Lifestyle changes
This also means temporarily staying away from any activity--Whether it's cooking or using a computer mouse--that forces you to bend your wrist all the way up or down or that puts pressure on the median nerve.
EXERCISES TO KEEP YOU CTS-FREE
Performing a few stretches and gentle exercise every day can help relieve pain and gradually improve function in your hands and wrists. These movements also double as preventive exercises, since toning and stretching the muscles and ligaments guards them against future injury.
You can do these exercises in any order you wish, and repeat each one as many times as you like. Do them once a day, or even every hour if necessary for quick relief.
PROMISING DEVELOPMENTS
Take breaks from repetitive tasks. If you're practising the piano, for instance, do so for just 15 minutes at a time, then take a five-minute break.
Practise good posture, and adapt it to the job you're performing. If you sit at a desk, for example, make sure your shoulders are not slumped forward (this puts pressure on nerves in your back and arms).
Modify your workspace. If possible, choose ergonomically sound devices, such as a chair with a supportive backrest, an adjustable keyboard table and a wrist rest (found at most office supply stores).
Once you've dealt with the pain, you should consider some larger lifestyle issues in order to keep CTS from recurring. Losing weight, if necessary, is one of them. Obesity has been frequently linked to carpal tunnel syndrome, in part because extra tissue appears to put undue pressure on nerves in the hand and wrist; furthermore, obese people are prediposed to diabetes, which can be an underlying cause of CTS. And if you smoke, stop. Smoking can aggravate CTS because it restricts blood flow to the small vessels of the hand.
Medications
To relieve pain and swelling, your doctor is likely to start with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs). such as aspirin or ibuprofen (Advil, Nurofen). If inflammation and pain persist, you may need a more powerful prescription NSAID, such as the COX-2 inhibitor ketoprofen (Orudis SR) or naproxen (Naprosyn). A diluretic such as chlorthalidone (Hygroton) may also be beneficial.
>How can I tell for certain that my problem is carpal tunnel syndrome?
Most doctors rely on your symptoms and their physical examination to make the diagnosis of CTS. If there is any doubt, your doctor will probably perform what the considered to be the best diagnostic tests: electromyography (EMG), which locates where the nerve is compressed, and the nerve conduction velocity (NCV) test, which measures any motor delay in your nerve fibres.
>If my carpal tunnel syndrome developed at work, is it covered under workers' compensation?
Yes, if your doctor is willing to state belief that your condition is related to the work you do. To make a convincing case, your doctor will first have to rule out other causes, such as obesity, smoking, hormonal changes, genetic factors and a wide array of medical conditions. These include diabetes, rheumatoid arthritis, lupus, hypothyroidism, chronic kidney disease, hepatitis C and any condition that damages the muscles and bones.
If none of these drugs works, you may require an injection of a corticosteroid medication (such as Depo-Medrol) directly into your carpal tunnel. This can reduce the inflammation for at least a month. To protect your tendon from lasting damage, don't heave more than a total of three injections.
Of course, if you have a medical condition (such as an under-active thyroid) that is contributing to your CTS, your doctor will advise you about treatment for the underlying disorder.
Procedures
Once your pain is under control, your best bet is to set up regular visits with a physiotherapist for supervised hand-and-wrist strengthening exercises. You'll probably have to stick with this program for at least two months to see improvement.
Your doctor may also suggest that you wear a wrist splint to keep your wrist from bending. You'll mainly wear the splint at night because as you sleep, you may unconsciously bend your wrist forward or back, aggravating the problem. You can also wear it during the day if the pain bothers you. Your best bet is to continue using the splint until you're pain-free for at least two weeks. Ultrasound therapy has been used with some success.
Finally, in some cases--even when you've followed your doctor's instructions to the letter---surgery may be required to cut the carpal ligament and free the median nerver form pressure. The most common procedures is open carpal tunnel release (OCTR). It requires a small incision in your palm and wrist, but the results are generally good, especially if you have physiotherapy after the scar heals. Recently, a new outpatient procedure called endoscopic carpal tunnel release (ECTR) has been developed. Here only two tiny incisions are made--one in your palm and one in your wrist. A telescope-like device called an endoscope then inserted, which allows the surgeon to see inside the carpal tunnel at the point of pressure and do the cut. Recovery is often quicker with ECTR, but the jury is still out on recurrence rates after the surgery.
Natural methods
Before resorting to surgery, you might also consider two other less conventional therapies. One is acupuncture, a centuries-old Chinese technique in which thin needles are inserted into key points on
your body to relieve pain. The other involves a visit to your local chiropractor. In addition to performing manipulation of your spine, the chiropractor can release pressure on the median nerve.
This also means temporarily staying away from any activity--Whether it's cooking or using a computer mouse--that forces you to bend your wrist all the way up or down or that puts pressure on the median nerve.
EXERCISES TO KEEP YOU CTS-FREE
Performing a few stretches and gentle exercise every day can help relieve pain and gradually improve function in your hands and wrists. These movements also double as preventive exercises, since toning and stretching the muscles and ligaments guards them against future injury.
You can do these exercises in any order you wish, and repeat each one as many times as you like. Do them once a day, or even every hour if necessary for quick relief.
- Lift your arms above your head and rotate them inwards and outwards.
- Extend your arms in front of you and circle your hands at the wrists. Circle them first one way, then the other.
- Hold your hands, palms up, in front of you palms. Open your finger as far as is comfortable for you, feeling the gentle stretch for a few seconds, then close them again.
- Position your hands with your palms facing each other and press your fingertips together. Hold for a few seconds, then release.
- Wrap a rubber band around the fingers of one hand, so it reaches from your thumb to your little finger. Spread your fingers, hold for a few seconds, then release. Do the same using your other hand.
PROMISING DEVELOPMENTS
- In the future, when surgery is required, a technique called percutaneous ballon carpal tunnel-plasty may be able to relieve carpal tunnel syndrome without cutting the carpal ligament. Through a tiny incision in the palm, the surgeon inserts a balloon under the ligament and inflates the balloon with saline solution, thereby stretching the ligament and inflates the balloon with saline solution, thereby stretching the ligament and taking pressure off the nerve. In one small investigative study, every patient who had this procedure experienced relief from symptoms with no complications.
Take breaks from repetitive tasks. If you're practising the piano, for instance, do so for just 15 minutes at a time, then take a five-minute break.
Practise good posture, and adapt it to the job you're performing. If you sit at a desk, for example, make sure your shoulders are not slumped forward (this puts pressure on nerves in your back and arms).
Modify your workspace. If possible, choose ergonomically sound devices, such as a chair with a supportive backrest, an adjustable keyboard table and a wrist rest (found at most office supply stores).
Once you've dealt with the pain, you should consider some larger lifestyle issues in order to keep CTS from recurring. Losing weight, if necessary, is one of them. Obesity has been frequently linked to carpal tunnel syndrome, in part because extra tissue appears to put undue pressure on nerves in the hand and wrist; furthermore, obese people are prediposed to diabetes, which can be an underlying cause of CTS. And if you smoke, stop. Smoking can aggravate CTS because it restricts blood flow to the small vessels of the hand.
Medications
To relieve pain and swelling, your doctor is likely to start with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs). such as aspirin or ibuprofen (Advil, Nurofen). If inflammation and pain persist, you may need a more powerful prescription NSAID, such as the COX-2 inhibitor ketoprofen (Orudis SR) or naproxen (Naprosyn). A diluretic such as chlorthalidone (Hygroton) may also be beneficial.
>How can I tell for certain that my problem is carpal tunnel syndrome?
Most doctors rely on your symptoms and their physical examination to make the diagnosis of CTS. If there is any doubt, your doctor will probably perform what the considered to be the best diagnostic tests: electromyography (EMG), which locates where the nerve is compressed, and the nerve conduction velocity (NCV) test, which measures any motor delay in your nerve fibres.
>If my carpal tunnel syndrome developed at work, is it covered under workers' compensation?
Yes, if your doctor is willing to state belief that your condition is related to the work you do. To make a convincing case, your doctor will first have to rule out other causes, such as obesity, smoking, hormonal changes, genetic factors and a wide array of medical conditions. These include diabetes, rheumatoid arthritis, lupus, hypothyroidism, chronic kidney disease, hepatitis C and any condition that damages the muscles and bones.
If none of these drugs works, you may require an injection of a corticosteroid medication (such as Depo-Medrol) directly into your carpal tunnel. This can reduce the inflammation for at least a month. To protect your tendon from lasting damage, don't heave more than a total of three injections.
Of course, if you have a medical condition (such as an under-active thyroid) that is contributing to your CTS, your doctor will advise you about treatment for the underlying disorder.
Procedures
Once your pain is under control, your best bet is to set up regular visits with a physiotherapist for supervised hand-and-wrist strengthening exercises. You'll probably have to stick with this program for at least two months to see improvement.
Your doctor may also suggest that you wear a wrist splint to keep your wrist from bending. You'll mainly wear the splint at night because as you sleep, you may unconsciously bend your wrist forward or back, aggravating the problem. You can also wear it during the day if the pain bothers you. Your best bet is to continue using the splint until you're pain-free for at least two weeks. Ultrasound therapy has been used with some success.
Finally, in some cases--even when you've followed your doctor's instructions to the letter---surgery may be required to cut the carpal ligament and free the median nerver form pressure. The most common procedures is open carpal tunnel release (OCTR). It requires a small incision in your palm and wrist, but the results are generally good, especially if you have physiotherapy after the scar heals. Recently, a new outpatient procedure called endoscopic carpal tunnel release (ECTR) has been developed. Here only two tiny incisions are made--one in your palm and one in your wrist. A telescope-like device called an endoscope then inserted, which allows the surgeon to see inside the carpal tunnel at the point of pressure and do the cut. Recovery is often quicker with ECTR, but the jury is still out on recurrence rates after the surgery.
Natural methods
Before resorting to surgery, you might also consider two other less conventional therapies. One is acupuncture, a centuries-old Chinese technique in which thin needles are inserted into key points on
your body to relieve pain. The other involves a visit to your local chiropractor. In addition to performing manipulation of your spine, the chiropractor can release pressure on the median nerve.
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