Carpal Tunnel Syndrome - pain in the wrist

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Carpal Tunnel Syndrome (CTS) comes about if the sensitive median nerve is compressed as it passes from the forearm through the narrow space of the carpal tunnel in the wrist, before entering the hand. The size of the carpal tunnel is variable, it is a rigid structure which also houses the nine tendons which bend the wrist and fingers. So space is limited and if the tendons are tense and swollen from overuse, they can irritate or put pressure on the nerve.

Carpal Tunnel Syndrome is often included under the umbrella term of Repetitive Strain Injury. Women are more prone to the condition than men and it is mainly found in people aged between 40 and 50.

Symptoms

The symptoms of carpal tunnel syndrome can affect one or both hands and include pain, numbness and tingling in the thumb and three fingers. The little finger and the outside of the fourth finger are not affected. The pain sometimes radiates up into the forearm and may be worse at night, or during specific activities such as driving, where the steering wheel is often held with great tension, with the wrist bent at an angle.

CTS is progressive, and as impulses gradually reduce in the median nerve, there can be a loss of sensation, then weakness in the thumb with a resulting loss of grip. People with the condition may lose some manual dexterity and experience some clumsiness when carrying out tasks which require fine movements, such as playing a musical instrument or sewing.

Causes

There are many factors which can contribute to the median nerve being compressed. Some of these you can have some control over and would be wise to avoid, so that you look after your hands. Many of these habits of mis-use are subtle, hard to recognize and change but this process would be made easier with the help of an Alexander Teacher.

Some of the causes of CTS are:

  • Activities which require constant flexion and extension of the wrist can lead to a build up of fluid within the carpal tunnel, which creates congestion, putting pressure on the median nerve. If such movements are done with tension and mis-use, or the wrist is held for long periods of time bent at an angle, for instance whilst pushing a heavy pushchair, the pressure on the median nerve will be increased.
  • Working with a negative attitude, or a tendency to be driven, will increase the likelihood of such tension and mis-use.
  • The combination of flexion, plus pressing the wrist onto a hard surface such as a desk whilst computing, can be particularly damaging.
  • Constantly vibrating power tools can cause carpal tunnel syndrome and this is a recognized industrial injury.
  • Pregnancy, obesity and conditions such as diabetes may also cause water retention in the wrist.
  • Arthritic conditions, fractures and dislocation of the wrist can cause inflammation and swelling.
  • Hormonal changes that occur during the menopause, with thyroid problems, or with the combined contaceptive pill, can contribute to the condition.
  • Cysts or swelling of blood vessels and tendons are likely to cause congestion and inflammation.
  • Bending and contracting down over work surfaces such as a desk, so that extra weight and pressure is put on the hands and wrists.

It is possible for similar neurological problems to be experienced in the hands as a result of certain diseases, from lesions, or pressure being put on the upper section of the median nerve in the neck or the brachial plexus. Such problems may come about, for instance, after accidents or from poor posture and general mis-use. For instance, holding the neck forwards with tense, rounded shoulders, which can put pressure on a variety of nerves.

Prevention is better than cure

Prevention is always better than cure, so being aware and looking after the way you use yourself whilst performing tasks, may help you avoid carpal tunnel syndrome or other forms of RSI altogether.

You can begin by asking yourself, what is your attitude towards work? Why are you so tense - are you stiff with boredom? Or are you intense, always on edge, perhaps feeling driven, so you think you need to work harder and faster than others, without taking any breaks? If so, observe how much pressure you put on yourself mentally and physically. How do you use your hands, wrists and arms - do you recognize how much tension you create in them? Maybe you don't need to live and work like that.

Take regular breaks and use them to calm down, undo the tension in your arms and allow your wrists to freely lengthen as much as possible. Try out a wrist support and see if it helps reduce the pressure whilst computing. The more aligned and poised you are when you work, the less of a downward drag and pressure will be put on your arms, allowing them to move more easily. If your furniture and equipment is hampering your ability to work in a poised manner, make sure some changes are made so that you have a chance to look after yourself. If you can no longer find a way of freeing-up, then you would be wise to seek the help of someone like an Alexander teacher who can work with you on these issues.

If CTS does begin to develop, the sooner carpal tunnel syndrome is recognized and action is taken, the more possible it is to stop the condition from getting worse. Left untreated, there can be permanent damage to the median nerve.

Treatment

Medical treatments for carpal tunnel syndrome generally treat the symptoms, not the cause and may include: anti-inflammatory drugs, cortico-steroids and ultrasound to reduce pain and inflammation; diuretics to reduce water retention; in severe cases, surgery is possible. Physiotherapists may provide wrist splints, to rest the wrist and maximize the space in the carpal tunnel and they may also teach patients some finger exercises. If someone is obese they will be encouraged to lose weight, in order to reduce fluid retention and therefore put less pressure on the median nerve.

Sometimes, temporary relief may be found by massaging or shaking the hand, which will free the wrist for a while. However, if the underlying causes are not addressed, the pain will return.

In Alexander Technique lessons, pupils are helped to become aware of their general thought patterns, tension, poor posture and mis-use that generally underlie the causes of CTS. Someone with CTS could also be helped to recognize and let go of, any specific habits that involve holding the wrist at an angle, which would irritate the condition. In this way the pupil can begin to modify the way they move and their perceived need to work so intensely, for instance. As a result of these changes, they will begin to free up their muscles and avoid compressing the median nerve.

If we take the example of a guitarist who has a habit of bending the wrist acutely whilst plucking his instrument, this could compress the median nerve and cause carpal tunnel syndrome. Such a manner of playing often goes with the guitarist curling down over the instrument somewhat intensely, in order to see his hands, to make sure he 'gets it right'. This downward thrust can put pressure on muscles and nerves in the neck and shoulders, plus create a twist in the torso, all of which could contribute to other problems and interfere with his playing.

An Alexander teacher would help the guitarist to become aware of such habits and attitudes, so that he could learn to inhibit them. This would take time but would be very worthwhile. He would gradually become calmer and more poised, allowing his arms and wrists to be free and less angled whilst playing. These changes would help reduce the pressure on the median nerve and thus the pain of CTS. It would also enable his arms to move around his instrument more freely and fluidly which will surely help his music making.