Carpal Tunnel: it’s all in the wrists.

One of the more common complaints I see in my office is carpal tunnel syndrome.  It is three times more common in women than men, and more likely in assembly line workers and those who operate power tools (think jack-hammer, for example).  However, it is now becoming more common in office workers and students  who type or text for protracted periods.

The syndrome refers to numbness at the wrist, usually because of a compromised median nerve that runs in a bundle of tendons to the fingers. What compromises this nerve is puffiness, usually of the tendons that flex the fingers.  While other causes include pregnancy, rheumatoid arthritis, hypothyroidism, diabetes, and obesity.   


The results of this condition are numbness and tingling in the finger tips, usually thumb, index and mid fingers, along with half of the ring finger.  If protracted, the condition will lead to muscle atrophy of the hand muscles, especially on the palm, over the “heel” of the thumb.  (aka the “thenar” muscles).

The ultimate test is an EMG, which confirms that the median nerve is being interrupted at the wrist, as opposed to other causes of finger numbness that are actually from nerve impingement higher in the arm or even neck.

The ultimate cure of an advanced case is surgery, to snip the fibrous band that holds the bundle of tendons, vessels and nerves into such tight quarters.  For less advanced cases, medical acupuncture,(see our post here), wrist braces (especially at night), and physical therapy can all have a role in treatment.

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However, there are a couple of considerations to prevent carpal tunnel:

1.       BEWARE THE WRIST REST: If you type, watch your ergonomics.  The wrist rest was intended to rest your wrists when your hands were relaxed over the keyboard. (In fact it was made necessary in lap-tops by the need to house the components and still have space for the keyboard to be next to the screen; then it was marketed as a “benefit”).   However, the rest encourages users to keep the wrists pressed against it, while the wrists extend to allow the fingers to keep typing.  This means the bundle of tendons at the wrist have to work around a corner, and these tendons over time will develop “rope burn” from the unnecessary friction.  Action item: consider a tack attack!  As demonstrated by my old typing teacher in school on her typewriter at the front of the class, the wrists can be held in neutral alignment if a row of thumb tacks is inserted into the sticky side of a piece of tape,  this barbed tape was applied to the wrist wrest area.  All we had to do was look at it, and the lesson was immediately processed (although she kept an open offer to apply this tacky-tape solution to any of us who needed reminders!).  No chance of letting those wrists rest now! Note that great piano players can perform from childhood into late age with hours of repetitive movements, never getting carpal tunnel problems.  The reason is their forearms and hands are all in the same alignment; if the piano stool was six inches too short, and the player had to bend the wrists to let the fingers reach the keys, then carpal tunnel would soon follow.

2.       WATCH THE TIME: Try to limit typing to periods of 15 minutes at a time.  Even if you need to do long hours at the computer, set up your screen (or simple kitchen timer etc) to alert you every quarter hour.  Simply drop your hands to your sides, let them relax as you shake them a bit, do a couple of neck and shoulder rolls, and then plunge back to work.  Doesn’t need to take more than a few seconds, and it will save a lot of aggravation later on.

3.       WATCH THE SIZE: In general, small keyboards are fine for small jobs.  But if you spend more than a couple of hours a day on one, you should consider getting a full sized wireless keyboard linked to your laptop.  If you text a lot on your cell phone, take breaks more often.

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