It's In Your Hands: Beating the Carpal Tunnel Syndrome (Part II)
It's In Your Hands: Beating the Carpal Tunnel Syndrome (Part II)
Yesterday's feature discussed what it means to suffer from Carpal Tunnel Syndrome. Part II of the article here will address what kind of treatments are available if you suffer from numbness and pain in your hands.
Ng Min Li Physiotherapist What treatments you can expect for CTS In the early stages of Carpal Tunnel Syndrome, non-operative treatment is the treatment of choice. Stop any activity that aggravates the symptoms to allow the injured structures to heal. Ice may provide relief by reducing inflammation and hence the pressure on the nerve. Wear a splint at night to prevent the wrist from bending to reduce night pain. By keeping the wrist in a neutral position, pressure on the nerve is reduced. The splint is used for several weeks or months, depending on how severe your condition is. These splints are resting splints and they should not be used during activity as they may exacerbate symptoms. If symptoms subside, a supervised hand and wrist conditioning exercise programme offered by physiotherapists or hand therapists may be started. There is evidence that exercise may prevent or control the symptoms of CTS. One study found that most people with CTS felt improvement after two months of physiotherapy that included exercises to improve balance and posture. Drug treatment includes anti-inflammatory medications to reduce pain and swelling. If these fail, the doctor may inject an anaesthetic and/or corticosteriod into the carpal tunnel. If the above-mentioned measures fail and symptoms persist and are disabling, or if weakness occurs, surgical treatment may be necessary. In this procedure, the transverse carpal ligament is divided and excess tissue removed to relieve the pressure on the nerve. Recently a method of less traumatic surgery has been developed, known as endoscopic carpal tunnel release that results in a more rapid recovery. Keep CTS at bay! Prevention of work-related CTS involves ergonomic controls to help minimise the risk factors predisposing to work-related CTS. Work stations, work tools and work tasks may need to be redesigned while workers must be educated on proper posture and work methods. Exercise programmes to condition the upper extremity and neck may help to prevent CTS. However, it should be stressed that these methods do not provide complete protection against CTS. If the underlying cause is a medical condition, controlling the problem can prevent CTS. Where to learn more The Singapore General Hospital's Department of Occupational Therapy will hold a talk on Office Ergonomics and Repetitive Stress Injuries. The talk will focus on risk factors, work posture and how to change your work station to prevent CTS. The talk is on April 7 at 1.30pm at the Department of Occupational Therapy. The fee is $5 per adult. Call 321 4129 for more details. References:
Feuerstein M, Burrell LM, Miller VI, Lincoln A, Huang GD, Berger R (1999): "Clinical management of carpal tunnel syndrome: a 12-year review of outcomes." Am J Ind Med 35(3):232-45
Rozmaryn LM, Dovelle S, Rothman ER, Gorman K, Olvey KM, Bartko JJ (1998): "Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome." Journal of Hand Therapy 11(3): 171-9.
Slater RR (1999): "Carpal tunnel syndrome: current concepts." Journal of Southern Orthopaedic Association 8(3)
Canadian Centre for Occupational Health & Safety Website, www.ccohc.ca
Stop any activity that aggravates the symptoms to allow the injured structures to heal. Ice may provide relief by reducing inflammation and hence the pressure on the nerve. Wear a splint at night to prevent the wrist from bending to reduce night pain. By keeping the wrist in a neutral position, pressure on the nerve is reduced. The splint is used for several weeks or months, depending on how severe your condition is. These splints are resting splints and they should not be used during activity as they may exacerbate symptoms. If symptoms subside, a supervised hand and wrist conditioning exercise programme offered by physiotherapists or hand therapists may be started. There is evidence that exercise may prevent or control the symptoms of CTS. One study found that most people with CTS felt improvement after two months of physiotherapy that included exercises to improve balance and posture. Drug treatment includes anti-inflammatory medications to reduce pain and swelling. If these fail, the doctor may inject an anaesthetic and/or corticosteriod into the carpal tunnel. If the above-mentioned measures fail and symptoms persist and are disabling, or if weakness occurs, surgical treatment may be necessary. In this procedure, the transverse carpal ligament is divided and excess tissue removed to relieve the pressure on the nerve. Recently a method of less traumatic surgery has been developed, known as endoscopic carpal tunnel release that results in a more rapid recovery. Keep CTS at bay!
Prevention of work-related CTS involves ergonomic controls to help minimise the risk factors predisposing to work-related CTS. Work stations, work tools and work tasks may need to be redesigned while workers must be educated on proper posture and work methods. Exercise programmes to condition the upper extremity and neck may help to prevent CTS. However, it should be stressed that these methods do not provide complete protection against CTS. If the underlying cause is a medical condition, controlling the problem can prevent CTS. Where to learn more
