B efore the 1980s, few people had heard of carpal tunnel syndrome (CTS). But as computer use proliferated, CTS seemed to proliferate right along with it, going from being nearly unknown to being the wrist and hand injury du jour.

To get the latest information about CTS I called hand surgeon Roy Meals, MD, clinical professor at the UCLA School of Medicine and former president of the American Society for Surgery of the Hand. Dr. Meals told me that CTS is eminently treatable and that computer use is no longer the most common cause of the problem. The previous problem was that people used the keyboard with their wrists in a flexed position and "flexing causes CTS because it stresses the nerve," says Dr. Meals. Today computer users are much savvier about positioning their hands correctly -- arms parallel to the floor and wrists straight when using the keyboard. Dr. Meals says you can achieve this position by adjusting the height of the chair or the keyboard... whichever is easiest and feels best.

SLEEP POSITION MAY CAUSE CTS

CTS is common in people over age 50, mostly because of health conditions that bring hormonal shifts (such as diabetes and rheumatoid arthritis)... menopause... and especially mechanical stress. All of these make the nerve more vulnerable to irritation. Repetitive motions that flex and extend the tendons in the hands and wrist such as job tasks on an assembly line or in carpentry, for instance, continue to be common causes. Surprisingly, Dr. Meals told me one of the most frequent triggers of mild CTS is when people sleep in the fetal position, flexing their wrist and curling up with the back of the hand under the chin, which puts hours of stress on the median nerve.

You should suspect CTS if you find yourself shaking your hands most mornings to get rid of numbness and tingling.

To help primary care doctors screen for CTS -- and with it provide proper referral to diagnostic tests and/or orthopedic hand specialists -- a group of researchers has now developed a simple screening questionnaire. It includes seven questions, but three of them were found to be especially important:

• Is tingling present in at least two of the first four digits?

• Do symptoms worsen at night or on awakening?

• Does shaking your hand cause symptoms to recede?

Researchers found that "yes" to at least two of these questions correctly predicted CTS by 97%, as was proven in follow-up electro-diagnostic tests.

Dr. Meals says it is fine to treat a mild case of CTS at home. Purchase a wrist splint at the drugstore and wear it at night for several weeks in order to break the habit of flexing your wrist in sleep and irritating the nerve. When symptoms are serious, though, including not being able to fasten buttons, put on earrings or even touch the thumb to the little finger, it indicates that the nerve is degenerating. 

Initial treatment from the doctor may be a cortisone injection to reduce inflammation in the area, but Dr. Meals says that about 25% of his patients end up needing surgery. Minimally invasive endoscopic surgery is used by some surgeons today, though Dr. Meals says he prefers open surgery -- the wrist area, unlike the abdomen, he notes, is tiny and difficult to see well with an endoscopy camera. Following surgery (of either kind, endoscopic or open) patients are generally almost immediately able to perform ordinary tasks involved in getting dressed and the like and return to desk activity in a few weeks... although participation in forceful grip and pinch work and athletic activities typically takes six to eight weeks. Fortunately, even nerves that have degenerated considerably will heal, says Dr. Meals, but it can take from six to 12 months.

NATURAL TREATMENT

Before resorting to surgery, natural treatments may be helpful in addition to lifestyle changes. Acupuncture has become a popular way to treat CTS, says Yi Hung Chan, LAc, DPM, who has a private practice in West Orange, New Jersey. Dr. Chan says that acupuncture needles can relieve the pain caused by CTS and also quiet irritation in the nerve. Some people also find that acupressure, in which hand pressure (rather than needles) is applied to certain areas of the hands and arms, is helpful as well. Obesity is known to contribute to CTS, so losing weight can have an effect. When performing activities that stress hands and wrists, be sure to take frequent breaks and try to avoid positions that cause extreme flexion or extension of the wrists, all of which will help keep your median nerve pain-free and working smoothly.