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Carpal tunnel syndrome

MagazineApril 2009 (Vol. 20 Issue 1)Carpal tunnel syndrome

Q) I've recently been diagnosed with carpal tunnel syndrome in my right hand, probably related to my job, which involves using a computer mouse for long hours

Q) I've recently been diagnosed with carpal tunnel syndrome in my right hand, probably related to my job, which involves using a computer mouse for long hours. Can you recommend any effective treatments that don't involve drugs or surgery?-J.F., London

A) Carpal tunnel syndrome (CTS) is caused by compression of the median nerve, which runs through a U-shaped space in the wrist called the 'carpal tunnel'. Symptoms include numb-ness, tingling, pain and weakness in one or both wrists and hands. In severe cases, the condition can lead to a permanent loss of feeling in some fingers.

Repetitive computer use is commonly assumed to cause CTS, but the scientific evidence is unclear. In one US study, the frequency of CTS in computer users was similar to that of the general population (Neurology, 2001; 56: 1568-70). In a Danish one, however, people who used a mouse device for more than 20 hours a week had a higher risk of developing CTS (JAMA, 2003; 289: 2963-9).

Other conditions can contribute to CTS, including diabetes, inflammatory arthritis, untreated thyroid disease and pregnancy (J Gen Intern Med, 1999; 14: 310-4). In your case, assuming an underlying condition has been ruled out, the following may help.

- Osteopathy. This has proven suc-cess in treating CTS, especially using the 'opponens roll' man-oeuvre. Used together with self-stretching exercises, it resulted in less restricted wrist movement and improved nerve conduction in all treated wrists (J Am Osteopath Assoc, 1994; 94: 647).

- Yoga. A study published in a pres-tigious medical journal found that a yoga-based regimen was more effective than wrist splints or no treatment in relieving the symptoms and signs of CTS. The study participants-median age 52 years-who practised 11 yoga postures that worked the joints

of the upper body, along with relaxation twice a week for eight weeks, significantly improved their grip strength and pain reduction compared with the controls (JAMA, 1998; 280: 1601-3).

- Massage. The results of a recent preliminary study suggest that both targeted and general massage may be useful for CTS sufferers. Targeted massage may be especially beneficial, as it resulted in greater gains in grip strength than general massage (J Altern Complement Med, 2008; 14: 259-67).

- Heat. Heat-wrap therapy can relieve various types of wrist pain, including CTS, within one to three days. In addition, it improves grip strength, joint stiffness and hand function (Arch Phys Med Rehabil, 2004; 85: 1409-16), so try applying a warm compress to the wrist several times a day.

- Vitamin B6. CTS might be a manifestation of a deficiency of this vitamin, as some sufferers do experience pain relief with its supplementation. However, so far, studies have been poorly designed and inconclusive (Nutr Rev, 2004; 62: 96-104). Nevertheless, given the low risk of toxicity at the suggested doses,

=it may not hurt to try B6 supplements at dosages up

to 200 mg/day (J Am Acad Nurse Pract, 2003; 15: 18-22).

- C-TRAC. This new hand-traction device (see www. or has proved to be both effective and well tolerated when used for only 5 minutes, three times a day, in a recent study of CTS patients, all of whom had failed to respond to conservative therapy. Overall, 79 per cent of patients rated the treatment as excellent; however, the study had no control group for comparison (J Hand Ther, 2007; 20: 20-7).

Less strain, less pain

By far, the best way to treat carpal tunnel syndrome (CTS) is to deal with whatever's causing it. Making the following changes may reduce repetitive strain while you work.

- Improve your posture. Make sure that you are sitting properly, and that your keyboard and monitor are positioned correctly:

- your back should be straight and not slouching, and you shouldn't

be stretching forward

- you should be looking down at your monitor, and it should be at least an arm's length away

- your chair and keyboard should be set so that the thighs and forearms are horizontal and level

- your wrists should remain straight when typing, and not be bent down or back, and they shouldn't be resting on anything when typing.

- Warm up. Before you begin work, warm up your muscle groups with a few simple exercises, just as you would prepare your body before beginning a workout at a gym.

- Take frequent breaks. Give your hands and wrists a break every 15-20 minutes by gently stretching and bending them. Alternate with other tasks whenever possible.

- Change your mouse. Choose a mouse design that fits your hand, but is as flat as possible to reduce wrist extension. Consider a larger mouse such as the Perfit or Whale mouse, or try a pen-shaped design for a more comfortable grip. In one study, a mouse with a pivoting pen-shaped handle significantly reduced muscle tension (Int J Occup Saf

Ergon, 2003; 9: 463-77).

For more tips on how to improve your computer workstation, visit the Cornell University Ergonomics Web at .

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