Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

Carpal tunnel syndrome is caused by compression of structures beneath the carpal ligament, often the result of overuse of the hands. The carpal ligament is a broad band of connective tissue encircling the wrist at the base of the hand. Carpal tunnel syndrome has been on the increase since computers have become widespread. Any job which allows people to hold the wrists bent in an unchanged position for long periods of time may be the culprit. Electricians who are repeatedly turning screwdrivers, anyone doing a job requiring bending the wrist, and people who sleep with the wrists bent down on the forearms are all at risk of getting carpal tunnel syndrome.

Certain medical conditions, such as diabetes, arthritis, or food sensitivity, can cause swelling which compresses a nerve inside the wrist, resulting in numbness, tingling, or pain of the forearm and fingers. The thumb and first three fingers are most often involved. Weakness may follow and atrophy from disuse. The knuckles may hurt and pain may shoot on the undersides of the fingers, up the forearms, or simply an ache in the hands, sometimes extending up the forearm toward the elbow, or even up the arm.‍

Some potential wrist-damagers:

• Long nails which force the fingers to extend to press keyboard keys.
• Pushing a heavy object repeatedly, such as a door.
• Opening jars repeatedly with excessive force or even a single strain may initiate the problem.
• Holding a telephone at an angle for long periods.
• Any repetitious job done by assembly line and clerical workers, food preparers and packagers, super market checkout clerks, and computer operators.

Prevention:‍

An analysis should be made of the worksite to determine the correct posture, and the optimum force and repetition of each movement. Changing the height of keyboard and screens, keyboard wrist rests, making sure chairs are well suited to the job and the worker will help some computer operators. The earlier the diagnosis and treatment are begun, the better it is. Sit an arm's length away from your monitor, keep relaxed, take periodic breaks, and avoid glare on the computer screen. Keep the wrists straight, even if a splint is needed.

The use of vibrating tools has been found to be strongly associated with carpel tunnel syndrome. Tools and protective equipment should be selected for those who do repetitive jobs requiring bending the wrists and using some force.

Far too many operations are being done on those who have carpal tunnel syndrome. More conservative methods should be applied first. Exercises which strengthen the hand and upper arm muscles, like squeezing a hand gripper or swimming, may help avoid the disease, or avoid an operation if one already has it.‍

Treatment:‍

One patient from Jackson, Mississippi, received remarkable relief by wrapping an electric heating pad with a towel and pinning it carefully to form a splint for her hand and lower arm. She slept with the warm splint on her arm, wearing gloves at night to prevent the slightest chilling. She did this for a year and had almost normal use of her hand with very little pain. She felt she avoided surgery by this remedy.‍

Exercises:

• Push all four fingers back from the inside of the palm with the opposite hand for five seconds. Repeat at least 20 times during the day.
• Gently pull the thumb back toward hairy part of the forearm until you can feel the stretch. Hold five seconds. Repeat at least 20 times during the day.
• Clench the fist. Release, forcefully fanning out the fingers. Do five times; repeat at least five times a day.
• With the fist clenched, palm up, resist an attempt of the other hand to hold the wrist down on the forearm.
• With fist clenched, palm down, resist a similar attempt of the opposite hand to fold the wrist on the forearm.
• Resist the same type of pressure with the thumb side of fist up.
• Resist a similar attempt to fold the wrist up while the fist is palm down.
• With palm flat on a table, bend forearm onto hand.
• Prepare a splint by wrapping a stiff object such as a strip of metal or heavy cardboard with a small towel or adhesive tape to make it comfortable. Bind it with a cloth bandage, roller gauze, or an ace bandage onto the palm surface of the hand and forearm to about halfway up to the elbow. Wear each night.
• Massage firmly inside and outside of the hand with thumb and fingers for two minutes or more three times daily. Use a good hand lotion as a massage lubricant.
• Rest the forearm on the edge of a table, palm down. Grasp the fingers with the other hand and gently bend the wrist backward for 5 seconds.
• While standing, place the palm down on the table and begin pulling the forearm forward trying to bend it down onto the hand. When it reaches its full capability, hold for 5 seconds.
• Make a loose fist and gently press downward against the clenched fist with the opposite hand, resisting the pushing movement and keeping the wrist straight.
• Do the same exercise with the palm down, trying to push the clenched fist downward.
• Do the same exercise with the thumb side of the fist up, trying to push the fist sideways toward the elbow.
• With the clenched fist palm down rest the opposite hand on the knuckles of the fingers and press them downward.
• Get a firm rubber band large enough to put all five finger tips into the band. The fingers are then separated as widely as possible. They should be separated at least an inch. If one rubber band is not sufficient to give a strong resistance, use two or three bands. The exercise should have 15 to 20 repetitions every three to four hours throughout the day for one to two weeks (Ref. The Physician and Sports Medicine 22(9);20, September, 1994).
• Take some anti-inflammatory herb such as licorice and white willow bark tea. Take a heaping teaspoon of licorice powder and a heaping tablespoon of white willow bark and simmer gently for 25 minutes. Strain and drink in one day. Make fresh daily. Take for 4 to 6 weeks.
• A well done elimination and challenge diet can find troublesome foods which cause wrist swelling. A list of foods is removed from the diet for 1 to 3 months, until symptoms go away. Then one food is added back every 5 to 10 days until symptoms recur. See separate list of "Top 10" food groups most likely to be troublesome.