Carpel Tunnel Syndrome: Women Much More at Risk

Women get carpal tunnel syndrome three times more often than men

By Barbara Pierce

Carpal tunnel syndrome is a common condition that causes numbness, tingling and pain in the hand and forearm. It happens when one of the major nerves to the hand is crushed or squeezed as it travels through the wrist.

Aymen Rashid, orthopedic surgeon at Mohawk Valley Health System Orthopedic Group, Utica.

“The most common cause of carpal tunnel is chronic, repetitive motions of the hands such as typing, driving, writing, or using vibrating tools,” said Aymen Rashid, orthopedic surgeon at Mohawk Valley Health System Orthopedic Group, Utica. “Sleeping with your hands bent can increase the symptoms.”

Women get carpal tunnel syndrome three times more often than men. It occurs most often in people ages 30 to 60. Conditions that increase the likelihood of carpal tunnel include diabetes, rheumatoid arthritis, being pregnant and previous trauma to your wrist, he added.

Symptoms usually start gradually, with frequent numbness or tingling in the fingers, especially the thumb and the index and middle fingers. For some people, their fingers feel useless and swollen, even though little or no swelling is apparent.

The symptoms often first appear in one or both hands or arms during the night. You might feel numbness, tingling, burning sensations. Your dominant hand is usually the first affected and produces the most severe symptoms. You may feel the need to “shake out” your hand or wrist. As you get rid of these symptoms with a few flicks of the wrist, you may not think much about them, but, for most people, it will continue to get worse.

As symptoms worsen, people might feel tingling during the day, especially with certain activities such as talking on the phone, reading a book or newspaper or driving. Hand weakness may make it difficult to grasp small objects or perform other manual tasks. Some people with very severe carpal tunnel can’t differentiate between hot and cold by touch and may burn their fingertips without knowing it.

Early diagnosis and treatment are important to avoid permanent damage to the nerve.

A physical examination of the hands, arms, shoulders and neck can help determine if the symptoms are related to daily activities or to an underlying disorder and can rule out other conditions that mimic carpal tunnel syndrome.

Routine laboratory tests and X-rays can reveal fractures, arthritis and nerve-damaging diseases such as diabetes.

Treatments for carpal tunnel syndrome should begin as early as possible, under a doctor’s direction. Underlying causes such as diabetes or arthritis should be treated first.

How is carpal tunnel syndrome treated?

“The simplest treatment to start with is using a carpal tunnel brace,” said Rashid. “This will help to prevent your wrist from being bent which increases your chances of having symptoms.”

The brace worn at night is often the initial treatment.

Also, avoid daytime activities that may cause your symptoms. Take frequent breaks from repetitive movement, to rest your hand. If your wrist is red, warm and swollen, applying cool packs can help.

Anti-inflammatory medications, such as aspirin, ibuprofen and other nonprescription pain relievers may provide some short-term relief from discomfort but haven’t been shown to treat carpel tunnel.

“Other treatments include a cortisone injection in your wrist to temporarily alleviate your symptoms,” Rashid added.

Those with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels.

Acupuncture and chiropractic care have benefited some individuals but their effectiveness remains unproved.

“Ultimately, when the symptoms become severe and constant, the best treatment for a long-term resolution of symptoms is surgery to open the carpal tunnel,” said Rashid.

Carpal tunnel release is one of the most common surgeries in the U.S. Generally, surgery involves severing a ligament around the wrist to reduce pressure on the median nerve. It is usually done under local or regional anesthesia and does not require a hospital stay. Many people require surgery on both hands.

Following surgery, most people need to modify work activity for several weeks or even change jobs upon the advice of the surgeon from the surgery center.

Recurrence of carpal tunnel syndrome following treatment is rare. Some residual numbness or weakness is common.

How can carpal tunnel syndrome be prevented?

“At the workplace, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks and use correct posture and wrist position,” suggested Rashid. ”Wearing fingerless gloves can help keep hands warm and flexible. Workstations, tools and tool handles, and tasks can be redesigned to enable the worker’s wrist to maintain a natural position during work. Jobs can be rotated among workers. Employers can develop programs in ergonomics, the process of adapting workplace conditions and job demands to the capabilities of workers.”

“However, research has not conclusively shown that these workplace changes prevent the occurrence of carpal tunnel syndrome,” he added.

“The best way to prevent carpal tunnel is to protect your hands from long stretches of repetitive motions,” advised Rashid. “Take frequent breaks from those repetitive actions, stretch your hands frequently. Try to change your posture and use padding and cushions around your hands if possible.”