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Traversing the Carpal Tunnel

By Alan Williams, PT, OTR/L, ATC, CSCS

Sometimes my hands fall asleep when I’m at the computer. There I am, well into a cutthroat game of Zuma or halfway through an email to my cousin Dennis, when I start to feel it – the itching, tingling, heavy feeling in my hands that signals their departure into dreamland. It also happens when I mow the lawn or use chopsticks. Like many people, I usually just shake it off and resume my activity; however, it’s important to know how to recognize when your hands’ napping habits may be turning into something more serious.

The carpal tunnel is a narrow ridge in the base of your hand that houses the median nerve as it stretches from your forearm into your hand. Carpal Tunnel Syndrome (CTS) occurs when the carpal tunnel becomes compressed, causing irritation and impaired function in the median nerve. The result is numbness and weakness of the hands in mild cases; untreated, this may progress into general immobility, muscle atrophy, and even nerve death in the most severe of cases.

CTS is somewhat controversial and may be difficult to diagnose accurately. Several overuse conditions (such as tendonitis or bursitis) often present with symptoms similar to CTS, and vice versa. A wrong diagnosis will lead to inappropriate treatment and may even make the condition worse. Employers often fear a diagnosis of CTS as this leads to lost productivity and increased insurance costs, and researchers are reluctant to name a direct cause for CTS. Some point to genetics (certain individuals have narrower carpal tunnels and are therefore predisposed to CTS), while others say arm use and positioning (such as occurs in computer usage and work that requires fine motor skills) may be to blame. Most are comfortable labeling the cause as idiopathic (meaning “unknown” in medical lingo). Trauma or injury to the wrist, hand, or arm is yet another possible suspect.

In reality, the causes of CTS are most likely varied. Being born with a narrower carpal tunnel does not guarantee you will develop CTS, nor does a career in data entry or assembly line manufacturing. The most important thing you can do is educate yourself about the symptoms of CTS, ways to alleviate those symptoms, and when it’s time to see a professional.

A good rule of thumb is to listen to your hands – what are you doing during the onset of your symptoms, and can you do it differently? Night symptoms (waking with numb or tingling hands) are a trademark of CTS because most people sleep with their wrists bent, compressing the median nerve. You may be able to retrain your body to sleep differently by being conscientious of your sleeping position; another option is to use braces that keep the wrists straight while sleeping.

If your symptoms occur during computer use or other fine motor activities (such as knitting, playing an instrument, etc.), pay attention to your ergonomics – what can you do to make the activity generally feel more “natural?” Pay attention to posture and avoid holding your wrists and arms in extreme positions. Braces, wrist supports, and ergonomically designed keyboards are options, but whether you use them or not, take frequent breaks if your hands tell you that they’re needed.

Symptoms that persist, worsen, or begin to interfere with your activities should be treated by a physical therapist or doctor. They will help you identify the triggers of your CTS and will suggest appropriate lifestyle adjustments. Strengthening exercises, stretching, massage, and inflammation reduction techniques may also be recommended. Surgery is available for severe cases of CTS, but success may be limited and relapses are possible – especially if the contributing factors are not already identified and adjusted or eradicated.

Education and early intervention are the keys to managing and even eliminating the symptoms of CTS. If your hands’ sleeping habits are becoming more serious than just the occasional catnap, don’t hesitate to make an appointment with your physical therapist or doctor today.

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