What is New About Carpal Tunnel Syndrome?

Sunset in the prairies. (Dr. Noorali Bharwani)
Sunset in the prairies. (Dr. Noorali Bharwani)

August seems to be my favourite month. Many good things and some not so good have happened during this month. One of the good things was starting this column 16 years ago. A by-product of these columns has been publication of my two books. Hopefully, there will be more.

OK, let us get back to what we are going to discuss today – carpal tunnel syndrome.

Last time I wrote about carpal tunnel syndrome was in 2003. This is a good time to review the subject again as I saw an article in the Canadian Medical Association Journal (CMAJ August 5, 2014).

Carpal tunnel syndrome was first described in 1853. It is a common, painful disorder of the wrist and hand. It is caused by pressure on the median nerve in the wrist. The median nerve travels from the forearm into the hand through a “tunnel” in the wrist.

The CMAJ article says the condition is not as common as thought. “A prospective long-term study of a general working-age population (16 to 74 yr) showed that the overall incidence of carpal tunnel syndrome over a 66-month period was 103 per 100 000 people per year,” says the article.

Who is at risk?

Individuals who are working in areas where there is exposure to excess vibration, use of increased hand force and repetitious movements increase the risk of carpal tunnel syndrome. In an analysis of 37 studies it was found that factors significantly associated with increased risk included vibration, increased hand force and repetition.

What about somebody spending many hours using computer keyboard?

The authors of the article say that the association between carpal tunnel syndrome and use of a computer keyboard or mouse is unclear. The authors reviewed eight epidemiologic studies and came to the conclusion that the evidence is insufficient to confirm that computer work causes carpal tunnel syndrome.

The review also found no evidence of an association with repetitive, low-force noncomputer work.

Personal characteristics that increase a patient’s risk include increase in age, sex (women were at higher risk than men) and obesity.

Is there a good treatment for carpal tunnel syndrome?

After 160 years, one would think we would have found a good treatment for this ailment. Let us see what we have.

Initial management may include occupational therapy and wrist splinting. A study found that eight weeks of splinting and education sessions with an occupational therapist was helpful in 63 per cent of the patients. These patients did not require surgery.

These patients showed improvement in symptom severity, functional status, pain perception and grip strength. The article says if symptoms do not improve within eight weeks, referral to a surgical specialist should be considered.

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