– It is natural to want to ascribe a simple cause to a problem. If your wrist hurts or your hands are numb it must be because of typing. However, according to Alejandro Badia MD, an orthopedic surgeon specializing in treatment of the upper limbs, including hands and wrists says “don’t blame that painful wrist on any physical requirements of your job, including time spent on a computer keyboard or other device. That’s because the problem – carpal tunnel syndrome – is more likely due to hormonal changes, underlying inflammatory diseases or simple wrist anatomy”.
The syndrome occurs when the median nerve, extending from the forearm to the hand through the narrow tunnel of bone and ligaments on the wrist’s palm side, becomes pinched and inflamed from irritated tendons or other conditions that cause swelling in the wrist canal. Symptoms, which begin gradually and worsen over time, include wrist or forearm pain; persistent burning, tingling or numbness in the fingers; and decreased hand strength, explains Dr. Badia, founder and chief medical officer of the Badia Hand to Shoulder Center and OrthoNOW®, a group of walk-in orthopedic clinics.
The National Institutes of Health reports women are three times more likely than men to experience carpal tunnel syndrome. The higher risk among females is likely due to their anatomically narrower wrist channels and the disorder’s suspected relationship to metabolic and hormonal-level changes during pregnancy and menopause, Dr. Badia says.
“Hormones are chemical substances that impact every organ and structure in the body. Variations in the levels of these substances – such as what occurs in menopause and pregnancy — can lead to fluid retention and thicken the extracellular matrix in the wrist, resulting in pressure on the median nerve” Dr. Badia says.
Statistics indicate that 20 percent or more of pregnant women develop carpal tunnel syndrome.
Other conditions increasing risk among both sexes, researchers say, are wrist injury, inflammatory and nerve-related diseases like rheumatoid arthritis and diabetes, and a dysfunctional thyroid. The thyroid controls metabolism – how the body utilizes energy from food.
What studies fail to show conclusively is any defined relationship between constant use of the wrist and development of carpal tunnel syndrome, Dr. Badia indicates.
“Repetitive wrist activities — like typing on a computer keyboard or handling a cash register — may further aggravate symptoms but are not linked to actual development of the syndrome,” he says. “The ‘myth’ that workplace responsibilities cause the problem has resulted in misdirection of billions of dollars into workers’ compensation to treat a condition that commonly occurs in the general population and is unrelated to on-the-job requirements.”
In fact, carpal tunnel syndrome is described as far back as 1025 AD when medieval Persian physician, Avicenna, correctly detailed the wrist problem in his book Canon of Medicine,according to authors of a 2018 article in Integrative Medicine Research. Avicenna suggested that chronic nerve impingement in the wrist is due to both physical disorders and lifestyle factors, such as improper nutrition and lack of sleep.
Whatever causes the syndrome, Dr. Badia encourages early diagnosis. “If left untreated, the syndrome can eventually make it difficult for patients to form a fist, coordinate their fingers and do simple, manual tasks like buttoning a shirt or blouse. The disorder may even lead to a wasting of muscle at the base of the thumb,” he says. Initial, recommended therapies tend to be conservative, involving wrist splints at night, anti-inflammatory medications and injection of corticosteroids. Some studies have supported the use of vitamin B6 and or B12.
Should the problem persist, the nerve compression prove severe enough or a physician determine the syndrome is causing deterioration of hand muscles, then minor procedure may be proposed.
“The procedure is performed in an outpatient setting under local anesthesia. It involves dividing the ligament that serves as the roof of the carpal tunnel to increase space in the wrist canal and take pressure off the nerve,” Dr. Badia says. “Using a recent treatment breakthrough called endoscopic release, the surgeon can divide the carpal tunnel ligament through a tiny cut in the crease of the wrist without making a larger, open incision,”
Carpal tunnel syndrome cannot always be prevented, but risks may be reduced. Dr. Badia offers these tips:
Alejandro Badia, MD, FACS, internationally renowned hand and upper-limb surgeon and founder of Badia Hand to Shoulder Center and OrthoNOW®, a walk-in orthopedic care clinic. He is a member the American Society for Surgery of the Hand, American Association for Hand Surgery and the American Academy of Orthopedic Surgeons. He is a specialist in treating all problems related to the hand and upper extremity including trauma, sports injury, joint reconstruction, nerve injuries and arthroscopic surgeries.www.OrthoNOWcare.com, www.DrBadia.com
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