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Loren Fishman, MD

Loren Fishman, MD

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Carpal Tunnel Treatment: Clamping Down On The Problem

Posted: 05/16/11 06:00 AM ET

A couple of years ago, a friend of mine, who was head writer for a television soap opera, came to me saying she needed to write more than 40 pages of script every week, but she could not push down the keys on the computer. Her right thumb, index finger, middle finger and the thumb-side of her fourth finger were numb. The numbness was almost worse than the pain, which started in her wrist and went up into her shoulder, then down to her palm, especially after typing. Her hand was so weak she dropped her hairbrush and cooking utensils. Her career was at stake. Like about 20 percent of the population, especially women over 45 years of age, she was suffering from carpal tunnel syndrome.

Carpal tunnel syndrome happens when, as the median nerve passes through a narrow space in the wrist, it must share space with many tough tendons and it becomes "pinched" or compressed. Any inflammation in that little area inside the wrist -- the carpal tunnel -- (whether it comes from overuse, hereditary factors, arthritis or a fracture) can cause extreme discomfort and substantial disability. As a specialist in physical medicine and rehabilitation, I help my patients avoid surgery when possible. And luckily, there seems to be a real benefit from conservative treatments including splinting, ultrasound, yoga and carpal bone mobilization, at least in the short-term.

Yoga and Physical Therapy
For those whose carpal tunnel problems are not severe, yoga can often help as much or more than physical therapy. The Iyengar postures that I practice myself can work wonders. These are the poses that help strengthen, stretch and balance the individual muscles in the upper body -- the neck, shoulders, torso, arms, wrists and fingers. Yoga can loosen the tight band of tissue that constricts the carpal tunnel. Patients who do a program of appropriate poses for eight weeks, coupled with relaxation sessions and a wrist splint if needed, do very well. Grip strength improves and pain decreases.

My experience has shown that one particularly beneficial exercise for carpal tunnel involves bending the affected wrist(s) toward the shoulders while puckering up the palm(s). This and other methods for stretching that small compartment which houses the nerve and tendons seems to relieve pain, even if it doesn't change the results of electrodiagnostic testing that shows nerve conduction. Using a splint on the wrist also provides relief, especially if it is worn at night while the patient is sleeping. Wrist splints can be bought over-the-counter in the drugstore and are not expensive. Get the kind that extends the wrist upward about 30 degrees.

Prevention

Overuse is bad for carpal tunnel, as it is for most narrow compartments. Everyone should take frequent breaks from repetitive activities like typing, and stretch the fingers and palms and bend the wrist. The cold laser, available from your doctor, physical therapist or chiropractor, may be effective in reducing swelling inside the wrist. When conservative methods don't work, I have found an injection of steroid into the carpal tunnel can reduce inflammation and take pressure off the median nerve. The shot usually works immediately and can last for weeks, months or sometimes indefinitely. If the first shot doesn't work, often a second shot will.

And of course, the last resort is surgery, which does seem to have longer-lasting results. If you do have surgery for carpal tunnel, you need physical therapy afterwards to restore as much function to your hand as possible. It can take weeks to recover from the surgery, which is almost invariably effective, but occasionally does not restore the hand to its previous health.

I'm happy to report that my friend, by resting her hand, by using cold packs to relieve discomfort and by exercising with the same discipline she applies to her script-writing, was able to avoid surgery. She still uses a wrist-splint just to prevent a recurrence of pain and numbness, but is typing away because the show must go on.