Health Notes Online . . .
Margaret Senn Schwartz, OTR , Certified Hand Therapist
(also known as compression of the median nerve at the level of the wrist)
Due to the industrial revolution, followed by technological advances, the human hand is under much more strain and repetitive forces than it was originally designed for. Carpal Tunnnel Syndrome has been around for centuries, once a disease of "scribes", then "telegraphers' , and secretaries. And now it is an ailment to many people; particularly those working in manual positions in factories, and clerical positions requiring continuous keyboard entry .
The median nerve may be compressed at the level of the wrist .Beneath the wrist, is the transverse carpal ligament and the carpal tunnel or mid-wrist and palm area, which can be compressed causing symptoms such as, decreased sensation or numbness of the first three fingers causing clumsiness, and weakness of the thumb or first three fingers and muscles affecting grip strength (particularly pinch and grasp). Carpal Tunnel Syndrome can be caused by many factors, or in some cases cause is not evident. A common cause is overuse of the muscles and tendons of the hands , causing inflammation and pressure in the "carpal tunnel, or wrist tunnel" which consists if many tendons, vessels, and other tissues in a tightly compacted area. When there is added compression or swelling, the main nerve to the thumb, index, and middle finger is also compressed.
Increased intratunnel pressure is most common due to:
Non-operative management is most likely to be successful with clients with intermittent or early symptoms. The purpose of treatment is to reduce the compressive forces on the median nerve in the carpal tunnel at the wrist area..
Splinting with a wrist support aims to control the wrist position. Intratunnel pressures are lowest with the wrist in a mid-position, so the "wrist straight" is the suggested splint position. If symptoms are intermittent and not severe, a splint worn at night may provide adequate relief. Otherwise, it is generally recommended that the wrist be immobilized for a period of 3-4 weeks with gentle exercises to prevent stiffness.
Its important to observe tools handles, and work postures, especially in the wrist, to encourage a neutral wrist position. Work habits, postures, repetitive forceful gripping, twisting or pulling motions also need to be assessed. Following are some other interventions used in the workplace for prevention:
Surgery and Post-Operative Therapy
The aim of surgery is to reduce intratunnel pressure by releasing the transverse carpal ligament. This may be achieved by endoscopic or open release and is an ambulatory surgical procedure (1/2 day). Surgical release enlarges the carpal tunnel and relieves the pressure on the nerve. There is a small incision at the area of the ligament that is restricting the carpal tunnel, and a splint may or may not be provided for support immediately following surgery. One side effect after surgery, is that the altered biomechanics have been linked with a decrease in grip strength. But, in long-standing cases, nerve damage can be of worse consequences if ignored. Hand Therapy following surgery can help to prevent complications and restore function. The key to therapy is to influence post-operative scar formation, decrease pain, and increase strength with a shorter period of recovery and return to work or daily activity. Therapy may focus on:
Other web sites for carpal tunnel syndrome:
Ms. Schwartz is a Registered Occupational Therapist at Elizabeth General Hospital in Elizabeth,N.J. She graduated from Towson University in 1983 with BS in Occupational Therapy. She also worked at Kessler Institute for Rehabilitation in New Jersey, a world renowned hospital for rehabilitation.
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