Our modern era home and work environments have created room for a debilitating injury to creep in and take control of many people’s hand function. As an Occupational Therapist who’s practiced and treated hand injuries since the mid 1970’s, I’ve seen an increase in the incidence of what is called Carpal Tunnel Syndrome (CTS). I’d like to explain what it is, how to detect if you might be having CTS symptoms and what to do after you determine you might be afflicted with it.
What is CTS? CTS is an inflammatory process concentrated in the palmar aspect of the wrist at the wrist crease. The inflammation is deep in the wrist in the cradle of the wrist carpal bones where all the flexor tendons to the fingers lay along with the median nerve that supplies sensation and motor innervation to the thumb, index, middle, and half of the ring finger. This condition is not always caused by how you are using your hands but can be a side effect of other metabolic processes such as pregnancy that can cause increased fluid volume in the body.
Our wrists are very flexible joints that allow us to use our hands with great dexterity and strength performing many precise and powerful actions with our hands. With this flexibility the wrists and contents of the carpal tunnel are subject to compression forces with the action of forceful bending of the wrists. A common problem many people have is during sleep they bend their wrists around a pillow, hang it off the side of the bed or get in tucked underneath them as they sleep in a position that decreases the blood flow. After a period of time they wake up with pain and/or numbness in their wrist, thumb, index, and middle fingers caused by the “kinked” position they were sleeping in. This done routinely every night can do damage to the median nerve over time that needs surgical correction/ release. HELP: Sometimes it helps to wear a wrist support that fits well and keeps your wrist in a straight position for awhile until the symptoms you are having decrease or no longer are problematic for you.
Conversely when the wrists are held in a prolonged stationary position with little finger motion such as when key-stroking a computer keyboard, there is also a decrease in blood flow to the fingers due to the lack of tendon movement within the carpal tunnel. Sustained grasping of hand tools, handle bars, steering wheels, kitchen sink sprayers, pressure washer or welding rod handles can also exhibit the same decrease in blood flow and all resulting in the sensation of numbness to the thumb sided fingers and/or deep wrist aching. The need for adequate blood flow to our extremities is dependent on relaxation/contraction of muscles and tendon gliding . People who use vibrating tools routinely or who drive a lot are also subject to damage caused by decreased circulation to the carpal tunnel. Anti-vibration/impact gloves are helpful to decrease damaging vibration. HELP: Simply taking a few minutes on a break every 20-30 minutes from whatever the static activity or vibration might be to open and close your fingers repeatedly and stretch the wrists.
Other causes have little to do with the wrist position and more to do with repetitive tasks involved the thumb index and middle fingers doing pinch work either with a tool like needle nose pliers or with the hand alone. The large thumb muscle in the palm of the hand swings the thumb across to meet the index and middle fingers to apply strong forces on objects i.e. twisting of soda or beer tops, opening jar lids, filing letters or files of other kinds. During this process the thumb muscle compresses the carpal tunnel and decreases the blood flow in the carpal tunnel. HELP: Try to limit the amount of pinching tasks done by using both hands for the task versus just using your dominant hand for the work. Spread out the task more with a variety of other tasks mixed in that are not thumb intensive tasks to allow the thumb muscle to relax and the blood flow to normalize. Stretching the thumb by grasping it with your other hand and pulling it along with the wrist bending backwards will help greatly in opening up the carpal tunnel and improving blood flow to the fingers.
These scenarios are only some activities that are possible risk factors for causing symptoms that may lead to CTS. If the HELPs listed in the narrative are not effective in helping decrease your numbness, tingling and aching issue, please contact your primary care physician for further evaluation of your complaints.