I was surprised to learn recently that diabetes mellitus is recognized as a risk factor for carpal tunnel syndrome. [i] Couple the high numbers of people living with diabetes [ii] with the increased use demanded of our hands for laptops, smartphones and tablets, it’s just a matter of time before more and more people present in your office with carpal tunnel syndrome.
Although the reason for the correlation between diabetes and carpal tunnel syndrome is unclear, the fact remains true according to 36 different studies conducted over a 65-year period. [iii]
What Is Carpel Tunnel Syndrome?
Carpal tunnel syndrome (CTS) is defined as a medical condition that causes tingling, numbness, burning and pain in the wrist, hands and all fingers, except the fifth. Although those symptoms may sound merely like an inconvenience, those sensations, if left unattended, lead to debilitating agony and the loss of ability to use the hand(s).
The condition results due to continual pressure on the median nerve as it travels under the transverse carpal ligament through a narrow path between the wrist bones. Repetitive actions, especially when the hand is extended and abducted, can cause swelling in the area that puts pressure on the cramped nerve. Certain professions and activities increase the risk of developing CTS – think massage, hair stylists, typing, using a mouse for a computer.
Impingement anywhere along the median nerve’s long route from the brachial plexus to the palm of the hand can cause the symptoms named above; however, true carpal syndrome is a result of pressure on the median nerve in the tunnel between the carpal bones (wrist bones) of the hand.
A number of other conditions can cause similar symptoms, and explain why many people are misdiagnosed. Some doctors can be quick to blame CTS (carpal tunnel syndrome) when the cause may be something totally else. My father was a great example of this. The pain in both of his hands had progressed so much that he was barely able to use them. Surgery for CTS provided no relief. Blood work ultimately showed he had rheumatoid arthritis.
In addition to RA and diabetes, CTS-like symptoms can arise from impingement of the median nerve at the brachial plexus, nerve compression at C5-C7 in the neck, wrist injuries such as a fracture or ligament damage, or long-term use of birth control pills or pregnancy, both of which cause a depletion of vitamin B6 in the body.
Tests
Following a detailed medical history and physical examination, a doctor may conduct the following two tests to determine whether CTS is evident:
* Tinel Test
The doctor will vigorously tap the median nerve in the wrist, either with her fingers or a reflex hammer. Tingling in the fingers or an electric shock-like sensation indicate a strong possibility of carpal tunnel syndrome.
* Phalen’s Maneuver
The patient presses the backs of his hands and fingers together with the wrists flexed and fingers pointing downward – for two minutes. Tingling or numbness in the fingers indicates CTS.
Reflexology and CTS
Reflexology for the hands is very helpful for people with carpal tunnel syndrome, especially if they are following through with a committed self-care program.
Make sure to include lots of gentle range-of-motion of the wrist and the digits. Traction the bones of the hand away from those of the forearm.
If your jurisdiction allows you to perform massage therapy, and you are trained in the art, then do connective tissue massage on the muscles of the forearms.
Self-Care
Different things work for different people, so you or your clients will have to experiment.
* Some people find that gently flexing and extending the hand while soaking in warm water three or four times/day helps. Others find icing the wrist for about 10 minutes a few times in an hour helps.
* Wearing a wrist brace to bed is reported by many to be very helpful, since people often end up bending their wrists while sleeping.
* Take breaks often and stretch your hands. Use only as much force as is necessary for a task, and use both hands to complete tasks, not just your dominant.
* This one is very important: Stop or correct whatever it is that is causing the carpal tunnel syndrome. Make whatever adjustments you need to make to improve work ergonomics and body mechanics. Keep the wrist straight!
* Do wrist curls with light weights (one to 3 pounds); both flexion and extension. As above, keep the wrists straight!
If you know any other strategies for addressing carpal tunnel syndrome, either as a practitioner or sufferer of the condition, please share. That way we can all learn from our collective experiences.
[i] http://www.ncbi.nlm.nih.gov/pubmed/22628597
[ii]According to the most recent numbers form the US Centre for Disease Control (2012) there are 29 million people living with type 1 or type 2 diabetes in the USA, and 2 million in Canada.
Does my PC doctor have to refere me to a specialist, for tests to find out more for pains and tingling of feet and hands?? Is it also possible that this might be caused by a pinched nerve of some sort, as there are times when hardly any pain.
Alvie – You’ll have to check with your insurance company on whether or not you can just make an appointment to see a specialist on your own, or if your primary doctor must order the tests or refer you to a specialist. Good idea to check it out so it doesn’t progress.