Thursday, January 22, 1998

Carpal Tunnel Syndrome can be debilitating but is treatable

By BRIAN BETHEL / Abilene Reporter-News

For Bill Guidera, education minister at Broadview Baptist Church, his bout with carpal tunnel syndrome began with a few aches and pains.

By the time he had surgery a year or so later, the pain had progressed to much more extreme levels, sometimes shooting into his fingers, other times lingering in his wrists.

Unlike the common carpal tunnel complaint, his bout with the condition was blamed on the amount of driving he had to do.

"Apparently, truck and cab drivers get (carpal tunnel syndrome) for the same reasons," he said. "Your hands to be in the same position for a long time, and that causes strain."

At the time of his struggle with carpal tunnel syndrome, Guidera was an administrator for a private foster care agency, which required him to travel a great deal.

Now, his current role requires him to do a lot of typing, one of the most commonly blamed causes of carpal tunnel syndrome.

The aches sometimes return, but he is much more cautious than he used to be, he said.

"I've changed a lot of things that I used to take for granted or do without thinking," he said. "It tends to make you more aware."

WHAT IT IS

Carpal Tunnel Syndrome manifests as a cadre of complaints that includes numbness, "pinsand-needles"-type feeling, generally in the thumb, index, long and on occasion ring fingers, said local hand surgeon Dr. Donald Wehmeyer.

Caused by pressure placed upon the transverse carpal ligament, a very strong ligament that lies across a U-shaped arch of eight bones at the base of the palm, the condition's symptoms come on gradually.

"The most common way it presents itself is that the patient will wake up in the middle of the night or the morning and find their hands are numb," he said. "Their hands may often go to sleep when they talk on the phone, read a magazine or newspaper, comb their hair, etc. Usually, that is in the more advanced stages."

Although no one knows exactly what causes CTS, it often appears in individuals whose job-related activities require repetitive, stressful microtrauma.

Examples of such activity might be typing, painting, using hand tools, driving in some conditions, painting, especially if detail work is involved, and any activity that requires holding the wrist flexed, extended or twisted.

Eventually, sufferers may complain of retrograde pain shooting up into the arm or shoulder, or a continual numbness of the fingers. In some cases, the pain may be constant.

"At night, I would lie down and my hands, wrists and fingers would ache," Guidera said. "I would sit at home, and pain would shoot into my fingertips. After a while, I would wake up and really be in pain. I knew I had to do something about it."

PREVENTION

Obviously, if your job requires you to do something repetitive and potentially stressful to your hands -- such as typing -- then there are certain cautions to keep in mind.

"Eventually, repetitive stress will take its toll," Wehmeyer said. "There are some things you can do to help prevent carpal tunnel syndrome, but remember that it is still not something we completely understand."

Most preventative steps fall into the realm of simple common sense: Keeping repetition to a minimum, reducing speed and force of activities if at all possible, allowing rest periods for your hands and keeping your wrist neutral (straight) can all help.

Good ergonomics -- sitting up straight, not slouching, using arm rests if necessary, etc. -- can also help.

If at all possible, and your employer will allow it, vary your tasks every few hours so that you are not constantly doing one action.

"Once you have (carpal tunnel) and understand it, you realize that you have to make some changes," Guidera said "... In my case, tending to keep my hands in the same position for so long was what caused my problems. Once you identify the probable cause, though, you can change your actions accordingly."

TREATMENT

Splints are usually the solution for someone who experiences carpal tunnel-related difficulties once or twice a week.

"That's one of the first mainstays," Wehmeyer said. Night splints and occupational splints are designed to keep the wrist from flexing downward or up.

Such motion, if unchecked, tends to worsen CTS symptoms because it narrows the tunnel formed by the transverse carpal ligament, the carpal bones, the median nerve that controls sensations to the hand and the flexor tendons that slide back and forth as fingers are used.

Some physicians prescribe anti-inflammatory drugs to help reduce swelling, although many do not have much confidence in their ability to help the problem, Wehmeyer said.

Some doctors will inject steroids into the carpal tunnel itself, while in some cases diuretics (water pills) or pryidoxine (Vitamin B-6), may help.

"You can always try to remove or lessen the activity that seems to be causing the problem, although that is not always possible," Wehmeyer said. "That option really depends on your employer."

Surgery is usually a last resort.

"Usually, the people I see have already been through these treatment programs and have been screened out somewhat by their physicians," he said. "By that point, surgery is usually the obvious option."

CAUTION AND CARE

Prevention is obviously the best treatment for carpal tunnel syndrome, but once symptoms begin to manifest, it is important that a doctor's care is sought soon.

Early diagnosis helps minimize symptoms, meaning less potential of permanent damage to your wrist and hands.

"If you suspect you might have it, then by all means go to the doctor," Guidera said. "The pain just isn't worth it."