More and more people, working in offices, in mechanics—everywhere—seem to be plagued with carpal tunnel syndrome, a medical problem of the wrist and its primary nerve, the median nerve. Carpal tunnel causes numbness and tingling in the fingers and can interfere with typing, hammering, handicrafts, and various activities that involve the position of the hands, both at work and at home. You frequently see people in all types of work wearing a brace or splint to support their wrist while they do their work, but even the positioning of their hands on the steering wheel must be adjusted to accommodate the pain and numbness in the fingers and hands, not to mention the frustrating effort of trying to pull up that tiny button to open the car door.
What causes it? There are two schools of thought: one is repetitive motion of the wrist over time, and the other is genetics—the structure of the hand itself. The syndrome can be diagnosed by the ability of the median nerve to respond to electrical stimulation, a nerve conductivity test. There are also two positioning tests that a doctor can do in the office that can help to diagnose carpal tunnel by what positions of the hand cause the pain.
You can’t do anything about your genetics, buy you can be kind to your wrists. That’s what ergonomic configurations of your chair, desk, and computer are about. But what if your work area is fine, but you frequently have to staple lots of documents at one time, over and over? Do you slam the heel of one hand onto the stapler? Or is there an automatic stapler in a common location that you can go to use instead? Your employer knows he’s better off buying a couple of electric staplers than having staff miss work, or be out of the office for weeks recovering from hand surgery.
If your job, on the other hand, is active and frequently requires you to do anything that puts your hand at a right angle to your wrist, such as using a staple gun or hammering for a long period of time, you may be risking carpal tunnel syndrome. As your hand particularly your thumb, loses its muscle strength and you begin to favor your nondominant hand, symptoms may begin there, too.
Many office workers have been advised to place a soft, flexible strip across the base of their keyboard to support their wrists while they type, often one made of foam or of fabric filled with small foam beads. But someone involved in working with tools in the field does not have that option.
If you develop symptoms, see a hand surgeon who can suggest several approaches you can try. Consciously trying to keep your hand on the same plane as your wrist as you work can help. And if the problem is diagnosed early, before a lot of muscle weakness occurs, it can be treated fairly easily. If nothing you or your doctor try—like a custom-made molded plastic splint to wear while you work and at night—brings relief in 3-12 months, she may suggest open tunnel or endoscopic surgery. It can be done as an outpatient, in a short surgical procedure, but it may require weeks of physical therapy to rehabilitate the muscles.
In open tunnel surgery, the ligament that holds the median nerve in place between it and the eight bones of the wrist can be cut, through a small incision at the base of the hand. That sets the irritated median nerve free from constraint, and the space formerly filled by the tautly stretched ligament fills in with scar tissue. The pain usually leaves—95 percent of hand surgery for carpal tunnel is effective. Once the dominant hand is more usable, the burden naturally shifts away from the nondominant hand, and sometimes the pain from overuse of this weaker hand ends, too.