Carpal tunnel syndrome (CTS) is characterized by pain, numbness, or tingling in the wrist, usually associated with engaging in repetitive, awkward or forceful hand movements. Some cases of CTS are thought to be unrelated to any specific cause, but there may be an increased risk of getting CTS if you have a medical condition which impedes the circulation and supply of oxygen to the nerves of the wrist. CTS results from pressure on the median nerve, a nerve that transmits sensory messages and motor stimuli from the thumb and some fingers to the muscles in the hand. This nerve, along with nine tendons permitting finger and thumb movement, pass through a tunnel of fibers at the base of the palm of the hand in the wrist area. The top of the tunnel is a strong band of connective tissue called a ligament. During CTS, the tendons become irritated and swell, pushing the median nerve up against this ligament and causing pain in the wrist.

Simple remedies for carpal tunnel include hanging your arm over the side of the bed at night while sleeping, gently rubbing or shaking your hand, and running warm or cold water over the hand. Any coexisting medical conditions should be sure to be adequately treated under the advice of a doctor. If you are overweight, lose some, and if you smoke, quit. Treatment may also include resting the affected hand at night in a splint, or continuous splinting to keep the wrist and forearm in a direct line.

Vitamin B6 supplements have produced reduction in CTS signs and symptoms in some patients, with the greatest improvement seen in those at high risk for deficiency-- i.e. women who are pregnant or taking oral contraceptives. Hard evidence is lacking, however, about the efficacy of supplements in average-risk patients with CTS. The usual dosage is 50-100 mg a day for at least a month. Be forewarned, however, that it increases urination. Oral anti- inflammatory medication can be used, or in cases of more severe pain, corticosteroid drugs may be taken orally, or injected into the wrist. If these remedies are not effective, surgery is the last option available. The surgeon cuts the ligament running at the base of the palm, to relieve pressure on the nerve, but the pain may recur if the person's movement patterns are not changed.

Your wife should work out an individual treatment plan with her doctor based on her specific activities and support needs. For more on carpal tunnel, see Alice's answers to Prevention of carpal tunnel syndrome and Computer hazards? in General Health. You can also contact the National Institute of Occupational Safety and Health at (513) 533-8287 or The National Institute of Arthritis and Musculoskeletal and Skin Diseases at (301) 495- 4484. The Arthritis Foundation can provide physician/clinic referrals for carpal tunnel treatment at (800) 283-7800.

Alice

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