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CARPAL
TUNNEL SYNDROME
Anatomy:
The carpal tunnel is a tightly closed space on the palm side
of the wrist surrounded by eight wrist (carpal) bones, and a strong
ligament (flexor retinaculum). Running through the tunnel are nine
tendons, median nerve and median artery.
Carpal Tunnel
Syndrome (C.T.S.)
This syndrome is the compression of the median nerve as it passes
through the tunnel of the wrist. The tendons or other structures within
the tunnel become inflamed and swollen due to excessive/prolonged
force/repetition. This swelling puts pressure on the median nerve
because the ligament does not stretch to allow for this fluid build-up.
Do not allow C.T.S. to persist since
permanent nerve or circulatory damage can occur.
What are the
Symptoms of C.T.S.?
- The earliest sign is dry skin
on the palm and fingers because of loss of sweating;
- Numbness and tingling in thumb,
index, middle, and half of the ring finger
- Pain and/or burning sensation
in the hand, often running up the arm
- Night awakening due to intense
pain or numbness and tingling
- Weakness of the thumb muscles
- Clumsiness or reduced ability
to use the hand effectively
- Loss of thumb bulk (rare)
What Causes
C.T.S.?
There are many situations that may lead to C.T.S. The most common
factors that contribute are:
- Improper wrist posture, or use of
hand-held devices (tools)
- Mechanical stress exerting pressure
on the base of the palm
- Exposure to vibration
- High force and/or high repetition,
high stress
- Abrupt changes in daily activities
(ie. change in job tasks)
- Poorly, designed work stations
- Working without rest periods
Who is at
risk?
- Pregnant women
- Workers with jobs that require repeated,
forceful bent wrists (mechanics, drivers, typists, hairstylists, factory
workers, piano players etc.)
- People 40-60 years old, but can occur
at any age
- Mostly women
Treatment
of C.T.S.?
A) MEDICAL TREATMENT INCLUDES:
- Anti-inflammatory medications
- Steroid injections into wrist
- Surgery to relieve the pressure
B) SPECIFIC OCCUPATIONAL THERAPY (O.T.) INTERVENTION:
Goal: To return to optimal level of functioning and performance
through:
- Splints (to be worn at night,
and or during activities in which symptoms appear)
- Education re: the condition,
proper wrist positioning, and ergonomics
- Exercise and activities to
strengthen muscles and encourage full movement of the hand
- Adjustment of the home and/or
work area
Prevention
Ergonomics is the study of people in their work environment.
It applies knowledge of body mechanics to improve performance and
well-being. It is important when using the wrist to try to keep
it in a straight or neutral position. This position is the
least stressful on the wrist structures, especially when force is
required for an action (A neutral position is as below)
Do's
- Avoid marathon work. Take frequent
rest and stretch breaks.
- Wear splint(s) as indicated by therapist.
- Use assistive devices or equipment
(ie. built-up handles, electric can openers etc.).
- Adjust the height of the work surface
according to your dimensions. Use elbow height as a guide (elbows
between 70-90 degrees).
- Organize your work so that the usual
operations are performed within easy reach (within 10 inches).
- Lift boxes/items using the palms
of the hands instead of the fingers (palms-up, both hands).
- Get tools redesigned.
Don'ts
- Do not go past the point of pain or
fatigue.
- Do not reach behind the shoulder line.
If necessary, turn to face object.
- Do not overextend your reach beyond
the point of comfort.
C.T.S. Sufferers
Should Avoid Activities Such As:
- Bending the wrist
- Heavy, prolonged gripping or pinching
(hammering, knitting, holding onto books)
- Twisting the wrist
- Leaning on the palm
- Heavy lifting
- Pulling things with your fingers curled
tightly
- Vibration
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