By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

OFFICE TYPING CLASSIC CAUSE OF CARPAL TUNNEL SYNDROME

Question: I began having pain and numbness in my hand recently. My friend says I have carpal tunnel syndrome. I work in an office. I do a fair bit of word-processing, but I do lots of other things as well. Can you tell me about carpal tunnel and what can I do to prevent it. My hand is better now with just taking some ibuprofen.

Answer: Carpal Tunnel Syndrome (CTS) is a condition usually caused by overuse of the hand and/or wrist in repetitive actions. The typing you do on your job is a classic example. The primary symptoms of CTS can be a painful tingling and numbness over the fourth and fifth fingers of the hand. To better understand this, we need a brief description of the anatomy of the wrist area.

On the underside of the wrist there is a thick band of dense, unyielding, fibrous tissue called the flexor retinaculum. This structure forms the “roof” of a tunnel through which run blood vessels, the median nerve and the tendons that control your finger movements. The floor and two walls of the tunnel are formed by carpal or wrist bones.

As you repeatedly flex and extend your wrist, the sheaths that protect the tendons thicken, causing the tunnel to become narrow and pinch the median nerve. When the tissue around the nerve gets inflamed in this manner from overuse (or sometimes injury), it doesn’t take much swelling to put enough pressure on the nerve to cause the pain and numbness that I described. This is because the nerves, blood vessels and tendons are all tightly packed in this tunnel with almost no extra space.

Early in CTS the pain is often centered in the palm of the hand and on the underside of the wrist. Many people describe the pain being worse at night. Oftentimes the person awakens with a numb hand from sleeping with the wrists flexed. Eventually there is a loss of grip strength in the hand or hands.

CTS can also be caused by diabetes, hypothyroidism, gout, and Lyme disease. If you suffer from one of those conditions, correction of the underlying problem will usually treat the CTS. Pregnancy is another possible cause of CTS. In this case, the birth of the baby usually produces the cure.

Treatment is aimed at the underlying cause, if one is found. If the CTS is primarily due to overuse, the treatment is straightforward and usually successful. Eliminating the repetitive action or wearing wrist splints to minimize wrist flexion works quite well. The use of non-steroidal anti-inflammatory medication, like the ibuprofen you are taking, is very beneficial. Hand and wrist exercises and physical therapy can also help bring relief. In rare cases, the sufferer may need surgery.

Even though you feel better taking the ibuprofen, I’d urge you to talk to your family physician about your problem. He or she can provide early treatment, help you make adjustments to how you do your work, and treat any underlying cause of your problem. This will insure the best possible long-term outcome.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.