BONES AND JOINTS

Can you avoid carpal tunnel � Exercises and stretches. A physical or

occupational therapist can guide you
syndrome? through stretching and nerve gliding
exercises for your wrist and hand.
Physical therapy, splinting, and corticosteroid injections “There are very few studies that sug-
may relieve symptoms temporarily. gest motion exercises might help, but
they’re not fully proven, and

Y ou may suspect that you have car- cal activity of the median
pal tunnel syndrome (CTS) if you nerve, and detect whether
experience numbness, tingling, and the activity is slowed due
their role remains unclear,”
says Dr. Mudgal.
� Injections. An injection
weakness in your hand. CTS is a com- to increased pressure in the of a corticosteroid into the
mon condition that doesn’t go away carpal tunnel. “But in the carpal tunnel may help re-
on its own. “The longer you wait to get early stages of the condi- lieve symptoms of CTS.

Image: Thinkstock
help, the less likely you will respond tion, it may not have pro- “Some people strongly be-
completely to treatment, if the process gressed enough to be picked lieve in the injections,” says
has progressed beyond a certain point,” up, so the study may be neg- Dr. Mudgal. “If the electrical
says Dr. Chaitanya Mudgal, a Harvard ative,” says Dr. Mudgal. Wearing a brace at night study shows a mild problem,
Medical School assistant professor. to keep the wrist straight one study has shown that
Nonsurgical treatments may help reduce swelling such injections are ben-
in the carpal tunnel.
The carpal tunnel If you have an electrical eficial. However, in more
The median nerve and nine tendons in study that confirms the diagnosis of than 80% of people with the benefit,
your forearm enter your hand through CTS, and your symptoms are mild or symptoms recur within one year.” He
a small area known as the carpal tun- moderate, nonsurgical treatments are cautions that approaching the nerve
nel. It sits beneath a ligament that runs the first types to be used. These are the with a needle carries a risk of pain and
across the bottom of your palm. Some- most common relief methods: injury, especially if the steroid is acci-
times the tissue around the tendons can � Splinting. Wearing a brace or splint dentally injected into the nerve.
swell and press on the median nerve, re- that keeps the wrist straight may help � Other options. You may also hear
sulting in tingling and numbness in the to reduce the swelling of the tendons about using acupuncture or vitamin
thumb and most fingers. Symptoms of- in the carpal tunnel and keep pressure B6 to relieve symptoms. There aren’t
ten wake people at night. “Patients have off the median nerve. It’s especially much data to support either, but Dr.
difficulty staying asleep because their helpful at night, when CTS effects are Mudgal says it won’t hurt to try. “And
hand goes numb. Or numbness starts at their worst. You can find a brace in people still talk about work station
when they’re talking on a phone, or a drugstore, or your doctor may pre- modification, so you don’t bend the
reading a newspaper,” says Dr. Mudgal. scribe one for you. wrist too far up or down, but that’s
The cause of CTS is un- never been shown to make
known. It is more common Move of the month: Hand/finger tendon glide any difference in the progres-
in people with diabetes, sion of carpal tunnel,” he says.
rheumatoid arthritis, gout, This move may decrease pressure in the carpal tunnel.
and wrist fractures. The con- Start with the fingers extended straight out. Make a hook fist; Surgical treatments
dition is most often linked return to a straight hand. Make a full fist; return to a straight For people with more severe
hand. Make a straight fist; return to a straight hand.
with aging. Dr. Mudgal is symptoms or for those whose
skeptical of the common idea symptoms don't respond well
that CTS is caused by activity, to nonsurgical treatments, the
especially using a computer only effective treatment, says
Illustration: Scott Leighton

keyboard. “There is not one Dr. Mudgal, is surgery. “It’s a

shred of evidence that carpal good procedure with a high
tunnel syndrome is caused by rate of success,” he says. The
keyboard use,” he says. surgeon relieves pressure on
the nerve by cutting the trans-
Diagnosis and treatment verse carpal ligament. Most
Diagnosing CTS requires Straight hand Hook fist Full fist Straight fist patients do not need physical
tests that measure the electri- therapy after surgery.
4 | Harvard Health Letter | September 2014 www.health.harvard.edu
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