June 4, 1999
Data from the Bureau of Labor Statistics indicates that carpal tunnel syndrome (CTS) or repetitive injury strain (RIS) results in the highest median number of work loss (30 days) among all major work-related injuries or illnesses. In addition, of the thousands of surgeries performed each year to relieve CTS, nearly half of them are work related.
According to Occupational Safety and Health Administration (OSHA) statistics, more than 647,000 Americans suffer serious injuries and illnesses each year due to overexertion or repetitive stress on the job. Work-related musculoskeletal disorders cost employers $15 to $20 billion annually in worker compensation. In fact, new proposed "ergonomic" standards intended to curb stress trauma cases such as carpal tunnel syndrome will be formally presented by OSHA this summer. The proposed standards apply primarily to industrial jobs, but office workers who perform tasks that require repetitive motions could be included under the guidelines.
"It doesn't make sense for an employer to go to the expense of recruiting and training an employee and then not provide a $100 chair or a $50 desk adjustment that could possibly prevent CTS from occurring," said Mark Mikulics, M.D., a hand surgeon affiliated with COAST Surgery Center. "I'm also concerned that the number of CTS cases in the workplace is probably higher than anyone suspects," he said. "There are, in all likelihood, thousands of unreported cases, employees who are afraid of losing their jobs if they mention they are having problems."
According to Dr. Mikulics, CTS can be a problem with any repetitive task involving the hands, and with increased use of computers this disorder has become a concern for many people. The carpal tunnel or canal is formed by a band or ligament that stretches across the wrist. Nine tendons and the median nerve pass through this tight tunnel. Any swelling of the tendons or decrease in size of the tunnel can cause the condition.
Although CTS is more common in women between 40 and 60 years old, it can be seen in adolescents and older people, especially those who use their hands for extended periods of time doing repetitive tasks. It is common among carpenters, secretaries, hairdressers, farm workers, racquetball players, supermarket checkers and assembly-line workers. Pain occurs during activities that involve prolonged use of the hand such as writing, pruning —even using a computer mouse.
Dr. Mikulics explained that symptoms of CTS, which usually first appear at night, include numbness in the hand along the median nerve affecting the thumb, first two fingers and half of the ring finger. "Other people report a burning or tingling feeling. There may be some pain that radiates up the arm, into the shoulder or even the neck," he said. "Some people report a feeling that the fingers are swollen even though there is no apparent swelling.
"In more advanced stages people have problems dropping things, difficulty grasping or pinching objects, or trouble using there hands for fine motor skills such as buttoning shirts or opening jar lids.
"Most importantly," Dr Mikulics said, "if left untreated, CTS can lead to permanent nerve and muscle damage. With early diagnosis and treatment, however, most people recover completely, especially those who make a conscious effort to change the way they do whatever caused the condition in the first place."
Catching the condition —and treating it— early on can make a world of difference. Treatments may vary but usually call for physical therapy to help reduce the inflammation and restore range of motion and strength of the hand and wrist. The goal of treatment is to decrease the motion of the tendons and decrease the swelling in the carpal canal. Rest helps to accomplish these goals. Also, anti-inflammatory medications can help reduce sheath swelling. The use of ultrasound or phonophoresis equipment have proven to be effective in decreasing pain and swelling around the tendons.
If relief is not obtained by conservative methods, then surgery may be necessary. The operation involves loosening the wrist ligament and opening up the carpel tunnel to relieve pressure on the median nerve. The surgery is usually performed on an out-patient basis. After surgery, a simple wrist splint is worn for several weeks. A newer endoscopic tunnel release procedure can cut recovery time, minimize pain, reduce damage to hand tissue and eliminate most scarring.
Preventing the problem in the first place is the best course of action. Dr. Mikulics made the following recommendations to help prevent CTS.
Make sure your chair is adjusted properly. To adjust height, sit up straight with your arms hanging down at your side. The crease of your elbow should be about even with the top of the keyboard. If you can't lower the desk and need to raise the chair, use a foot rest to reduce leg discomfort.
* Don't rest your wrist on the keyboard or desk while keying or using the mouse. This puts compression on the area of the carpal tunnel while your hands and fingers are working. The hands should be held up with the wrists in a straight position while keying and letting the wrist rest during pauses.
* Use a gentle touch when striking the keyboard.
* Don't talk on the phone with the receiver squeezed between your ear and your shoulder.
* Practice good posture whether sitting or standing. Sit up straight in a straight-backed chair while using the keyboard.
* Alternate tasks and take frequent mini-breaks during the time spent on the computer (or any other activity that requires repetitive motion). Take a 30-second break every 30 minutes. Do stretches for the hands, forearms, shoulders, neck and back. Stand up to change position.
* Keep your hands and forearms strong and flexible. Strong muscles work more efficiently and flexibility of the muscles help take tension off the tendons.
"Numbness of the hand can also be due to certain diseases such as cervical spine disease. If you develop pain or numbness in the hands or wrists it is important to see your physician for an accurate diagnosis," said Dr. Mikulics.
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