Path: utzoo!attcan!utgpu!news-server.csri.toronto.edu!cs.utexas.edu!yale!bunker!wtm From: 34AEJ7D@CMUVM.BITNET (Bill Gorman) Newsgroups: misc.handicap Subject: Carpal Tunnel Syndrome (long) Message-ID: <12643@bunker.UUCP> Date: 7 Jul 90 04:58:24 GMT Sender: news@bunker.UUCP Reply-To: 34AEJ7D@CMUVM.BITNET (Bill Gorman) Distribution: misc Lines: 261 Approved: wtm@bunker.UUCP Fidonet: None Index Number: 9053 Here is a reposting (with permission) of information about this condition which may be of interest ==================================CUT HERE============================== Date: Wed, 27 Jun 90 09:40:34 CDT From: Andrea Frankel Carpal Tunnel Syndrome: This is a slightly edited reposting; apologies if you've seen it before, but many people who read this on an internal HP notes group have found it useful and asked for it to be more widely distributed. Disclaimer: I am not a doctor (but I sometimes play one on the Net ;@). This is from my own personal experience with the malady, supplemented by a little research and lots of talking to doctors and such. Carpal Tunnel Syndrome is being seen more and more frequently among the computer set (my neurologist jokingly refers to it as "hacker's hand"); when caught early, conservative treatment can completely cure it. However, if you let it go on long enough you can cause irreversible damage. If you have any question at all, PLEASE SEE A DOCTOR! Better safe than sorry. 1. The setup The bones in your wrist form a 3-sided tunnel, with the fourth side closed off by a very tough piece of cartilage. In this carpal tunnel run the tendons of the muscles which flex your fingers, as well as the very important median nerve which ennervates the thumb and the first two fingers. If something happens to cause the contents of the tunnel to swell, or to cause the tunnel itself to get smaller, the pressure exerted on the median nerve results in carpal tunnel syndrome. Pregnancy, sudden weight gain, drugs which cause water retention, and repetitive overuse (or abuse) which causes tendinitis in those flexor tendons, can all cause carpal tunnel syndrome. (I recently learned that hypothyroid condition can also cause CTS.) Positions where the wrist is bent back while being used really exacerbate the problem (e.g. bicycling with drop handlebars, if you are not careful about hand positioning). Other things can contribute as well - if you are doing carpentry in your spare time and twisting many screws by hand, for example. When you become aware of the problem, start becoming aware of both the wrist position and the stresses on it in various activities. The median nerve runs up the heel of the hand onto the palm, along the "life line". Direct repeated blows to this area can mimic or add to the carpal tunnel syndrome, and are often lumped in with it. Our HP keyboards are awful in this respect. Kayaking, bicycling, gardening without heavy gloves, all sorts of things can bang on this exposed nerve. 2. The symptoms and diagnosis Any or all of the following: pain, numbness, tingling, or sensations of fullness in the fingers, hands, or shooting up or down the arms. Quick test #1: make an "O" with thumb and forefinger, insert the thumb and forefinger of the other hand, and resist while trying to force the "O" apart with the other hand. The "O" should not come apart! Quick test #2 (Tinnel sign): place the backs of your hands together, bend each hand 90 degrees towards the inner wrist, fingers pointing down (forearms parallel to the floor, held out in front of you). =======oo========= key: === forearms || o wrists .. | metacarpals .. . fingers Press the backs of the hands together and hold for 30-60 seconds. If you start getting some numbness or tingling or pain, this is suspicious. Loss of grip strength is a sign that you may have a more advanced case. (I finally sought help when I was unable to open a can of tuna fish with a standard Swingline manual can opener.) I believe the best specialist for diagnosis is a neurologist. A neurologist will do nerve conduction studies, comparing rates of conduction above and below the wrist, and between hands. A good one will also do electromyography, to see if the muscles enervated by the nerve are firing properly or not. (As a techie, I was fascinated to watch the 'scopes while he poked me!) 3. The treatment Standard treatment is to start with the most conservative, least invasive approaches, and move up only if they don't help. The old RICE formula - rest, ice, compression, and elevation - is the place to start, but omit the compression as this is not a muscle strain. A wrist splint (basically a velcro-and-ace-bandage type of thing with a bent metal strip in it to hold the wrist in the right position) is worn at night for a month to see if it helps; it can also be worn during the day for stretches. (Do not make it tight - it is for positioning only.) In many cases, that plus correcting one's work habits is sufficient. Some people find that a month is all it takes; others use the splint at night for the rest of their lives, or off and on as needed. I still use mine occasionally when I've been overdoing it. It's also a good idea to wear it in situations where you might be tempted to do something silly (like lugging suitcases or lifting weights), both as protection and as a reminder to be careful. Non-steroidal anti-inflammatories (e.g. Motrin) are used, if it looks like inflammation is a major cause of the problem. Icing the wrist helps alot, both for the pain and the swelling. (Be aware that over-icing has a rebound effect as the body attempts to warm the area by increasing circulation. Best is to ice for 10-20 minutes max each time, leaving at least an hour between icings.) I keep a couple of the soft gel-type blue ice packs in a little fridge near my desk, so that I can ice several times a day if I need to. Bags of frozen peas work great (hit 'em a couple whacks on the counter to loosen them up, then pat the bag around your wrist so it conforms to the curves). For obvious reasons, jacuzzis (especially if you leave your arms in) will tend to make things worse. If water retention is a problem, you might try a mild OTC diuretic. (Women: it isn't uncommon for CTS symptoms to be worse during PMS time.) Also, simply elevating the wrist (for example, resting it on the back of a padded chair or car seat, or sleeping with your splinted wrist wresting next to your head on the pillow) can help relieve some of the discomfort at least temporarily by reducing the swelling. As a long-time fan of vitamins, minerals, and Prevention magazine, I of course asked my doctors about B6 as a treatment for CTS. Unfortunately, the original article reporting success from B6 treatment was not reproducible by other experiments. What's more, excessive doses of B6 (over 50 mg/day supplement to a normal diet) can actually cause peripheral neuropathy, mimicking some of the symptoms of CTS. My doctor said it wouldn't hurt if I wanted to take up to 50 mg/day, but since I had been taking that amount for quite some time for other reasons, he advised against increasing it. Some doctors go for cortisone injections, although mine cautioned that the carrier substance is not well absorbed, and can actually make the problem worse by increasing the fluid pressure in the tunnel. Your doctor will decide based on the type of CTS and how it is responding to other treatment (or not). The final stage is surgery. I had mine a few years ago; if you're facing it, I'd be glad to chat with you about it. The surgery itself was a piece of cake, taking maybe 10 minutes once I was fully prepped - very simply, they slit that piece of cartilage along the "life line" and onto the wrist, and it spreads apart before it heals up, making the tunnel larger. Instant relief, although the recovery and rehab takes a couple months. For those interested in such things, I talked them into skipping general anaesthesia in favor of a Bier Block, which worked splendidly - I was out of there and wolfing down antipasto and garlic bread an hour after surgery. A friend notes that not everybody who has had the surgery finds it a piece of cake. His advice would be to make sure you have absolutely the best doctors when it come to surgery on one's hands, with which I heartily concur! Hands are incredibly complex, considering all the different types of finely coordinated movement they are capable of (and all the muscles and nerves that requires). I would strongly recommend that you look for an orthopedic surgeon who is board certified in Hand Reconstruction Surgery - my scar is almost invisible, compared to some pretty horrific looking ones I've seen. (I asked the neurologist, who was really top-notch, to look through my CCN [preferred provider] booklet and recommend someone to me.) An orthopedic surgeon who handles a little bit of everything - shoulder tears, knee arthroscopy, back problems - probably won't be as good at carpal tunnel surgery as someone who spends their entire professional life specializing in the elbow down. For example, my surgeon stopped the surface cut at the first wrist fold, lifted the skin, and continued the surgery under the skin to minimize the scarring; other surgeons (who don't specialize in hand reconstruction surgery) often don't think to do that. It doesn't affect how effective the surgery is, but it sure makes a difference in how pretty your hand looks afterwards! 4. The progression The symptoms may come and go with heavy bouts of typing, bicycling, etc. When it gets really bad, it can hurt all the time or start aching spontaneously. In the early stages, relieving the pressure on the median nerve will quickly reverse the symptoms (in a matter of days to weeks). Untreated, the pressure on the nerve will eventually cause it to die back to the point of constriction. When this happens, the muscles atrophy. (The large adductor which forms the mound at the base of my thumb had shrunk to half its size by the time I was operated on.) If you don't catch it quickly at that point, the nerve sheaths (which the nerve had been inside before it died back) start to fray. This is bad news. If you have surgery while the sheaths are still intact, the nerve will grow back along the sheath (around 2 mm/day - you can actually track it!) and pretty much recover all of its connections and functions. I have a tiny patch less than 1/4" diameter on two finger tips which is numb, and otherwise have full function back. If the nerve sheaths have frayed, however, the nerve can't find its way back to make the right connections, and you're screwed. IF YOU THINK YOU MIGHT HAVE CARPAL TUNNEL SYNDROME, GET IT LOOKED AT *NOW*!!! Don't delay, or you might not make a full recovery. Workman's comp studies looking at prognosis for recovery give very low odds, based on most factory workers (who used to account for most of the CTS claims before computeritis hit) being too macho or too scared of losing their jobs to file a claim before it was too late. 5. Prevention The optimal position for your wrist is with the hand bent back just 20-30 degrees; you want the position where the front of your wrist makes a straight line with the first inch of the heel of the palm. Play with it a bit until you find the place where the wrist seems to be maximally "open", but without bending the hand back so far that you feel strain. Look down at your hands as you type - if you are dropping your wrists, you are at risk. Think about how they used to teach piano technique: an almost straight line along the back of the forearms, through the wrist, onto the back of the hand; fingers dropping down. (My sister's piano teacher used to place pennies on the back of her hands while she played, to teach keeping it level.) Practice typing that way, and instead of resting the heel of your hands on the edge of the keyboard when you're thinking or reading, rest them in your lap instead. I got a very nice padded wrist rest from a local office supply house, that allows me to rest my forearms or wrists while I type in this position; I have one under my 320 keyboard, and one for my Vectra. You can also improvise by taking a length of bubblewrap, rolling it up and securing the ends with rubber bands, then taping the roll to your desk in front of the keyboard. Warning: this padded wrist rest can actually make it worse for some people, if it distorts the normal typing motion or presses too hard against the wrist. I currently have a keyboard draw from Devoke (about $115) that has a full 6" height adjustment, slides in and out and swings to both sides. It mounts with two screws, and I have one in the "L" of my workstation table at work, and on the desk at home where I have my PC. This has made the most difference when my CTS flared up again (along with rest and splinting). Wear padded gloves for anything which might bang on your hands. Bicycling gloves with Spenco pads can be used for many things (I wear mine ice skating!). The Spenco pads are definitely superior to leather or other types when it comes to cushioning that area against shocks. (After the surgery, I was warned that the median nerve would always be a bit more exposed and sensitive, and it definitely made me a connoisseur of bicycling gloves!) Learn to back off when you realize you're about to lift or torque something heavy with your wrist bent. If you can't rethink the movement so you can keep your wrist straight, get help (person or tool)! p.s. Feel free to copy and distribute this to anyone who might be helped. I only request that you not delete anything, especially the disclaimer. Andrea Frankel, Hewlett-Packard (San Diego Division) (619) 592-4664 UUCP : {hplabs|nosc|hpfcla|ucsd}!hp-sdd!andrea USnail : 16399 W. Bernardo Drive, San Diego CA 92127-1899 USA