The carpal tunnel is on the palm side of your wrist, and it’s a narrow passageway made up of bones and ligaments. When the median nerve, which runs through this passageway to the thumb and first three fingers, is continually under pressure, you can end up with carpal tunnel syndrome. The inflammation is often caused . an underlying medical condition that causes swelling in the wrist and sometimes obstructed blood flow, such as diabetes, thyroid dysfunction, high blood pressure or an autoimmune disorder such as rheumatoid arthritis. Fluid retention during pregnancy or menopause can be another cause. When tendons that attach muscles to bone get used repetitively, they alert us via pain signals to try to protect the area from further damage. “In a small area like the wrist, tendons run through a narrow tunnel over the carpal, or wrist bones,” explains Amy Baxter, MD. “When the cells are overtaxed they release lactic acid that can stick the fibers together for protection, and the inflammation causes swelling.”
Common carpal tunnel symptoms are pain, numbness, and tingling. “Patients feel characteristic numbness and tingling of the thumb, index, middle and half of the ring digit on the palm side of the hand, most commonly at night (waking them up), while driving, using a cellphone or other activities with the hands,” says David Clark Hay, MD. “Patients will find themselves shaking their hand out to get the burning and tingling to go away.” The symptoms often develop slowly, beginning with a “pins and needles” type sensation first thing in the morning or when falling asleep at night.
The most common treatments involve immobilizing the affected area so the repetitive movements stop, or surgically opening up the area to relieve pressure. However, a study published in the Journal of Orthopaedic & Sports Physical Therapy suggests physical therapy may work just as well as surgery. The study followed 100 women from Madrid with the condition, half of whom were treated with physical therapy and half underwent surgery. Researchers found that physical therapy (in particular an approach called manual therapy) improved hand and wrist function and reduced pain as effectively as a standard operation for the condition. Moreover, after one month, the patients who had physical therapy reported better results than those who had surgery.
- Treating with cold and vibration
You’ve probably heard about icing the inflamed area, but Baxter warns that this stiffens muscles and tendons and slows the blood flow. Try massaging the area following icing to stimulate the flow of blood, Dr. Baxter. The massage “keeps the muscle fibers supple,” he says, “so the re-injury damage of moving fibers that are trying to stick together to decrease movement is minimized and ice is more tolerable.”
The simplest remedy is to rest your fingers, hand and wrist. Stop activities that you think may be causing numbness and pain. When symptoms improve, the activity can be resumed gradually. Shari Liberman, MD, suggests that patients evaluate their home and work space ergonomics to identify issues that could be contributing to their symptoms. “Changes at the office that might help relieve symptoms include switching to an ergonomic keyboard or mouse, changing the position of keyboard and mouse to allow the wrists to be a neutral position, or using a padded rest for the wrist,” she says. “At home, patients could take breaks from repetitive tasks to stretch and move their hands and wrists.”
Simple wrist exercises can be done any time throughout the day, whether you’re at your desk at work or waiting in line at the store. Healthline suggests making a fist and then slide your fingers until they are straight again, repeat the action five to 10 times, to help relive any pressure on the wrist. If you have issues with fluid retention from pregnancy or fractures, get into the habit of elevating your hands and wrists whenever possible.
Keeping your wrists straight can help relieve the pressure on your median nerve. Symptoms are more common at night, so wearing a splint in the evening may help relieve your symptoms before they start. If you have issues with repetitive tasks at work, you can also wear wrist splints during the day. “The purpose of the splint is to keep the wrist in a neutral position keeping the tunnel open and preventing pressure on the nerve,” says Dr. Liberman. “We tend to sleep with our wrists bent, which exacerbates the symptoms. These splints can also be worn during activity that exacerbates the symptoms.”
- Anti-inflammatory treatments
Mild cases may respond well to anti-inflammatory medication such as ibuprofen or naproxen, says Dr. Liberman. “Some patients find that other anti-inflammatory techniques such as acupuncture and natural anti-inflammatory compounds such as turmeric and omega-3 can help mild cases,” says Dr. Clark Hay. However, he warns that persistent or worsening symptoms such as burning or tingling that becomes constant, the onset of persistent numbness or the onset of weakness can become permanent if left untreated.
When home remedies don’t work
If you’re not finding relief with these methods, the next step is a steroid injection, says Dr. Liberman. “The steroid injection reduces inflammation, which leads to additional space in the tunnel and less pressure on the median nerve,” she says. The success rate is high: 90 percent of patients get relief from their symptoms from steroid injections. Alternatively, surgery will usually cure carpal tunnel. “Modern surgical techniques, mini open surgery or endoscopic surgery allow us to give the vast majority of patient near complete relief of their symptoms if they have not waited too long and developed permanent nerve injury,” says Dr. Clark Hay. For anyone with carpal tunnel syndrome, it’s important to take action quickly. “Don’t wait more than 2-3 months to see your local hand surgeon or orthopedic specialist,” says head of Skills 4 Living Therapy Jeanne Harper, who has 30 years of occupational therapy experience and a certification in Hand Therapy (CHT). “Prolonged compression can cause nerve damage and a longer rehab post surgery period.” Patience is also required. “As with any overuse syndrome or injury, remedies take a while and aren’t quick fixes,” says Baxter.
.: Reader’s Digest
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