If you’re here, I’m assuming it’s because you are concerned about getting carpal tunnel syndrome, and what you can do to prevent or treat it. Well, I have good news for you. Even if you have it, you are not necessarily destined for surgery. And if you don’t, you can likely prevent it.
The following outline was used in a one-hour class I taught at James Madison University to staff who primarily worked on computers in the Fall of 2010. This class was specifically tailored to this audience, and your case may be different. If you have any questions, please post them here or email me, and I’ll do my best to get back to you quickly.
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(Outline for Presentation)
INTRO
(Brief bio – where I studied, what I study, what I typically treat) – This is found elsewhere on my website, so I didn’t include it here.
WHAT IS A REPETITIVE STRAIN INJURY? (Broad category)
- result of combining repetitive movement with physical stress
- primarily muscular
- numbness and tingling (means that nerves are involved in the injury.)
Common sources of Repetitive Strain Injuries (RSI)
- poor posture
- repetitive movements that include strain
- tissue changes which affect the fascia as a result of old injuries or surgeries
- chronic emotional or physical stress
- unconscious habits that result in strain
- improper ergonomics on the job or at home
The most common type of RSI include: Carpal Tunnel Syndrome (Thoracic Outlet Syndrome, deQuervains Syndrome, Ulnar Tunnel Syndrome, Tendonitis, Medial Epicondylitis (Tennis Elbow), Lateral Epicondylitis (Golfers Elbow), forearm pain or chronic neck and shoulder pain.)
What are some common symptoms of Carpal Tunnel Syndrome?
NUMBNESS (can be accompanied by tingling)
- Numbness in the thumb, index, middle finger, and often part of the ring finger. This is frequently brought on when doing anything that requires bringing the fingers together in a pinching motion like grasping a tool or paintbrush.
- Numbness can be so extreme that people experience burn injuries and other trauma to their hands because the numbness keeps them from feeling pain when accidents occur.
- When severe enough the numbness can also cause night waking.
PAIN (Burning, aching, sharp)
- Pain in the wrist, elbow, or shoulder (frequently the sharp pain is with movement), usually relieved momentarily by pressure and immobility
- Any twisting motion to the wrist can be painful or impossible; as in turning a key in a door, hooking a bra, or rolling down a car window.
SOFT TISSUE PROBLEMS (range of motion and weakness)
- Increasing weakness in grip strength, resulting in dropping things (even pens/pencils). Even simple tasks like pouring liquids from a half gallon container or squeezing the pump of a gas handle, can be excruciating and impossible.
- Inability to raise arms completely overhead (so that your upper arms reach all the way up next to your ears) without causing numbness, tingling, or muscle pain. Often, muscles and connective tissues are so stuck, they impede the full range of motion of the arms.
- Loss of range of motion is also often caused by the shoulder blades becoming stuck, preventing the normal full motion of the shoulders and arms without strain to the whole upper body complex. Adhesions of this nature will create areas that tug on injured nerves as the sufferer moves shoulders and arms, contributing to further strain and irritation for the over stimulated and injured median nerve.
- Shaking your hand relieves the symptoms at first, but may not work after awhile
WHAT IS CARPAL TUNNEL SYNDROME? (type of RSI)
- Carpal Tunnel Syndrome is caused by a compression of the median nerve. The median nerve is one of three main nerves that bring feeling to the palm side of the hand and wrist, the thumb, the index and middle fingers and sometimes to part of the ring finger.
- It is one of the five main nerves originating from the brachial plexus.
WHERE DOES CTS START? WHAT REGIONS OF THE BODY ARE INVOLVED?
The brachial plexus originates at the neck, passes under the collarbone and across the front of the shoulder. It is at this point that true Carpal Tunnel Syndrome anatomy begins.
14. significant amount of tissue change and muscle adhesions higher up along the median nerve pathway, especially through the shoulders and armpits. Tissue adhered through the armpits is often the culprit here.
WHAT CAUSES CARPAL TUNNEL SYNDROME
- swelling of a wrist, the swelling may in turn pinch the median nerve and thereby bring about CTS.
(What can cause swelling in the wrist?)
- Obesity
- pregnancy
- rheumatoid arthritis
- diabetes
- thyroid problems
- birth control pills
- overuse of wrists (keyboard work, playing Guitar, knitting, prolonged driving, or work related-duties – mechanics, dentists, plumbers, etc)
- UNCONSCIOUS HABITS:
- Grasping objects too tightly which creates significant strain in the flexor muscles on the inner portion of the forearm
- Keeping your arms down at your sides for extended periods of time which leads to restriction, congestion and adhesions of the tissues that pass through the armpits
- Resting wrists on desk surfaces or on wrist rests which compresses tissues as they pass through the carpal tunnel of the wrist
- Sleeping with wrists curled palm ward leading to more strain for the flexor muscles and the carpal tunnel
- Gripping objects while the arms are extended forward of the body which tightens the tissue all the way from the fingertips to the top of the shoulders
HOW CAN YOU OVERCOME/PREVENT CTS?
- reduce or eliminate the constant sources of strain affecting the median nerve along its entire pathway. (The most common source of strain is from adhesions in the fascia that covers and permeates through the muscles in the shoulders, armpits, arms and hands.)
- Stretch:
- Neck and shoulders
- The armpits
- The biceps and triceps muscles
- The flexor muscles in the forearms
- The retinaculae surrounding the wrists (a bracelet of fascia which holds the tendons next to the wrist bones)
- The fingers
- Maintain good posture, or get help (Rolfing) to get that. Proper posture places the least amount of strain on all the soft tissues of the body. Evaluate your posture and make corrections when you notice slouching, reaching forward, a forward head, or any of the other markers for improper posture.
- Unconscious habits that create added strain to the body must be recognized and eliminated if at all possible. Some of the most common offenders include:
WHAT SHOULD TREATMENT INCLUDE?
- therapy to improve flexibility and strength.
- daily program of stretching and resistance exercises
- Physical Therapy
- Massage Therapy is also useful and can be done on yourself (with a little training – see references below) if you can’t afford to see a therapist. The best type of massage therapy involves Myofascial Release techniques and Neuromuscular Therapy.
- work station ergonomics – make appropriate changes to avoid angling your wrists away from a neutral alignment as much as possible.
WHAT THERAPIES CAN YOU SEEK OUT TO PREVENT OR TREAT CTS?
- MEDICAL massage (opening up and decompressing the restricted tissue and stretching the fascia back into its designed form)
- Yoga
- Acupuncture
- Physical therapy
- (drugs, injections, surgery)
WHAT CAN YOU DO TO PREVENT OR TREAT CTS?
- Ergonomics at work
- wrist/arm/shoulder support (keep wrist in a straight line with the arm so that the hand is not angled up or down.)
- hydration – Tissues that are properly hydrated can help reduce the irritation that affects tissues injured by Carpal Tunnel Syndrome. Simply drinking enough water can go a long way to correcting this chronic source of unnecessary strain.
- stretches – Extend and stretch both wrists and fingers acutely as if they are in a hand-stand. Straighten both wrists and relax fingers. Hold for a count of 5. Make a tight fist with both hands. Then bend both wrists down while keeping the fist. Hold for a count of 5. Straighten both wrists and relax fingers, for a count of 5. Then let your arms hang loosely at the side and shake them for a few seconds. The exercise should be repeated 10 times.
- rest
- self massage (myofascial, nmt, trigger point) and Yoga
HOW CAN YOU MINIMIZE RISK WHEN WORKING ON COMPUTERS?
Make sure that your workspace is set up properly…
- Your keyboard should be directly in front of you with your mouse or trackball sitting next to it.
- Your elbow should be next to your side.
- Place your mouse or trackball within easy reach.
- You do not need to use a mouse pad with a high- performance mouse. If you choose to use a mouse pad anyway, be sure to consider the thickness of the mouse pad when you set up your workspace, because a mouse pad may raise your mouse higher than your elbow.
- Support elbows with arms on desk or arm of chair. Pull-out trays are no good.
Keep your shoulders, arms, wrists, & hands relaxed and comfortable as you work…
- Let them hang loosely at your sides for a moment, allowing them to dangle toward the floor and to become relaxed. Try to maintain this relaxed feeling while you work.
- When you are ready to use your mouse or trackball, avoid resting your wrists on sharp edges, or on your desktop.
- As you use your mouse or trackball, make sure that your elbow is next to your side. Keep your wrist relaxed and straight – don’t bend it up, down, or to either side. Keep your shoulders relaxed. Do not hunch or shrug.
- Rest your hand lightly on the mouse or trackball…
- You’ll find it easier and more comfortable to get the control you want if you’re not squeezing the mouse or trackball too tightly.
Take Breaks…
- Get up and walk around at least twice every hour. Some studies suggest staying too long in one position – or repeating the same motion many times – may cause discomfort and injury. Do something different with your hands and arms for a while. Vary your tasks throughout the day.
Be alert to signs of discomfort…
- Contact a doctor if you experience pain, tenderness, swelling, burning, cramping, stiffness, or numbness in your fingers, hands, wrists, arms, or shoulders.
DEMO SELF MASSAGE AND STRETCHES
The following is a list of common locations that the median nerve can be compressed:
- In the neck, the roots of the median nerve can be compressed by the spine
- Under the clavicle: It is common for upper extremity nerves to be compressed between the clavicle and the underlying first rib.
- Under the pectoralis minor muscle. This muscle is often short in people with forward-rounded shoulders.
- Under the prontator teres muscle in the forearm. The pronator teres muscle is responsible for twisting type motions of the forearm and wrist. It is often tight in people who use their hands for manual labor.
- Under the flexor retinaculum. Finally, the median nerve can be compressed in the palm side of the wrist.
- Compression in any one location makes the nerve more vulnerable to compression everywhere else along its course. This has been termed the “double crush” phenomenon. Effective therapy usually includes decompressing the nerve at multiple sites along its course!
