Download Feeling Fat Fingered

October 2008
Fenton
Physical
Therapy
Linden
Physical
Therapy
Milford
Physical
Therapy
400 Rounds Drive
Fenton, MI 48430
(810) 750-1996
319 S. Bridge Street
Linden, MI 48451
(810) 735-0010
135 S. Milford Rd
Milford, MI 48381
(248) 685-7272
Feeling Fat Fingered
Carpal Tunnel Syndrome And You
It starts with episodes of numbness or burning in the
thumb, index, and middle finger. It gradually progresses to pain in the wrist and hand. You start to
notice difficulty with handling small objects and
maintaining a strong grip. The hand may feel swollen and stiff. As the problem progresses, pins and
needles will wake you from sleep, and you want to
“shake out” the hands. In severe cases, the muscle
at the base of the thumb shrinks. You begin to have
pain when performing basic activities of daily living.
It can progress to the point that you are unable to
function and seek medical attention. This is the
general history given by a patient with carpal tunnel
syndrome.
Carpal
tunnel
syndrome
( C T S )
occurs
when the
median
n e r v e
gets compressed
at
the
w r i s t .
The median nerve allows you to feel sensation in the thumb,
index, and middle fingers. It provides the impulse
that controls important hand and thumb muscles.
The carpal tunnel is a rigid space located at the
base of the hand. This passage is made up of the
wrist bones on one side and a tough ligament band
on the other side. Nine tendons that produce movement in the fingers and thumb pass through the tunnel along with the median nerve. The problems with
pain and weakness occur with compression of the
nerve in this tight space.
CTS is often the result of a combination of factors
that join together to increase pressure inside the
carpal tunnel and compress the median nerve. In
many individuals, the carpal tunnel is just smaller
than normal; and, unfortunately, this makes it easier
to develop CTS. If the tendons become enlarged by
inflammation and you have a naturally small wrist,
the median nerve can more easily come under pressure. Trauma or injury to the wrist, such as fractures or sprains, can alter the architecture of the carpal tunnel and lead to CTS. Fluid retention during
pregnancy or menopause, rheumatoid arthritis, and
thyroid problems can also produce increased pressure in the carpal tunnel. Women are three times
more likely than men to get CTS. The dominant
hand is usually affected first and becomes more
painful. Persons with diabetes are far more prone to
CTS. It is more common in those performing assembly line work, but has not been linked to data
entry work.
Medical diagnosis is verified with electrodiagnostic
testing that measures the function of the median
nerve. Surgical decompression of the median nerve
is accomplished by performing a carpal tunnel release procedure that loosens the ligamentous roof of
the carpal tunnel. Carpal tunnel release does not
require hospitalization, and the procedure has a high
success rate. Individuals with a long history of median nerve irritation may continue to have “pillar
pain” in the wrist and hand for up to six months after
a release. Some manual physical therapy and a series of tendon gliding exercises resolve the remaining symptoms.
Michael S. O’Hara, P.T., O.C.S., C.S.C.S.
Fenton Physical Therapy
Linden Physical Therapy
Milford Physical Therapy
Carpal Tunnel Self Help
Management Is The Best Medicine For CTS
Many of the factors that contribute to CTS are out of your control. Your sex, the size of your carpal tunnel,
and health issues, like diabetes, cannot be changed. There are several things you can do to manage the
stress placed on your wrists and hands. This will decrease the likelihood of developing CTS or limit the intensity of CTS symptoms.
Ergonomic Common Sense
When lifting, carrying, pushing, or pulling, try to keep the wrists in a straight or neutral position. Avoid resisted
or forceful motions at extremes of wrist flexion and extension. Take frequent breaks when performing strenuous hand tasks. Industry has learned that rotating work tasks does wonders to decrease CTS claims. Some
fairly common activities that can cause CTS if performed for extended periods of time are washing windows,
working on all fours, and pushing overhead.
Use Protection
If you regularly perform activities that stress the hands, invest in some good antivibration gloves. The gloves will improve your grip, thereby decreasing strain on the
tendons of the hand. They also dampen vibration forces that are highly associated
with carpal tunnel syndrome. Many of the electric hand tools and motorized landscaping implements, such as string trimmers, produce vibration that can cause carpal
tunnel syndrome. A good source for these gloves is ergoboy.com.
Loosen Up
Research has implicated poor posture and tight muscles in the upper extremities and cervical region with
greater incidence of carpal tunnel syndrome. Studies of industrial stretching programs have demonstrated a
significant decrease in the number of claims for carpal tunnel syndrome. If you are an industrial athlete that
must lift, carry, push, or pull as part of your occupation, you should stretch every day. See the back page of
this newsletter for some of the most beneficial stretches for CTS.
Pajamas and Splints
Nocturnal pins and needles in the hand and forearm are often the first symptoms
of CTS. Symptoms that wake you from sleep can be the most aggravating part
of CTS. Wrist splints are worn at night on the hands to keep the wrists from falling into extremes of wrist flexion or extension. This helps prevent compression
of the median nerve and keeps these night time symptoms from occurring. The
splints are adjustable, and the current recommendation is to set the splints so the
wrists are straight rather than “cocked up” into extension.
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Fenton Physical Therapy
Linden Physical Therapy
Milford Physical Therapy
10/08
Ask The P.T......Michael O’Hara, P.T.
Q: I had pain in my right wrist and hand for six years before having carpal tunnel release surgery. It has
been five months since the surgery, and I continue to have pain in my wrist and hand. My grip is still weak
and I have to use my left hand for any heavy lifting. Is there anything I can do to get rid of the pain? I am
supposed to have the other wrist operated on next month.
A: The longer you had the symptoms of carpal tunnel syndrome, the longer it takes for the pain to go away
and function in the hand to return. Your median nerve had been irritated for six years, and it may take up
to a year for it to completely heal up and begin to function properly. “Pillar pain” is the term given for pain
and sensitivity that commonly occurs across the palmar aspect of the wrist and incision site after a carpal
tunnel release. Physical therapy treatment with soft tissue mobilization, tendon gliding exercise, and antiinflammatory medications can speed the recovery process along. Many times, postural correction exercise
is very beneficial. Your median nerve is part of an elaborate neural system that flows down the arm from
your neck to your fingertips. Eliminating stress on the neural structures “upstream” from the wrist often
abolishes the pain that remains after a carpal tunnel release. Discussing occupational activities with the
physical therapist is important. Patients are often unaware of the activities that they are performing on a
daily basis that can aggravate their condition. Ergonomic modifications of postures, work sites, and tools
can alleviate excessive stress on the wrists and hands.
CTS Is An Economic Pathology
Physical Therapist, Athletic Trainer, and Orthopedic Specialist
Carpal tunnel syndrome (CTS) is second only to lower back pain for the number of workers’ compensation
claims. It is one of the most common causes of lost employee work days in American businesses. Every
year in this country, we perform over 220 thousand carpal tunnel release surgeries. The National Council on
Compensation Insurance reports that each carpal tunnel claim averages 30 thousand dollars in costs. CTS
strikes women and older (+35 years) employees far more often. Any business that employs older workers
and is concerned about keeping them healthy and productive should be aware that a proactive approach to
CTS is very cost effective.
Industrial and office physical therapy ergonomic consultation assists employees with proper posture, body
mechanics, and daily stretching programs. All of these interventions reduce the incidence of CTS and the
number of lost work days. CTS is a cumulative trauma injury that frequently takes months or years to develop. Educating employees on the signs and symptoms of CTS and making them aware of solutions can
stop the progression of CTS. Simple changes such as better lifting mechanics, modification of hand tools,
use of wrist guides on computers, and soft flex wrist splints can stop symptoms before they develop into a full
blown case of CTS.
Fenton Physical Therapy is an active provider of industrial and office ergonomic physical therapy. If you are
interested in what we can do for your employees, contact Heidi Bush, DPT at 810-750-1996.
Hours
Mon-Thur: 5:30am-10pm
Friday: 5:30am-9:00pm
Saturday 8am-5pm
Sunday 8am-2pm
404 Rounds Drive
Fenton, MI 48430
810-750-0351
Fit Fingers
Exercise can place stress on the wrists and hands
and exacerbate the symptoms of Carpal Tunnel
Syndrome (CTS). Whether you have been diagnosed with CTS, or just have some of the symptoms of CTS, it is important that you be cautious
when exercising or participating in sports. Below
are listed some of the do’s and don’ts of exercise
for individuals with Carpal Tunnel Syndrome.
Don’t Lean on the Cardio Machines
I have treated numerous exercise enthusiasts who
have given themselves roaring CTS from leaning
on the handles of a Stairmaster or elliptical machine. These patients have almost all been women
who spend twenty to forty minutes a day on one of
these machines. Stairmaster changed the design
of its original units secondary to problems with users getting CTS. If you need to use your hands,
grip lightly and do not weight bear through your
wrists.
Dumbbells not Barbells
Using dumbbells gives your wrists/forearms more
freedom to move and decreases the load on the
structures in the carpal tunnel. Barbells fix the wrist
into a fully supinated (palms up) or pronated (palms
down) position. Good quality lifting gloves or Lynx
Grips can decrease the gripping demands on the
hands, and allow you to perform strengthening exercises with less stress at the wrist.
Don’t Muscle Up
Many men with CTS often attempt to overcome
their symptoms with the “I will get better if I just get
stronger” approach. CTS does not respond to aggressive wrist, hand, or grip strengthening. Very
often, the extra exercise just aggravates the condition and causes even more symptoms.
Do These Exercises
Exercises specifically designed to improve the mobility of the nerves in the upper extremity are beneficial for individuals with symptoms of CTS. Start
in position one, and reach the arm out, keeping the
palm to the sky until you feel some pressure in the
arm or hand or until the arm is fully extended. Hold
for no more than two counts, and release the arm
back to position one. Perform five to ten repetitions
before and after your training session, and at least
once a day on off days.
See a Trainer for Postural Exercise
Numerous studies have linked poor posture with
greater incidence of CTS. I have treated many patients with CTS whose symptoms improved or resolved with postural correction exercises. Postural
training is a prescription of exercise suited to your
specific postural restrictions or compensations. It
entails using stretching, strengthening, core stability, and balance training to make correct postural
alignment as automatic as breathing.
Get a Proper Grip
If you play tennis, golf, or softball, get your racquet,
club, or bat properly sized for your hand. The
proper grip size is especially important for women
with smaller hands and thinner wrists. Using a grip
that is too large will place extra stress on the wrist
and hand, making you more susceptible to CTS.
Michael S. O’Hara, P.T., O.C.S., C.S.C.S.
Fenton Physical Therapy
Linden Physical Therapy
Milford Physical Therapy
08/08
Diver Down
Vacation Injury Recovers With ASTYM
Donna was on vacation in the Bahamas when she struck her left thigh on the side of a boat during a diving
trip. She had left hip pain that caused her to limp for the next four weeks. The pain with walking resolved
after five weeks, but when she attempted to return to her exercise classes the pain returned. Diagnostic imaging tests were normal ,and she was prescribed Motrin and daily stretches for her hip. She stated the treatment with stretching and Motrin did not produce any changes in her pain. Three months after the injury,
Donna was referred to our office for physical therapy treatment by her physician.
Donna reported pain in the front and outside of the left hip with walking up stairs, running, and tennis. The
pain was recreated with resisted hip abduction and with squatting. Donna was unable to fully flex the left
thigh or sit cross legged on the floor. The outside of the upper thigh was tender to palpation. Her initial treatment consisted of augmented soft tissue mobilization (ASTYM) of the left leg and a daily home program of
stretches for the hip. As her pain decreased, she was progressed to strengthening drills. After five sessions ,Donna was able to return to her exercise class and remained pain free. Her left hip range of motion
was normal after her eighth and final session. Donna spoke with us a month later and reported she remained
pain free.