administration Medical Center in Michigan."I think [injections are] underutilized," said Werner, who was not involved with the study. Injections should be part of systematic approach to treating carpal tunnel syndrome, beginning with a wrist splint, he said, and if the splint does not provide relief, injections should become an option, followed finally by surgery, if necessary.Studies suggest that anti-inflammatory medicines provide little, if any, relief for the irritation symptoms, Werner said.The review did not look at the effectiveness of surgery compared to injections or the benefit of injections for treating less-than-severe carpal tunnel syndrome.Regardless of the medical or surgical treatment received, the overall treatment plan should include an ergonomic assessment of the workplace with the goal of reducing the risk of a repetitive stress injury, Marshall said. "It's a very complex picture, with many different angles."The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions.
Visit http://www.cochrane.org for more information.
Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome (Review). Cochrane Database of Systematic Reviews 2007, Issue 2.Health Behavior News ServiceCenter for the Advancement of Health 2000 Florida Ave. NW, Ste 210Washington, DC 20009United Stateshttp://www.hbns.org

very interesting article

Heavy blogging and digging on an eight-year-old OSHA legend raises interesting questions about workers' compensation.
The story goes like this: Back in 1999 Marci Lyn Deutsch, a Florida phone sex operator, supposedly won a workers' compensation settlement alleging "she was injured after regularly masturbating at work." Her lawyer Steven Slootsky had claimed, according to reports, that she developed carpal tunnel syndrome in both hands because of repetitive self-gratification while speaking on the phone to customers as often as seven times a day. Deutsch had asked her employer CFP Enterprises for "$267 a week, based on her salary of $400, plus $30,000 to cover her medical bills after neurosurgery to relieve the pain in her hands." However, the case was settled for a "minimal" amount because "mediator Joseph Hand, a retired workers' comp judge, told her she'd have a tough time" winning.
While some consider this tale to be another example of America's "I sue, you sue, we all sue" culture, it seems unfair to say that just because someone derives pleasure from her job, it is frivolous to sue for an injury caused by that pleasure. After all isn't masturbatory carpal tunnel for a legal sex worker no different than typing carpal tunnel for a secretary? On the other hand, judges and juries might not be inclined to see it that way. After all, can you imagine a porn star attempting to get cash for a sex-related stress injury? Even in Australia, where prostitution is legal, "sex workers have entitlement to workers compensation for a work-related injury," but "[i]n practice this rarely occurs."
So as ridiculous as these cases may appear on the surface, they raise an important question that I'll throw out to you readers: Should the morality of one's job be called into question when interpreting employment law?
by Emil Steiner www.washingtonpost.com

Helping hands with CTS

COLUMBIA - Doctors say carpal tunnel results in more than two million visits to the doctor's offices each year.
In this week's Your Health with Angie Bailey, we take a look at a local doctor who's lending a helping hand.
A lot of those who have carpal tunnel don't know the early symptoms. The most common symptom is that your hands and fingers become numb and tingly while you're sleeping, causing you to wake up frequently during the night.
Dr. Matt Anderson has been an orthopedic surgeon at MU since June. He's an expert on relieving pressure for those with questions about carpal tunnel syndrome.
"I hope that people can come away with a basic understanding of the anatomy and causes of carpal tunnel syndrome and what kind of symptoms are related to that, so that they know when its appropriate to seek medical attention from a doctor," Anderson said.
Lisa Crowley helped coordinate the event and says information like this is important to the community.
"We like to go out to the community and present our orthopedic surgeons and give them an opportunity to see what type of services we do provide," said Crowley of MU Health Care.
Dr. Anderson hopes that having an open forum will help people better understand treatments.
"The simplest forms of treatment are activity modification, wearing a splint at night, sometimes trying an anti-inflammatory medicine, but as the severity of symptoms increases, we tend to need more things, such as injections, or sometimes surgery," Anderson said.
Dr. Anderson says surgery has advanced enough that now most people can return to work one to two days later.
Taken from www.ehand.com:
Symptoms usually start gradually with frequent burning, tingling, or itching. This is usually accompanied by numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent.
The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to "shake out" the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks.
In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to differentiate between hot and cold by touch.
Women are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain. People with diabetes or other metabolic disorders that directly affect the body's nerves and make them more susceptible to compression are also at high risk.
Carpal tunnel syndrome usually occurs only in adults. The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job. However, it is especially common in those performing assembly line work such as manufacturing, sewing, finishing, cleaning, and meat, poultry, or fish packing. In fact, carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel. A 2001 study by the Mayo Clinic found heavy computer use (up to 7 hours a day) did not increase a person's risk of developing carpal tunnel syndrome.
During 1998, an estimated three of every 10,000 workers lost time from work because of carpal tunnel syndrome. Half of these workers missed more than 10 days of work. The average lifetime cost of carpal tunnel syndrome, including medical bills and lost time from work, is estimated to be about $30,000 for each injured worker.
Reported by:: Shayla Krile source- komu.com

Interesting news release!

"Carpal Tunnel Syndrome is now thought to be acquired mainly through genetics and biology rather than repetitive hand movement. Chiropractic care can help treat and prevent this ailment.
(AddPR) Carpal Tunnel Syndrome is the most common reported medical problem in the workplace, according to the U.S. Bureau of Labor and Statistics. It accounts for well over half of work related injuries and results in a median time away from work of 7 days, according to the Carpal Tunnel Syndrome Bureau of Labor Statistics Reports.How much does this ailment cost Americans in medical treatment and lost income? A staggering $27 billion per year, according to the American Academy of Orthopedic Surgeons!Dr. Mitchell Shea, a chiropractor in Cookeville, Tennessee and owner of Shea Chiropractic, aims at educating his patients about Carpal Tunnel Syndrome. He said, "Traditionally, Americans think the main cause of Carpal Tunnel to be repetitive hand use. New research indicates that biology and genetics actually play a larger role than ever expected."There are certain groups that are genetically more susceptible to developing Carpal Tunnel Syndrome. "It is almost like some people are preselected to be in a group of likely sufferers. Women, for example, are about 5 times more likely to suffer from it than men," said Dr. Shea. While opinions about the cause of Carpal Tunnel Syndrome have changed, treatment remains the same. Chiropractic is one of the primary choices for non-invasive treatment. Some treatments used at Shea Chiropractic include: manipulation, nutritional supplements, electro-acupuncture, the use of a splint, hand exercises, and therapies such as ice, ultrasound, and electrical stimulation. Dr. Mitchell Shea, D.C. has had great success in treating patients without the use of surgery. He urges patients to seek treatment while symptoms remain minimal, especially if there has been any history of it in the family.Often times, chiropractic offices, such as Shea Chiropractic will offer a discounted consultation or in some cases offer it free of charge. Contact your local D.C. if you have any questions about prevention and treatment of Carpal Tunnel Syndrome.
About Us: Shea Chiropractic is a family chiropractic center.
Contact Info: Dr. Mitchell SheaShea Chiropractic"

Surprising news!

Dr. Jeffrey Greenberg, an orthopedic hand surgeon at the Indiana Hand Center and a spokesman for the American Academy of Orthopaedic Surgeons, discusses carpal tunnel syndrome.
Question: What symptoms suggest you have carpal tunnel syndrome?
Answer: Carpal tunnel is a condition that causes numbness and tingling of the fingers of the hand. Classically, it involves the thumb, index finger, middle finger and the half of the ring finger that's closer to the thumb. It's caused by pressure on the median nerve, which runs in a relatively confined space at the wrist that also holds the nine tendons that bend your fingers.
One reason we think people get carpal tunnel is that the lining of the tendons becomes thicker, and that puts pressure on the nerve. There are many conditions that can cause that: age, diabetes, an underactive thyroid, pregnancy and inflammatory conditions like rheumatoid arthritis. The majority of people have idiopathic carpal tunnel in which we can't find an underlying cause.
Q: Is it more common today?
A: I think we're diagnosing it a lot more frequently, but I'm not sure that the frequency in the population is any greater.
There are some job activities that we do know can cause it, where vibration is generated and translated to the hand, like drillers, grinders, people who use power washers and weed eaters.
Q: How do you treat this?
A: The first thing we try to do is identify if a particular activity is causing the symptoms. With vibratory stimulation, we'll sometimes use a specially designed glove that has material in it to dampen vibration. We'll also use splints and injections of medicine, like steroids. The ultimate treatment, which is very effective, is surgery.
Q: Does technology play a role?
A: There's nothing scientific that shows that carpal tunnel is directly correlated to the usage we would typically associate with it, such as computer or keyboard. A recent study looked at computer programming and office work. We don't have any scientific evidence that shows those things cause carpal tunnel syndrome.
There is some evidence from epidemiological studies that shows other factors are more important, such as age, race and genetics. From an epidemiologic standpoint, these factors were twice as strong as repetitive hand use.
It's an interesting thing that we're learning. We have this entrenched in our society, if you work on a computer, you're going to get carpal tunnel, whereas there are other factors.

Contact Info

For more information on carpal tunnel syndrome, contact the:
-- National Women's Health Information Center, 800-994-9662;
-- National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse, 301-495-4484, 877-226-4267 or www.niams.nih.gov;
-- National Institute of Neurological Disorders and Stroke, 301-468-5981, 800-352-9424 or www.ninds.nih.gov;
-- National Institute for Occupational Safety and Health, 513-533-8471, 800-356-4674 or www.cdc.gov/niosh/pubs.html;
-- American Academy of Orthopaedic Surgeons, 847-823-7186, 800-346-2267 or www.aaos.org;
-- American Chronic Pain Association, 916-632-0922 or www.theacpa.org;
-- American Society for Surgery of the Hand, 404-523-8821 or www.hand-surg.org.

Treatment options

If you develop carpal tunnel, see a doctor to avoid permanent damage to the nerves and muscles of the hand and thumb. Trust me, this is a very important step. Treatment options include:
-- Physical therapy to strengthen the wrist and hand; yoga, ultrasound, chiropractic manipulation and acupuncture to reduce symptoms; massage to relieve pain, slow CTS progression and boost grip strength, according to a report by University of Miami School of Medicine researchers published in the Journal of Bodywork and Movement Therapies.
-- A wrist splint, worn round-the-clock or only at night within three months of symptoms to support and brace the wrist until the nerves and tendons recover.
-- An occasional rest from the repetitive motion to reduce or eliminate mild symptoms.
-- Temporary use of nonsteroidal anti-inflammatory drugs -- aspirin, ibuprofen and other non-prescription pain relievers -- to help control discomfort. In severe cases, it may take a cortisone injection or corticosteroids pill to reduce swelling. Diabetics should be aware long-term corticosteroid use can make controlling insulin levels more difficult.
CTS surgery, one of the most common procedures performed in the United States, is usually reserved for severe cases after other treatments have failed for at least six months.

Keep your hands warm

Government and other scientists recommend taking steps to prevent carpal tunnel syndrome, including:
-- Change your work environment to lessen the stress and strain on the wrist and hand. Make sure the workspace and equipment are at the right height and distance for the hands and wrist. For computer users, the keyboard should be placed high enough to permit the wrist to rest comfortably without bending. For most people, the workspace should be some 27 to 29 inches above the floor. Keep your elbows close to your sides as you type to reduce the strain on your forearm. Maintain good posture and wrist position.
-- Take a 10-to-15-minute break every hour to give your hands and wrists time to rest and recover.
-- Vary your tasks, avoiding repetitive motions, or at least breaking them up each hour with movements that work different muscles.
-- Relax your grip, unwind your muscles and practice gentle, loose hand and wrist motions to avoid stress and tension that can strain and irritate muscle.
-- Exercise, flexing and bending the wrists and hands in the opposite direction from the repetitive movement. A sample: after typing, make a tight fist, hold, stretch the fingers, hold, repeat several times.
-- Keep your hands warm, even if you have to wear fingerless gloves during work.

Bad news for us women

According to the Department of Health and Human Services, women are three times as likely as men to suffer from CTS, perhaps because their wrist bones tend to be smaller, creating a tighter space through which the nerves and tendons must pass. Their genetic makeup may also increase the likelihood of musculoskeletal injuries, and their hormonal changes during pregnancy and menopause may make them more susceptible. CTS also can be brought on or exacerbated by a misalignment of the carpal bones and wrist, trauma to the wrist, arthritis, gout, neck and shoulder problems and tumors.

How to tell...

Carpal Tunnel Syndrome is characterized by:
-- An ache in the wrist that may move into the hand or forearm;
-- Swelling in the wrist and hand;
-- Numbness, burning or tingling in the hand and fingers;
-- Increased pain when moving the hand or wrist;
-- Weakness in the thumb and first three fingers;
-- Loss of strength and difficulty gripping objects;
-- Pain in the wrist, palm or forearm;
-- Pronounced pain and/or numbing during sleep;
-- Muscle atrophy.

You are at risk if:

If you're performing jobs or participating in activities that require repetitive hand movements, you might be at risk for developing carpal tunnel syndrome. The condition, caused by inflammation and irritation in the narrow groove formed by eight small bones and tissue in the wrist, affects an estimated 3.7 percent of the U.S. population, or some 8.1 million individuals. Those most susceptible to the potentially debilitating ailment include mechanics, cashiers, carpenters, grocery store checkers, manufacturing or assembly-line workers, violinists, gardeners, golfers and knitters. Heavy computer use and typing also are suspected of bringing on CTS.