Carpal Tunnel Syndrome
Writer: Lynn Xiaolin Li, Occupational Therapist Candidate Reviewer: Irene Poon, MScOT, Reg. OT
What is Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is a common condition caused by pressure on the median nerve. A Carpal tunnel is an anatomical structure that is a narrow passageway located on the base of the palm. The median nerve and other nine finger tendons run through the passageway. Multiple factors can narrow the carpal tunnel and compress the median nerve, such as carpal bone fracture, arthritis, swelling, or awkward wrist position.
Risk factors and symptoms
Multiple factors can increase the risk of CTS, such as repetitive and prolonged forces, incorrect posture, and exposure to extreme temperature and vibration. Workers who engage in certain occupations are more vulnerable to have carpal tunnel syndrome, such as assembly line workers, frozen food processing workers, computer users. Patients often feel numbness and tingling in their fingers or hand and weakness while grasping. The thumb, index, middle or the radial side of the ring finger are affected, but not the small finger. Many patients experience difficulty in sleeping because the symptoms could wake them up at night. Severe CTS can lead to challenges in participating in daily activities, such as typing, buttoning, cooking, carrying items with fingers, or driving.
CTS Treatment, prevention and daily management
The treatment in patients with CTS includes surgery and conservative intervention. Conservative options, such as corticosteroid injection, ultrasound, posture adjustment, activity modification can relieve the symptoms of CTS. You should consult with your family doctor promptly if you have suspected symptoms, otherwise numbness, pain and sensation will get worse if left untreated.
To prevent CTS, the most important tip is to avoid overuse of the wrists in repetitive motions, such as prolonged use of vibration tools (such as dills) or tools that can induce vibration to hands (such as hammers); Avoid too much heavy lifting that is beyond your usual capacity; Avoid wearing jewelry/watch that are too tight to the wrist. Or, you should take frequent and regular breaks if you cannot bypass these activities. Daily hand stretches or icing on the affected hand are also beneficial. However, you should perform them after consultation with healthcare professionals.
If you are already experiencing discomfort in the wrist, excessive wrist bending and extension during daily activities may reduce the space inside of the carpal tunnel further and hence potentially lead to the compression of the median nerve. It is key to keep the wrist in a neutral position (not bent forward or backward) to prevent or alleviate CTS symptoms. If you have frequent night wake-ups due to pain or numbness of your wrists, it may be helpful to stretch out your arms, use pillows to maintain good alignment, and prevent curling the body or wrists, or wear a splint as recommended by your healthcare professional to protect your wrist in a neutral position and allow you to have uninterrupted sleep.
Assistive devices
While adequate rest and regular breaks away from the activities that are causing discomfort is the best solution, various assistive devices can also help us with daily activities. We want to introduce some office gadgets and assistive appliances used in everyday life that allow a more ergonomically friendly posture. Ultimately, because the daily occupations that people are engaged in and the challenging activities that people experience are diverse, we also recommend you consult with healthcare professionals if you have hand discomfort so that you can have an individualized treatment plan.
Wrist support
Due to the pandemic, many of us would use computers to work or socialize with people. However, prolonged use of a keyboard and mouse may cause pressure to the carpal tunnel. The wrist support can lift the wrist so that the wrist stays in a neutral position, which allows the largest space in the carpal tunnel and the hands to work more efficiently. The wrist support is very helpful for people who need to work from home and sit extended hours in front of a screen. You may also put a towel or DIY other items underneath to support your wrist.
Ergonomic mouse
There are various types of ergonomic mice. This vertical mouse enables the wrist in a neutral position by putting the hand similar in a “handshake” state (as the picture shows). As such, the side of the wrist can rest on the desk and no wrist support is needed. However, because each person’s hand and preferred positions are different, you may need time to adjust to this design due to the change in the way of using a mouse, or find the one that works for you. When moving the mouse, try moving at the shoulder and arm instead of fully controlling at the wrist.
Ergonomic keyboard
The keys of a standard keyboard are vertically facing the users. Thus, we need to extend the wrist outward in order to adapt to the keys especially when we want to reach the keys in the left or right border. This wrist position could lead to muscle soreness, decreased carpal tunnel space and compression of the median nerve.
The ergonomic keyboard is designed to adapt to our anatomic structure. The keys are slightly tilted so that our hands are in line with the wrists when we are typing. Some designs of the ergonomic keyboard raise the middle part of the keyboard and allow hands to naturally rest on it instead of making hands flat.
Wrist splints
As we mentioned, many people cannot have a good sleep because of CTS. Studies support that wearing a splint at night can protect the wrist and alleviate the symptoms of CTS. Some splints can also be used in the daytime and support the wrist while you are performing daily activities. There are various types of wrist splints. You may find some of them in stores and you can also get custom splints from healthcare professionals. In order to choose an appropriate splint for yourself, you can consult with a trained specialist, such as an occupational therapist.
Kettle tipper
There are many occasions where we need to use a kettle in daily life, such as making tea or coffee. However, because of the weight and movement required for using kettle, some conditions, including CTS disable people to use a kettle due to pain and weakness. A kettle tipper can support the weight of a kettle and tilt as you pour out the water. Therefore, it can alleviate the pressure in the wrist caused by lifting the kettle. Different sizes and shapes of kettle tippers are available for users. Some designs can also support different kettles.
The list of assistive devices we introduced is not exhaustive. You may find some of them are very helpful or you don’t find the one you need most. We recommend you talk to healthcare professionals to get the most effective help.
References
Presazzi, A., Bortolotto, C., Zacchino, M., Madonia, L., & Draghi, F. (2011). Carpal tunnel: Normal anatomy, anatomical variants and ultrasound technique. Journal of ultrasound, 14(1), 40-46.
Carpal tunnel syndrome. (2020, February 01). Retrieved December 22, 2020, from https://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/symptoms-causes/syc-20355603
Jagga, V., Lehri, A., & Verma, S. K. (2011). Occupation and its association with Carpal Tunnel syndrome-A Review. Journal of Exercise Science and Physiotherapy, 7(2), 68.
Standard of care: Carpal Tunnel Syndrome. (2007, n.d.) Retrieved from https://www.brighamandwomens.org/assets/BWH/patients-and-families/rehabilitation-services/pdfs/wrist-carpal-tunnel-syndrome-ot.pdf
Pictures from:
https://nerdtechy.com/best-mouse-wrist-support-cushion
https://www.ebay.com/itm/303321834114
https://www.alzashop.com/trust-verto-wireless-ergonomic-mouse-d5360999.htm
https://www.forbes.com/sites/forbes-personal-shopper/2020/07/06/best-ergonomic-keyboards/?sh=77e747276a3a
https://www.staples.ca/products/24421967-en-logitech-ergo-k860-ergonomic-keyboard
https://www.vivehealth.com/blogs/resources/wrist-brace
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These presentations are intended for general information purposes only. Audiences are recommended to consult with a qualified healthcare provider and obtain professional advice and subsequent management for your particular conditions. The views and opinions expressed by the speakers do not necessarily reflect the policy or position of Assisting in Medical Expectations.
