Pain Relief: The L.A. Pain Clinic Guideby Sota Omoigui

CARPAL TUNNEL SYNDROME

This is a numbing disorder of the hand that rarely affects men but is fairly common in women. The carpal tunnel is a passageway that leads through your wrist. The area is called a tunnel because it has bones on three sides and a ligament on the palm side. Feel your wrist. Can you feel that it has three bony sides and soft tendons on the underside? The carpal tunnel protects the median nerve that runs inside and provides sensation to your fingers. Normally you aren’t conscious of that nerve, but when tissues in the tunnel swell from inflammation, there’s less room in the area and the median nerve becomes irritated and inflamed. People with carpal tunnel syndrome (CTS) experience numbness, tingling and pain in the fingers, wrist and even the arm. It is commonly described as pins and needles tingling or fingers going to sleep, such as when you’ve rested on a part of your body for a long time. The pain is worse at night when your body is warm and blood vessels expand taking up more space in the carpal tunnel. CTS may be brought about by activities that involve repeated or strenuous use of the wrists. Repetitive motions may range from typing all day at a computer to biking or playing tennis on a regular basis. Staying in one position for so long that it causes compression on the nerve such as during a long bike ride may also cause CTS. Swelling and pressure and carpal tunnel syndrome may also be caused by conditions such as arthritis, diabetes, low levels of thyroid hormones, pregnancy, hormonal changes associated with menopause and broken or dislocated bones in the wrist.
When sitting at a keyboard, make sure your hands are at elbow level or slightly below elbow level to prevent excess bending or stretching in the wrist. You may also use a wrist rest that is a foam pad placed at the end of the keyboard for extra support. Take a break every hour or two or whenever you feel tired, to change your posture. Lean back and take your hands off the keys. Take a second to bend your wrists the opposite way from the position they normally maintain. Stretch your fingers and shoulders, moving them around naturally to get them out of the fixed position. Take a thick rubber band and place it around the tips of your fingers including your thumb. Now open and close your fingers. For more wrist exercises, you may squeeze a tennis ball several times a day or try sports dough called “Power Putty” If you ride bikes; you should wear properly padded biking gloves and change positions during a long ride. If you play tennis or handball, take lessons to learn the proper grip. If you are pregnant, the numbness will disappear after the baby is born. Treating any of the conditions mentioned above (arthritis, diabetes, low levels of thyroid hormones, hormonal changes associated with menopause, broken or dislocated bones in the wrist) should also bring relief to your CTS.
Aspirin or other over the counter pain relievers such as Aleve, Motrin or Tylenol may relieve the pain. Take herbal supplements such as Quercetin, Rutin, Curcumin, Red Wine tablets, Cinnamon and Ground Clove Extracts. These contain polyphenols which are the best anti-inflammatory agents that nature has provided to us. Your doctor should first prescribe a wrist splint to help hold the wrist in an upward position. This position is important because it allows the nerve the room it needs. The splint may be worn round the clock or only at night depending on what gives you the most comfort. Elevate your hands when you sleep so that fluid drains back down your arm and decompresses the tunnel through which the nerve is passing. Strap an ice pack to your wrist for 10 20 minutes; place your wrists under a cold running tap or soak in an ice water bath to relieve the inflammation. You may add a few tablespoons of salt to the water bath. A therapist may do paraffin or hot wax bath and wrist massage. If you are not feeling better after a few weeks, your doctor may recommend a cortisone injection in the wrist. The purpose of the cortisone is to decrease inflammation and thus decrease the swelling around the tendons. It is like putting the aspirin right into the wrist. Some people get better after one injection. Others might require a repeat. Cortisone should not be used frequently because it may cause the tendons to breakdown. Cortisone may also be injected in the muscle or in an intravenous (IV) line. Other drugs that help control the median nerve inflammation include a subcutaneous injection of the biologic drug Kineret as well as an intravenous (IV) infusion of the anti-seizure drug Depacon combined with IV infusion of magnesium sulfate. Vitamin B2 (riboflavin) and Vitamin B6 (pyridoxine) supplements may be helpful especially if you have a deficiency of the vitamin. However excess doses of Vitamin B6 may also cause nerve damage. If these treatments do not work, then surgery may be necessary. The procedure called a “release” involves cutting the ligament forming the roof of the carpal tunnel to relieve pressure on the median nerve. The operation is usually done on an outpatient basis and successful in most cases. Before you consider surgery, make sure you’ve made changes in the work place and seen a physical or occupational therapist to learn new ways to work or play. Surgery may not be able to undo muscle or nerve problems brought on by years of strain. Even after surgery, these changes will still be necessary if you do not want your CTS symptoms to come back.

Call your Doctor: If making changes in the way you work or play doesn’t seem to help and the pain is sufficient to keep you awake at night.