Free Pain Relief Newsletter  Click Here Pain Relief Articles - Carpal Tunnel Exercise:  A Natural Reliever For Chronic Low Back Pain 4 Natural Home Remedies to Ease the Pain of Sunburn Getting A Grip on Carpal Tunnel Syndrome Exercise Your Way To Pain Relief Benefits of Alternative Medicine Neck Pain Management Migraines - Food and Diet Tendonitis Pain Relief Treating Arthritis - Naturally Getting Well With Smell Guided Imagery - The Healing Power of Imagination The Healing Power of Food Healing With Herbs Healing With Movement Healing With Water Self-Healing With Homeopathy Laughter Is Good Medicine Treat Your Own Back Pain Healing With Your Mind Getting A Grip on Carpal Tunnel Syndrome By Dan Ullrich Carpal tunnel syndrome (CTS) is perhaps the most far-reaching musculoskeletal disorder in the US. It touches the lives of millions of people – estimates put the number at about 3.7% of the population – and costs untold amounts of pain and suffering as well as billions of dollars in lost production. The most common upper-extremity surgical procedure is for CTS release, with more than 400,000 such operations performed nationwide each year. Dramatic growth in the identification and treatment of CTS in the past half-century has revealed a critical need for accurate diagnostic techniques, better understanding of the causes of the disorder, and more “hands on” research into effective prevention practices. Jacqueline J. Wertsch, MD, Medical College of Wisconsin Professor of Physical Medicine & Rehabilitation, has emphasized carpal tunnel syndrome in her patient care since joining MCW in 1980 and is serving as the Medical College’s primary investigator in a major new study of upper limb musculoskeletal disorders. She discussed CTS and the new science that surrounds it in a recent HealthLink interview. “If we just start with the question ‘what is carpal tunnel?’ the answer is very straightforward and very simple,” said Dr. Wertsch. “It’s a pinched nerve at a specific place, which is the median nerve pinched at the wrist. Very clear cut, and one of the most published topics in the medical literature. “When I started out as a doctor in the late 70s, there were a lot of people who we could see, clinically, had the symptoms of carpal tunnel syndrome. Everything, including the physical exam, told us they had it. ‘Syndrome’ implies history, physical and other confirming tests. They’d have history that sure sounded like carpal tunnel. We’d clinically examine them and it sure looked like carpal tunnel. But we couldn’t prove it. That has changed.” Symptoms Define Three Stages of CTS According to the National Institutes of Health, approximately 75% of diagnosed CTS patients are women. For both men and women, the mean age at which the disorder appears is about 50. Roughly four out of five CTS patients are more than 40 years old. CTS is most commonly thought to be the direct result of repetitive motion in the workplace – including many areas of factory work, activities like typing, or even in playing a musical instrument. But a multitude of risk factors have been identified that predispose patients to the disorder. Certain diseases, pregnancy, obesity, alcoholism, sleep position, vibration, deformity after trauma and carpal bone anomalies are among those systemic and anatomic factors. The “tunnel” in CTS is the pathway for ligaments and bones in the wrist. In the simplest terms, CTS can result when the tunnel narrows because of inflammation. The narrowed tunnel compresses a portion of the median nerve, which normally sends signals to muscle (through motor fibers) and to the thumb, index and middle fingers, and half of the ring finger (through sensory fibers). When the median nerve is pinched in CTS, its reduced capacity to send signals causes symptoms ranging from mild tingling or numbness in the affected areas to difficulty gripping or making a fist to severe muscle atrophy. The three stages of CTS are early (mild), intermediate (moderate), and late (severe). Treatments include using a splint to hold the wrist in position, elimination of or breaks from repetitive motion, ergonomic changes in the workplace, medication including diuretics, anti-inflammatories and corticosteroids, and surgery to release the pressure in the carpal tunnel and “free up” the pinched nerve. Newer Tests Far More Precise Appropriate treatment, of course, depends upon accurate diagnoses. Dr. Wertsch uses the newest testing tools in her clinical practice at Froedtert & Medical College Clinics and at the Zablocki VA Medical Center in Milwaukee. “My field is clinical neurophysiology, and it used to be that I’d see people and couldn’t prove carpal tunnel syndrome, but now the diagnostic testing is really good,” said Dr. Wertsch. “It changed dramatically in the 1980s, when specific tests came into use – including one of the originals I like best, the Mills technique. It’s technically detailed, but it allowed us to look at a very specific area and control those technical details.” For example, said Dr. Wertsch, “the Mills technique has to do with exactly where you put the electrodes. That’s one of the things that fit in the concept of shocking the nerve one place and recording in another. Mills is very specific and the way that I have found to be the most reliable, reproducible and accurate.” “Another issue that caused confusion was when it looked as if a patient had carpal tunnel, and then had surgery, but wouldn’t get any better,” said Dr. Wertsch. “That’s been resolved since we’ve been able to use accurate testing to determine, first, if it is carpal tunnel, and second, to determine just how bad it is. “One basic concept is that nerves are like the wiring system in the body and we’re electricians checking to see if there’s a blockage in the wire right at the wrist. We tape electrodes on various places and then we give a mild shock to the nerve – it feels like hitting your funny bone – and record the responses in tenths of milliseconds.” “This is extremely precise, and therefore it’s very important to be highly accurate in things like how you hold the hand when you measure,” said Dr. Wertsch. “There is a lot of training emphasis in this area here at the VA and at the Medical College. Nerve connection studies, the gold standard for carpal tunnel diagnosis, is one part of the broad field of EMG. Paying attention to and fine-tuning technical details is making all the difference in the world. If you don’t do that you can have false positive tests.” Research Study Exemplifies Continuing Collaborations In 2002 the National Institute for Occupational Safety and Health awarded a $2 million grant to support a four-year study of how conditions in the workplace contribute to hand injuries and disorders, including carpal tunnel syndrome. The research is a collaborative effort among the University of Wisconsin-Milwaukee, the Medical College of Wisconsin, and the University of Utah-Salt Lake City. Study participants in Utah and Wisconsin will be drawn from at least five different industries. Dr. Wertsch is primary investigator at the Medical College and will direct the examinations of as many as 300 Wisconsin participants out of the two-state pool of 600 “blue collar” workers. Primary investigator for the study is Dr. Arun Garg, a UW-Milwaukee industrial manufacturing and engineering professor and renowned ergonomics expert. Scientists have yet to quantify in detail the exact circumstances and specific practices that lead to hand injury in the workplace. The joint study will be a large-scale assessment of those risks. Up to 25 researchers will be involved, with therapists and physicians monitoring symptoms and medical conditions of the workers while the engineers and ergonomics professionals track their jobs and workplace practices. “The Medical College has always been among the leaders in moving carpal tunnel research forward,” said Dr. Wertsch. “We’ve had the surgeons and the rehab diagnostic people together for years. By working with UWM and the ergonomics folks there, the people who analyze jobs, we’ve got a full team of some of the best in the country now,” said Dr. Wertsch. “We’re going to set some huge standards for the whole issue of causation of carpal tunnel, among other things.” The great majority of carpal tunnel cases do not involve permanent injury, and Dr. Wertsch and her colleagues are working to keep it that way. “There’s no reason that anybody who has carpal tunnel has to have a permanent disorder,” said Dr. Wertsch. “If it’s ignored, or if it’s the wrong treatment, or if it’s already a severe injury before any treatment is attempted, there might be permanent injury. But there’s absolutely no reason it should have to happen that way nowadays.” Dan Ullrich is a contributing writer to HealthLink http://healthlink.mcw.edu/ .  This article includes information from the Medical College of Wisconsin Department of Physical Medicine & Rehabilitation