Carpal tunnel syndrome

Dear Partner,

First, what a great thing you are doing to help your wife.  Learning about the options and supporting her is an important part of addressing her health concerns. 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 is 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. With 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 the arm over the side of the bed at night while sleeping, gently rubbing or shaking the hand, exploring proper ergonomic set ups for various tasks, 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 health care provider. People who are overweight may benefit from weight loss and quitting smoking may help as well. 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 other 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.  As you might suspect, the surgery option has the longest recovery period.

Your wife will likely want to work out an individual treatment plan with her health care provider based on her specific activities and support needs. For more on carpal tunnel, check out the National Institute of Arthritis and Musculoskeletal and Skin Diseases or the Arthritis Foundation for information and physician/clinic referrals for treatment. All the best to you and your family!