What Can I Do To Prevent Carpal Tunnel Syndrome?

To help prevent carpal tunnel syndrome:

• Sleep with your wrists straight or use a splint.
• Keep your wrists straight when using tools but try not to use splints.
• Avoid flexing and extending your wrists repeatedly.
• Perform conditioning and stretching exercises.
• Use correct positioning of hands and wrists while working.

How Is Carpal Tunnel Syndrome Treated?

There are several ways to treat carpal tunnel syndrome:   

• Lifestyle changes. Treatment first involves adjusting the way the person performs a repetitive motion: Changing the frequency with which the person performs the motion and increasing the amount of rest time between movements.
• Immobilization. Treatment also includes immobilizing the wrist in a splint to minimize or prevent pressure on the nerves. Splints that support the wrist in a comfortable neutral position can be of great value if worn at night to relieve painful numbness or tingling. This can provide a restful sleep and allow the median nerve to endure daytime activities.
• Medication. Patients may be given short courses of anti-inflammatory drugs or injections of steroids in their wrist to reduce swelling. Injections are most successful when people have mild to moderate carpal tunnel syndrome as a result of an acute (severe) flare-up.
• Surgery. If carpal tunnel syndrome does not respond to conservative treatment, then surgery is the next treatment option. During surgery, your surgeon will open the carpal tunnel and cut the ligament, relieving the pressure. Carpal tunnel surgery is quite effective at relieving painful symptoms when the condition involves only nerve constriction.

When carpal tunnel syndrome is just one manifestation of repetitive stress, the surgery cannot be expected to relieve symptoms that are not attributable to carpal tunnel syndrome. The difficulty is not in recovering from the operation, but in recovering the ability to return to work, especially to the same job that caused the repetitive disorder to occur. Whether or not true carpal tunnel symptoms recur in these patients, many continue to have pain and are unable to use their hands to any great extent.

What Tests Help Diagnose Carpal Tunnel Syndrome?

Two useful clinical tests for diagnosing carpal tunnel syndrome are the Tinel and Phalen maneuvers. Tingling sensations in the fingers caused by tapping on the palm side of the wrist is a positive Tinel test, whereas reproduction of symptoms by flexing the wrist is a positive Phalen test. (Dr. Phalen created this maneuver many years ago when he was a hand surgeon at The Cleveland Clinic.)

If needed, an electromyogram and nerve conduction studies, are done to document the extent of nerve damage. An electromyogram is a test that measures the electrical activity in your nerves and muscles. Nerve conduction studies measure the ability of specific nerves to transmit electrical impulses or messages.

These tests, however, may not become positive until there is significant nerve damage. In addition, the severity of a person's symptoms is often not correlated with the findings of a nerve conduction study.

Do Certain Medical Conditions Make People More Likely to Develop Carpal Tunnel Syndrome?

People with rheumatoid arthritis, diabetes, or other metabolic conditions like thyroid disease may be more likely to develop carpal tunnel syndrome. These conditions affect the nerves directly, making them more vulnerable to compression. Pregnancy may also cause carpal tunnel syndrome but it usually resolves within a few months after delivery.

What Happens in Severe Cases of Carpal Tunnel Syndrome?

When chronic irritation occurs around the median nerve, it becomes coompressed and is continually pushed against the ligament above it. When the nerve is continually constricted, it can become compressed to the point that it begins to deteriorate. This results in a slowing of nerve impulses, which may cause a loss of feeling in the fingers and a loss of strength and coordination at the base of the thumb. If the condition is not treated, it could result in permanent deterioration of muscle tissue and function.

What Are the Symptoms of Carpal Tunnel Syndrome?

Usually, people with carpal tunnel syndrome first notice that their fingers "fall asleep" and become numb at night. They often wake up with numbness and tingling in their hands. The feeling of burning pain and numbness may generally run up the center of the person's forearm, sometimes as far as the shoulder. As carpal tunnel syndrome becomes more severe, symptoms are noticed during the day.

What is Carpal Tunnel Syndrome?

The carpal tunnel is the passageway in the wrist and is made up of the arching carpal bones (eight bones in the wrist) and the ligament connecting the pillars of the arch (the transverse carpal ligament). The median nerve and the tendons that connect the fingers to the muscles of the forearm pass through the tightly spaced tunnel.

Carpal tunnel syndrome occurs when the median nerve becomes pinched due to swelling of the nerve or tendons or both. The median nerve provides sensation to the palm side of the thumb, index, middle fingers, as well as the inside half of the ring finger and muscle power to the thumb. When this nerve becomes pinched, numbness, tingling, and sometimes pain of the affected fingers and hand may occur and radiate into the forearm.

While there are many possible causes of carpal tunnel syndrome, the vast majority of people with the condition have no known cause.

However, we do know that excessive repetitive movements of the arms, wrists, or hands can aggravate the structures of the carpal tunnel, triggering the symptoms of carpal tunnel syndrome. Untreated, this can become chronic, but when detected early, carpal tunnel syndrome can be treated more easily and recovery is possible in a few months. Severe carpal tunnel syndrome can also be treated, but recovery may take up to a year or longer and may not be complete.

Computer Users for Some Ergonomic Exercises

Try the following Ergonomic Exercises:

1. Take short 1-2 minute stretch breaks every 20-30 minutes. After each hour of work, take a break or change tasks for at least 5-10 minutes. Always try to get away from your computer during lunch break.
2. Avoid eye fatigue by resting and refocusing your eyes periodically. Look away from the monitor and focus on something in the distance.
3. Rest your eyes by covering them with your palms for 10-15 seconds.
4. Use correct posture when working. Keep moving as much as possible. 

The most common places that employees experience discomfort is in their hands, wrists, shoulders, neck, and upper body.

This is due to the fact that so many jobs require prolonged work days spent at desks and workstations that are not always designed with the employees comfort in mind.

By taking frequent breaks and performing these computer exercises every hour, you can break through pain and continue to work productively throughout the day.

During your coffee or lunch breaks, be sure to stand up and stretch your legs a bit to get your circulation going.

Rotate your wrists and bend your fingers at all of the various joints. Raise your hands above your head to stretch your neck and shoulders, and also consider moving your head side to side and your shoulders up and down.

Extend your arms across your body and twist side to side to stretch the upper body. To release muscle tension, consider going on a short walk outside your building. The fresh air should help to invigorate and recharge your body.

 If you regularly use a computer while working, be sure to practice ergonomic mousing, which means that you always keep your mouse at the same height as your keyboard and avoid letting your wrist rest on a cushion.

Your forearm should be free to move the mouse in order to relieve stress on your wrist. Also try to keep the mouse right next to the keyboard to allow your forearm to rotate easily between the keyboard and mouse.

Can I treat my work-related injury at home?

If you have a musculoskeletal injury such as back or neck strain or carpal tunnel syndrome, try home treatment for a few days when you first notice symptoms. These steps are usually helpful in relieving discomfort caused by stress and overuse. Home treatment includes:

• Resting the painful area and avoiding or modifying activities that make your pain or discomfort worse. Return to some daily activities as soon as possible to help maintain flexibility and general well-being. Be aware of any tingling, numbness, weakness, or pain that may indicate an injury.
• Using ice to reduce pain and inflammation. Place an ice pack or cold pack over the painful area for 10 to 20 minutes at a time, as often as once an hour. This will help decrease any pain, muscle spasm, or swelling.
• Using nonprescription pain relievers. Acetaminophen (such as Tylenol) can help relieve pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen sodium (such as Aleve), can also help relieve pain and reduce inflammation. People younger than age 20 should not take aspirin because of the risk of Reye syndrome (a central nervous system complication in children).
• Doing gentle stretching exercises to keep flexible and prevent stiffness. These exercises include stretches for your neck , back , shoulders , and wrists and arms .
• Examining your workstation setup and workstation tools. Apply the ideas of ergonomics to make sure your workstation and tools fit you and the activity you are doing. Then try making changes that will limit any injury.
• Keeping good health habits. Exercise regularly (including aerobic, muscle strengthening, and flexibility exercises), eat a balanced diet, don't smoke, get enough sleep, and lose weight if needed. If possible, reduce stress and tension at work and at home.

Home activities may contribute to workplace injury. For example, doing an activity at home that requires the same repetitive movements as at work may not allow your body time to recover. Also, driving long distances to and from work may contribute to workplace injury. Using special seat covers for added comfort (such as those made of wool or beads), carpooling, or using public transportation may help reduce this added stress.

Is other treatment available?

Other treatments to relieve pain, prevent further injury, and return to normal activities include:

• Physical therapy, to relieve pain and keep or improve strength and flexibility.
• Orthotic devices, such as wrist splints or a neck (cervical) collar, which may be worn at home to relieve stress and provide temporary support.
  • Wrist splints should not be worn while you work because they can increase strain on your tendons.
  • A cervical collar is not to be used on a continuous basis at the workplace. Follow your doctor's instructions for wearing the collar. And if you find it to be uncomfortable, talk to your doctor. Cervical collars are not usually used for long periods of time.
• Complementary therapies are health care practices that may be used along with standard medical treatment. They include:
  • Acupuncture, which is used to relieve pain and treat certain health conditions. It is done by sticking thin needles through the skin at certain points of the body to reduce pain.
  • Massage, which involves applying pressure to the soft tissues of the body, such as the muscles, to reduce tension and pain, improve circulation, and encourage relaxation.
  • Yoga, which is a program of exercises to help improve flexibility and breathing, decrease stress, and maintain health. The basic components of yoga are proper breathing and posture.
  • Chiropractic or spinal manipulation. Manipulation treatments usually involve a trained practitioner performing twisting, pulling, or pushing movements to realign joints and bones.

Surgery usually is not needed for injuries related to workstation design.

Where can I go for help?

If you have tried the home treatment suggestions but your pain and discomfort have lasted for several days (for example, 7 continuous days), call your doctor. Health professionals who can diagnose and treat work-related injuries include:

• Family medicine physicians.
• General practitioners.
• Neurologists.
• Nurse practitioners.
• Occupational medicine specialists.
• Occupational therapists.
• Orthopedic doctors.
• Physiatrists.
• Physical therapists.

You may be able to get help or information through:

• Your human resources department at work.
• Your state's Labor Department.
• Occupational Safety and Health Administration (OSHA), for information on treating and preventing injury.
• National Institute for Occupational Health and Safety (NIOSH), a division of the Centers for Disease Control and Prevention (CDC). NIOSH is the federal agency responsible for conducting research and making recommendations for the prevention of work-related disease and injury.

Will physical therapy help?

Physical therapy is treatment to improve mobility (such as walking, going up stairs, or getting in and out of bed), to relieve pain, and to restore physical function and overall fitness. The physical therapist uses exercise, manual therapy, education, and modalities such as heat, cold, and electrical stimulation to work toward these goals.

Depending on your injury, disease, or condition, you may need to work on flexibility, strength, endurance, coordination, and/or balance. To do this, your treatment may focus on preventing problems or treating problems that affect:

• Your muscles, tendons, ligaments, and bones (musculoskeletal system).
• Your nerves and related muscles (neuromuscular system).
• Your heart and related blood vessels (cardiovascular system).
• Your lungs and breathing (pulmonary system).
• Your skin, including wounds and burns.
• Any combination of two or more of these.

What can you do if you have a work-related injury?

You can try home treatment for a few days when you first notice symptoms. Try to:

• Rest the painful area and avoid activities that make your pain worse.
• Use ice to reduce pain and swelling.
• Take over-the-counter medicines to relieve pain.

If you've tried home treatment for several days in a row and it hasn't helped, call your doctor. You may need physical therapy or other treatment to prevent more injuries.

You may be able to get more information about workplace safety and ergonomics from your human resources department at work or from your state’s Labor Department.

How can you prevent injuries at work?

Here are a few ways you can prevent injuries at work:

• Try to place your work so that you can sit in a comfortable position while you do it.
• Try not to put too much stress on one area of your body, such as your lower back or arms.
• Change your position often.
• Turn with your whole body instead of twisting to face your work.
• Take breaks to stretch or get out of your chair every 20 to 40 minutes. If you can, switch to another task.

What kinds of injuries happen at work?

Most injuries that happen at work are caused by physical stress and strain, such as sitting in the same position for a long time, making repetitive movements, and overuse. These injuries can cause stress and strain on your muscles, nerves, tendons, joints, blood vessels, and spine.

Symptoms can include pain in your:

• Back.
• Hand, wrist, or arms.
• Neck and shoulders.

You could also be at risk for problems such as tendinopathy and bursitis. These are caused by overuse and repetitive movements. Over time, these kinds of movements can make you feel bad. They can cause long-term health problems. And they use up your sick time.

You may be at greater risk for injuries at work if you have other health problems, such as arthritis or emotional stress.

Why should your work area be ergonomic?

It's common for injury and illness to happen at work. Both can cost you and your employer time and money.

They can also affect how well you do your job.

In one study, more than half of the workers who used computers for at least 15 hours a week had joint problems in the first year of a new job.

 Most on-the-job injuries are caused by:

1. Falls. 
2. Repetitive movements. 
3. The way you sit or stand (posture). 
4. Bending over, lifting heavy objects, or using pressure or force. 
5. Working with vibrating tools.  

Office ergonomics can help you be more comfortable at work. It can help lower stress and injury caused by awkward positions and repetitive tasks. It focuses on how things are set up in your office work space, such as:

1. Your workstation setup, how you sit, and how long you stay in one position. 
2. How you do a certain task, the kinds of movements you make, and whether you make the same movements over and over. 
3. Your work area, including light, noise, and temperature. 
4. The tools you use to do your job and whether they are set up to fit your needs.

What is ergonomics?

Ergonomics (say "er-guh-NOM-iks") is the study of the kind of work you do, the environment you work in, and the tools you use to do your job. The goal of office ergonomics is to set up your office work space so that it fits you and the job you are doing.

When your workstation is set up right, you may:

•  Be less likely to have problems such as headaches or eyestrain. 
•  Reduce neck and back pain. 
• Prevent bursitis or tendon problems that are linked to doing the same task over and over (repetitive tasks).