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Understanding Carpal Tunnel Syndrome- A Case Study

Mrs.Singh's Story of Wrist Pain

**Mrs.Singh is a 45 year old secretary who presented in our office last August with right wrist pain and numbness and tingling in her right hand. This numbness and tingling has been going on for a few months. Mrs.Singh describes a sudden sharp piercing shooting pains that travel through the wrist and up the arm. She states that she has difficulty clenching the fist or grasping small objects and finds that she is more clumsy; Furthermore, it is noted that her symptoms flare up through the night thereby making sleep difficult. Upon further examination and orthopedic tests we have determined that Mrs.Singh suffers from Carpal Tunnel Syndrome, a painful progressive condition caused by compression of a very important nerve in the wrist- The Median Nerve
What is carpal tunnel syndrome?

Carpal Tunnel involves a very important nerve called the Median Nerve. The Median Nerve controls impulses to some small muscles in the hand that allow the fingers and thumb have movement.It runs from the forearm into the hand and innervates the thumb and index finger and 1/2 of the middle finger on the palm side. When this nerve becomes pressed or squeezed Carpal Tunnel Syndrome results. The Median nerves lives in the Carpal tunnel which is a narrow, rigid passageway of ligament and bones at the base of the hand � houses the median nerve and tendons. At times, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be squeezed.
What are the signs and symptoms of Carpal tunnel syndrome?

In Mrs. Singh's case, her symptoms began gradually with increase in frequent burning, tingling, and itching numbness in the palm of the hand and the fingers, especially in the thumb and the index and middle fingers. In other cases, some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. Often, the symptoms often begin to appear in one or both hands during the night, since many people sleep with flexed wrists. Like other typical cases, Mrs.Singh woke with a feeling the need to "shake out" her hand or wrist. Her symptoms have worsened, where now Mrs. Singh feels tingling during the day. Furthermore, Mrs.Singh has decreased grip strength and has difficulty in forming a fist, grasping small objects, or performing other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch.
What are the causes of carpal tunnel syndrome?

Mrs.Singh is a secretary; She spends a lot of time on her computer typing and is constantly doing wrist related activities at work. Repetitive Strain Injuries (RSIs) can happen to anyone whose work calls for long periods of steady hand movement, from musicians & dental hygienists to meat cutters & cashiers. RSIs tend to come with work that demands repeated grasping, turning and twisting; they are particularly likely if the work requires repeated twisting or involves repetitive vibration, as in hammering nails or operating a power tool. Stressful neck, arm and hand positions � whether from working at a desk, long-distance driving or waiting on tables � only aggravate the potential for damage.

It has been shown that Carpal tunnel syndrome is often due to a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; overactivity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a tumor or cyst in the canal. Many times the disorder is due to a congenital predisposition - the carpal tunnel is smaller in some people than in others.In some cases no cause can be identified.
Who is at risk of developing carpal tunnel syndrome?

Women are 3 times more likely than men to develop carpal tunnel syndrome; one reason may be because the carpal tunnel itself may be smaller in women than in men. In many cases, the dominant hand is usually affected first and produces the most severe pain. Persons with diabetes or other metabolic disorders that directly affect the body's nerves and make them more susceptible to compression are also at high risk. It usually occurs in adults only.

Although, the risk of developing carpal tunnel syndrome is not confined to people in a single industry or job, it is especially common in those performing assembly line work - such as sewing, manufacturing, finishing, cleaning, and meat, poultry, or fish packing. Research has shown that carpal tunnel syndrome is 3 times more common among assemblers than among data-entry personnel.

During 1998, an estimated three of every 10,000 workers lost time from work because of carpal tunnel syndrome. Half of these workers missed more than 10 days of work. The average lifetime cost of carpal tunnel syndrome, including medical bills and lost time from work, is estimated to be about $30,000 for each injured worker.
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What can be done for the treatment of Carpal Tunnel Syndrome?

Treatments for carpal tunnel syndrome should begin as early as possible. Underlying causes such as diabetes or arthritis should be treated first.
Mild cases may be treated by applying a brace or splint which is usually worn at night and keeps your wrist from bending. A Reflex Wrist Support can Reflex Wrist Support Helps provide comfortable relief from repetitive motion discomforts. A Carpal Lock Wrist Splint helps guard against carpal tunnel syndrome without limiting finger and hand dexterity. Unique dorsal splint design helps protect the wrist from repetitive motions.
Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint as described above to avoid further damage from twisting or bending. Cold therapy can aid in decreasing inflammation and reduce swelling. Certain exercises can help with Strengthening and stretching the wrist muscles so that injury is less likely to take place. Using Power Putty can help relieve tension and stress.
In this case Mrs.Singh was immensely helped by Chiropractic Care. With regular adjustments, traction and certain exercises her symptoms dissipated within a few months. For her computer work she was recommended to use a Keyboard Support to keep her wrist in a neutral position. She also took up Yoga which has also been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome.
** From the case studies of Dr. N Gill BSc D.C.; BF Chiropractic Clifton Park NY; Patients name has been altered to protect the identity of those involved. For more information visit: HealthandAge Website: Carpal Tunnel Syndrome
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