Question:I have carpal tunnel syndrome, but I have been wearing a brace at night when I sleep and my hand seems back to normal. I had scheduled surgery but I am going to cancel. Is there an exercise I can do to prevent its recurrence? Dr. Hibberd Responds:Carpal tunnel syndrome is caused by irritation of the median nerve where the nerve itself is "entrapped" within the carpal tunnel of our wrist. It is more common in middle aged women and more often affects the dominant hand.
The carpal tunnel is located on the flexor (palm) side of our wrist and contains the median nerve together with our flexor tendons. These tendons allow us to flex or make a fist. It is associated with wrist pain often worse with movement. It often presents with decreased hand sensation sometimes with associated thumb muscle weakness and atrophy (shrinkage of muscle bulk) if left untreated.
Recurrences are unpredictable, but tend to be associated with wrist or hand overuse, re-injury or trauma. Patients with diabetes, hypothyroidism, pregnancy, renal failure on dialysis, rheumatoid and other arthritis conditions affecting the wrist, amyloidosis, and those with previous wrist trauma have an increased frequency of carpal tunnel syndrome.
When present, these underlying conditions associated with carpal tunnel syndrome of course need to be addressed. Though vitamin B6 (pyridoxine) is often used as an adjunct to conservative treatment, its overuse (usually more than 500mg per day) has also been associated with the occurrence of carpal tunnel syndrome.
The most common preventable cause of recurrent carpal tunnel syndrome is hand and wrist overuse injury so often seen with computer keyboard use. Placing a wrist pad to lay your wrist on when typing seems to help minimize problems such as this. Other work related tasks involving repetitive flexion-extension of your wrist should be minimized.
Surgical management is used only for those who do not respond to conservative measures such as the cock-up nocturnal wrist splint that you were correctly advised to use. Anti-inflammatories (naproxen, ibuprofen, etc.) and local infiltration of the carpal tunnel with injectable steroid solution are also commonly used conservative treatments. Generally surgery is indicated only for those with progressive weakness and/or intractable pain.
Peter Hibberd is a medical doctor with over 28 years of outpatient and hospital-inpatient experience. He is board certified by the American Board of Emergency Medicine and is a member of the American College of Emergency Physicians. He also is a member and a fellow of the American Academy of Family Physicians.
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