Carpal Tunnel Syndrome is a Pain in the Wrist

By: Frank Ferrantelle
From: Thinking Bigger Business Magazine, October, 2011

Education and prevention can help keep your employees free from repetitive injuries.

Carpal Tunnel Syndrome (CTS) is an all too common condition that causes pain and numbness, as well as the potential loss of ability to pinch or grasp items. In addition to the health consequences of CTS for the employee, business owners and managers should know that the business impact can be substantial, including time off from work, rehabilitation, workers’ compensation and lost revenue.

CTS presents itself at the wrist, fingers and palm while frequently progressing proximally to the elbow and shoulder. Consider these finding in recent studies:

Cashiers, hairdressers, bakers, keyboarding personnel, butchers, assembly line workers and, yes, milk farmers are all susceptible. The common thread is that each of their job tasks involves repetitive hand motions day in and day out, including gripping, awkward positioning and mechanical stresses to the palm. Other workers may be affected by tools that provide significant vibration, such as jackhammers and lawn mowing equipment.

What is CTS?

The wrist is surrounded by a thick band of fibrous tissue (think: a piece of tape) called the transverse ligament, which assists in a supportive capacity. The tight space formed by the wrist bones and the transverse ligament is referred to as the carpal tunnel. Among the anatomical structures that pass through this tunnel on their way to the fingers is the median nerve (think: electrical wire). This nerve is especially important in providing the ability to appreciate varying sensations at the palm and fingers, as well as allowing you to move, pinch or grip. When a condition arises that causes inflammation, swelling or squeezing of the median nerve in the carpal tunnel, that is CTS.

Interestingly, another group of people susceptible to CTS are pregnant women. The swelling and fluid retention all too common during pregnancy can increase the pressure in the relatively narrow canal, thus compressing the median nerve. Furthermore, heredity is a very important factor, as some people simply have carpal tunnels that are more narrow than others.

For most people, CTS will progressively worsen without appropriate treatment. Nonsurgical care, however, is straightforward and basic:

  1. Modify job tasks and take frequent short breaks to perform special exercises, which stretch the hand and forearm
  2. Use a brace or splint: a simple device that maintains the wrist in a neutral position
  3. Steroid injections to relieve inflammation and pain may provide significant, albeit, sometimes only temporary relief
  4. Physical therapy in conjunction with any or all of the above can assist with pain control, as well as restoration of mobility and strength
  5. Ergonomic work aids/devices such as split keyboards, anti‐vibration gloves, redesigned work stations and larger grips on equipment handles can decrease the stress at the carpal tunnel
  6. Consider having a professional conduct a worksite assessment to prevent or remedy problem areas or merely instruct staff on exercise programs to prevent CTS

Surgical Solutions

When conservative care fails, there are two surgical options. The first, an open procedure, involves and incision from the wrist to the mid‐palm, exposing the transverse ligament. A cut is made, the median nerve is relieved of pressure and several weeks of physical therapy ensures to prepare for return to work status.

The second procedure, endoscopy, involves a smaller incision and a tiny camera (an endoscope) inserted into the area of the transverse ligament. Once located, the ligament is severed, all from inside the carpal tunnel. Generally, all endoscopic post‐operative timelines, including reduction of pain, increase in mobility and strength, as well as return to work status, are shorter than with the open procedure.

Prevention First

Because prevention is always better than a cure, your best bet to keep your employees symptom‐free is to focus on preventative measures. Acknowledge potential problem areas, modify those workstations and/or procedures as efficiently as possible and allow for appropriate exercises to be routinely completed.