Many people believe they suffer carpal tunnel syndrome because they sit at a computer all day. But, that might not be to blame.
Seven's on call with Dr. Jay Adlersberg.
If you're spending long hours at the keyboard, you've probably thought of carpal tunnel syndrome at one time or another.
But think again. Experts now say those long hours of typing are only one part of the reason people get a painful hand injury.

Carpal tunnel refers to an area of the wrist that basically becomes inflamed and painful. It gets worse over time if not taken care of requires surgery. But before you blame the keyboard, think about your genes.
It's a common misconception. Overusing the keyboard can give some people painful hands and wrists.
Staten Island resident Jean Gantel was an executive assistant working in Ohio who suffered painful hands for years and years without ever getting them diagnosed.
"It was like my arms were asleep and very numb," she said. "The worst part was a burning pain and toward the end it was constant."
Jean finally sought help from Dr. George Pianka who diagnosed her painful hands as carpal tunnel and performed surgery to fix the problem.
There's a major shift in our understanding of conditions like carpal tunnel syndrome," Dr. Pianka said.
The problem, says Dr. Pianka, does not orginate from the keyboard.
"The occupations have always been correlated or associated with symptoms, but the more objective data is now showing that genetics plays a very high role," he said.
Genetics? That's right. Good old mom and dad. Is it in Jean's family?

"My parents did not have carpal tunnel that I know of, they're both decesased now," she said. "But my son has, and he is starting out the same way mine started, just intermittent."
Carpal Tunnel Syndrome occurs when the median nerve in the wrist is compressed under the carpal ligament. And this tendency is inherited.
Early treatment is important, says certified hand therapist Wendy Burnett. Treatment, which can be splints, ultrasound or massage can work.

"The goal is to decrease the swelling of the nerve, which will then decrease the swelling and decrease the symptoms," Burnett said.
This problem is so widespread it's generated a host of other treatments, including shock wave therapy and laser heat treatments. But whatever you try, make sure you go to the doctor soon after symptoms occur.

Carpal tunnel syndrome can result from direct trauma to the median nerve, wrist fractures or be associated with some medical conditions such as rheumatoid arthritis, swelling from a sprain or fracture and pregnancy.

It affects more women than men, perhaps because women generally have small wrists, and thus more narrow carpal tunnels.
But the main contributing factor to the syndrome, say area physicians, is excessive repetitive motion.

Robin Grant, a nurse who lives in Willard, says her acute carpal tunnel syndrome was probably the result of repetitive motions done during quilting and sewing, as well as some time spent on the computer at work.
Like Triplett, she ignored the tingling, numbness and pain in both of her hands at first — and did so for years.

"I just put up with it for about five years," says Grant, 46. "... I would say mine was super-painful. I had difficulty holding a pen to write, or a cup of coffee, a hairbrush, a blow dryer. I had difficulty riding a bicycle."

During the day, Grant felt "tingling from the tips of the fingers to the palms," but at night it was worse — an intense throbbing that she describes as a 10 on the pain scale from 1 to 10.

Carpal tunnel syndrome has been noted in up to 20 percent of diabetics. This usually is seen in both hands, with patients complaining of a burning pain that radiates up the forearm. Some also complain of adhesive capsulitis, a stiffness involving the shoulder, which is discussed below. If no improvement comes with the use of braces, splints and anti-inflammatories, an electroneuromyogram and nerve-conduction tests are ordered to determine the severity of the problem. Carpal tunnel release surgery also is a very successful option.

Another common disorder in diabetics is flexor tenosynovitis, commonly called "trigger finger," when the finger locks in place, usually in a bent position. This is very common in 1 percent to 2 percent of the general population and in 11 percent to 15 percent of diabetics. If patients do not improve with anti-inflammatories, injections or physical therapy, surgery is recommended in severe cases; this has an extremely high success rate.

Another common problem for diabetics is adhesive capsulitis in the shoulder, which is often seen in carpal tunnel patients. Up to a third of diabetics develop this, and women are more commonly seen with it than men. It is usually seen in both shoulders, and it includes significant pain and very limited range of motion. The treatment is very aggressive physical therapy, anti-inflammatories and a steroid injection. Surgery is sometimes undertaken, but the success rate in diabetics is not as good as in the patient without diabetes.

What research is being done?

The National Institute of Neurological Disorders and Stroke (NINDS) conducts research on nerve-related conditions such as carpal tunnel syndrome in its laboratories at the National Institutes of Health (NIH) and also supports research through grants to major medical institutions across the country. Current studies include several randomized clinical trials to evaluate the effectiveness of educational interventions in reducing the incidence of carpal tunnel syndrome. Another clinical study is collecting data about carpal tunnel syndrome among construction apprentices to better understand specific work factors associated with the disorder and develop strategies to prevent its occurrence among construction and other workers. Scientists are also investigating the use of alternative therapies, such as acupuncture, to prevent and treat this disorder

How is carpal tunnel syndrome treated?

Treatments for carpal tunnel syndrome should begin as early as possible, under a doctor's direction. Underlying causes such as diabetes or arthritis should be treated first. Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. If there is inflammation, applying cool packs can help reduce swelling.

Non-surgical treatments
Drugs - In special circumstances, various drugs can ease the pain and swelling associated with carpal tunnel syndrome. Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease symptoms that have been present for a short time or have been caused by strenuous activity. Orally administered diuretics ("water pills") can decrease swelling.

Corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into the wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve and provide immediate, temporary relief to persons with mild or intermittent symptoms. (Caution: persons with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels. Corticosterioids should not be taken without a doctor's prescription.) Additionally, some studies show that vitamin B6 (pyridoxine) supplements may ease the symptoms of carpal tunnel syndrome.

Exercise - Stretching and strengthening exercises can be helpful in people whose symptoms have abated. These exercises may be supervised by a physical therapist, who is trained to use exercises to treat physical impairments, or an occupational therapist, who is trained in evaluating people with physical impairments and helping them build skills to improve their health and well-being.

Alternative therapies - Acupuncture and chiropractic care have benefited some patients but their effectiveness remains unproved. An exception is yoga, which has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome.

The term 'carpal tunnel' is also used quite commonly to refer to 'carpal tunnel syndrome' which is a condition where the median nerve is pinched within the tunnel and causes pain and/or numbness of the wrist/hand, once thought to be a result of repetitive motion such as painting or typing, and sometimes using instruments like drumsticks too much.
The carpal tunnel is important because the median nerve can be compressed in cases such as the following:
Carpal tunnel syndrome
Wrist dislocations
Fractures around the wrist

injure-proofing your wrists

Exercises to Injure-Proof Your WristsKeeping your wrists strong and flexible and alleviating strain on the carpal tunnel by stretching your wrists often during the day can help prevent injury. These exercises should be done three to five times a week. (A sixteen ounce soft-drink bottle or can of food can be used instead of a dumbbell.)
Note: Do not do these exercises if you already have pain or numbness. They are meant as a preventive measure and may aggravate an existing problem.

1. Limbering up:
Massage the inside and outside of hand with thumb and fingers.
Grasp fingers and gently bend back wrist. Hold for five seconds.
Gently pull thumb down and back until you feel the stretch. Hold for five seconds.
Clench fist tightly, then release, fanning out fingers. Repeat five times.

2. Wrist Rotation: Stand or sit with your elbows close to your waist, your forearms extended in front of you and parallel to the floor, and your palms facing down. Make fists with both hands and make circles with your fists in one direction. Do 10 repetitions, then reverse the direction. Next, open your hands, extend your fingers and repeat the entire sequence.

3. Wrist Curl: Stand or sit with your elbows close to your waist, your forearms extended in front of you and parallel to the floor, and your palms facing down. Grasp a one-pound dumbbell in each hand and slowly bend your wrists down, holding for five seconds. Do 10 repetitions.

4. Sideways Wrist Bend: Stand or sit with your elbows close to your waist, your forearms extended in front of you and parallel to the floor, and your palms facing down. Grasp a one-pound dumbbell in each hand. Keeping your forearms still, slowly bend your wrists from side to side, moving the weights toward, then away from one another in a windshield wiper-like motion. Do 10 repetitions.

5. Wrist Twist: Stand or sit with your elbows close to your waist, your forearms extended in front of you and parallel to the floor, and your palms down. Grasp a one-pound dumbbell in each hand and slowly turn your wrists and forearms until your palms are facing up, then turn them down again. Do 10 repetitions.

what research is being done?

The National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health, is the federal government's leading supporter of biomedical research on neuropathy, including carpal tunnel syndrome. Scientists are studying the chronology of events that occur with carpal tunnel syndrome in order to better understand, treat, and prevent this ailment. By determining distinct biomechanical factors related to pain, such as specific joint angles, motions, force, and progression over time, researchers are finding new ways to limit or prevent carpal tunnel syndrome in the workplace and decrease other costly and disabling occupational illnesses.
Randomized clinical trials are being designed to evaluate the effectiveness of educational interventions in reducing the incidence of carpal tunnel syndrome and upper extremity cumulative trauma disorders. Data to be collected from an NINDS-sponsored clinical study of carpal tunnel syndrome among construction apprentices will provide a better understanding of the specific work factors associated with the disorder, furnish pilot data for planning future projects to study its natural history, and assist in developing strategies to prevent its occurrence among construction and other workers. Other research will discern differences between the relatively new carpal compression test (in which the examiner applies moderate pressure with both thumbs directly on the carpal tunnel and underlying median nerve, at the transverse carpal ligament) and the pressure provocative test (in which a cuff placed at the anterior of the carpal tunnel is inflated, followed by direct pressure on the median nerve) in predicting carpal tunnel syndrome. Scientists are also investigating the use of alternative therapies, such as acupuncture, to prevent and treat this disorder.

Treatment Info

Treatments for carpal tunnel syndrome should begin as early as possible, under a doctor's direction. Underlying causes such as diabetes or arthritis should be treated first. Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. If there is inflammation, applying cool packs can help reduce swelling.

Non-surgical treatments

Drugs - In special circumstances, various drugs can ease the pain and swelling associated with carpal tunnel syndrome. Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease symptoms that have been present for a short time or have been caused by strenuous activity. Orally administered diuretics ("water pills") can decrease swelling. Corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into the wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve and provide immediate, temporary relief to persons with mild or intermittent symptoms. (Caution: persons with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels. Corticosterioids should not be taken without a doctor's prescription.) Additionally, some studies show that vitamin B6 (pyridoxine) supplements may ease the symptoms of carpal tunnel syndrome.


Exercise - Stretching and strengthening exercises can be helpful in people whose symptoms have abated. These exercises may be supervised by a physical therapist, who is trained to use exercises to treat physical impairments, or an occupational therapist, who is trained in evaluating people with physical impairments and helping them build skills to improve their health and well-being.


Alternative therapies - Acupuncture and chiropractic care have benefited some patients but their effectiveness remains unproved. An exception is yoga, which has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome.
Surgery
Carpal tunnel release is one of the most common surgical procedures in the United States. Generally recommended if symptoms last for 6 months, surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. Surgery is done under local anesthesia and does not require an overnight hospital stay. Many patients require surgery on both hands. The following are types of carpal tunnel release surgery:
Open release surgery, the traditional procedure used to correct carpal tunnel syndrome, consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical considerations.
Endoscopic surgery may allow faster functional recovery and less postoperative discomfort than traditional open release surgery. The surgeon makes two incisions (about ½" each) in the wrist and palm, inserts a camera attached to a tube, observes the tissue on a screen, and cuts the carpal ligament (the tissue that holds joints together). This two-portal endoscopic surgery, generally performed under local anesthesia, is effective and minimizes scarring and scar tenderness, if any. One-portal endoscopic surgery for carpal tunnel syndrome is also available.
Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Some patients may have infection, nerve damage, stiffness, and pain at the scar. Occasionally the wrist loses strength because the carpal ligament is cut. Patients should undergo physical therapy after surgery to restore wrist strength. Some patients may need to adjust job duties or even change jobs after recovery from surgery.
Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely. At least, that's good news, right?

Clinical significance

The term quite commonly to refer to 'carpal tunnel syndrome' which is a condition where the median nerve is pinched within the tunnel and causes pain and/or numbness of the wrist/hand, once thought to be a result of repetitive motion such as painting or typing, and sometimes using instruments like drumsticks too much.
The carpal tunnel is important because the median nerve can be compressed in cases such as the following:
Carpal tunnel syndrome
Wrist dislocations
Fractures around the wrist .

Easy exercises

Stand straight up and extend both arms straight out in front of you. Extend your wrists and fingers acutely as if they were in a hand stand position. Hold this position for 5 seconds. Now straighten your wrists and relax your fingers.Keeping your wrists straight, make a fist and squeeze it tightly. Hold for 5 seconds.Keeping your fists clenched, bend you wrists down. Hold this position for 5 seconds. Straighten both wrists and relax your fingers again. Repeat steps 10 times, then stand up with your arms relaxed by your sides.

Signs and Symptoms

Carpal tunnel syndrome typically starts gradually, with a vague aching in your wrist that can extend to your hand or forearm.

Other common signs and symptoms include:

Tingling or numbness in your fingers or hand, especially your thumb, index, middle or ring fingers, but not your little finger. This sensation often occurs while driving a vehicle or holding a phone or a newspaper, or upon awakening. Many people "shake out" their hands to relieve their symptoms.
Pain radiating or extending from your wrist up your arm to your shoulder or down into your palm or fingers, especially after forceful or repetitive use. This usually occurs on the front (palm) side of your forearm.
A sense of weakness in your hands, and a tendency to drop objects.
A constant loss of feeling in some fingers. This can occur if the condition is advanced.