Carpal Tunnel’s Hidden Impact

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Kuala Lumpur, June 12: Every day, we go through our daily routines without giving much thought to how repetitive motions, such as using a computer keyboard and mouse, scrolling our phone screens, occupational use of vibrating tools or even housework can actually contribute to hidden health risks that can deteriorate over time. 
These activities can lead to conditions such as carpal tunnel syndrome that can affect anyone, regardless of age. Thus, it is important to tackle its root cause so we can be more aware of how our seemingly innocent day-to-day activities can create such an impact.
The condition occurs when the median nerve, located in the carpal tunnel where a narrow passageway running from the forearm to the palm of the hand becomes compressed. Common symptoms of this syndrome include weakness when gripping objects, along with pain, numbness, or tingling sensations. While there are several contributing factors to its development, it is often triggered by the repetitive movements we regularly perform with our hands.
According to Dr Raymond Yeak Dieu Kiat, Consultant Orthopaedic, Trauma and Sports Surgeon at Sunway Medical Centre Velocity (SMCV), this epidemiological observation highlights the association between carpal tunnel syndrome and daily activities but merely scratches the surface. 
“Other factors such as joint or bone diseases, hormonal or metabolic changes and fluctuations in blood sugar levels can contribute to the development of carpal tunnel syndrome as well. Inflammatory arthritis can cause the protective sheath around multiple tendons in the wrist’s carpal tunnel to thicken which then reduces the already limited space in the carpal tunnel, putting pressure on the median nerve.  
“Moreover, diabetes itself can cause neuropathy, which means even a slight narrowing of the carpal tunnel can have a significant impact on diabetic patients, leading to symptomatic carpal tunnel syndrome,” Dr Raymond adds. 

Are women more susceptible?

While individuals who have experienced previous wrist injuries, sprains, dislocations, or inflammation are more prone to developing carpal tunnel syndrome, it is interesting to note that this condition also tends to affect women more than men – with pregnancy being a significant contributing factor. 
Dr Maria Shelynn Wong, Consultant Orthopaedic, Trauma and Paediatric Orthopaedic Surgeon at SMCV highlights that while approximately four per cent of adults in the general population are affected by carpal tunnel syndrome, the prevalence of symptoms among pregnant women is estimated between 31 per cent to 62 per cent.
“During pregnancy, every expectant mother experiences a doubling of their blood volume. As a result, the additional fluid exerts increased pressure, leading to swelling in the blood vessels throughout the body. Consequently, in confined areas like the carpal tunnel region of the wrist, this swelling can compress the median nerve, potentially resulting in carpal tunnel syndrome,” Dr Maria said. 
Fortunately, after giving birth, symptoms of carpal tunnel syndrome typically subside, as the fluid levels return to normal and alleviate the extra pressure on the blood vessels. Nonetheless, it is advisable for pregnant mothers to consult a doctor if they experience carpal tunnel-like symptoms in their hands. Seeking medical guidance allows for a better understanding and assessment of the condition, providing mothers with peace of mind during their already challenging pregnancy journey.

Trigger finger and carpal tunnel syndrome

Similarly, individuals who experience carpal tunnel syndrome may face another prevalent non-traumatic disorder known as trigger finger. Scientifically referred to as stenotic tenosynovitis of the flexor tendons, the trigger finger presents as a digit or digits that become stuck, causing pain and tightness. Dr Maria describes it as a clicking or catching sensation when opening and closing the fingers, which can be uncomfortable. 
Dr Maria highlights that one of the main causes of trigger fingers is repetitive actions such as twisting, squeezing, grasping, or forceful hand activities. Additionally, medical conditions such as diabetes and rheumatoid arthritis can potentially contribute to its development as well. Similar to carpal tunnel syndrome, pregnant women are also vulnerable to trigger fingers due to fluid retention and swelling during pregnancy. Lastly, the trigger finger is more commonly observed in older individuals and is rare in children. However, Dr Maria mentions that there is a rare condition called congenital trigger thumb that can cause locked flexion of an infant’s thumb.
Apart from the elderly, another vulnerable group prone to trigger fingers is housewives. The repetitive gripping and grasping of kitchen utensils and cleaning tools could contribute to this condition. This condition can affect anyone engaged in activities involving repetitive finger flexion and extension. This also includes activities like sewing, knitting, and hand-washing clothes.  
In addition, Dr Maria emphasises that individuals with jobs or hobbies that involve repetitive hand work, typing-intensive tasks, or prolonged gripping are also at a high risk of developing trigger fingers. Nevertheless, there are preventive measures and treatment options available.

Reducing the risk and available treatment options

To prevent the occurrence of carpal tunnel syndrome and trigger finger, Dr Raymond suggests reducing unnecessary repetitive hand motions, such as limiting leisurely use of a mobile phone and taking breaks to rest. Gentle stretching exercises during resting periods can decrease stiffness and improve the affected area’s range of motion. 
Treatment options are tailored to each individual case, the first of which is splinting and this involves using a neutral wrist splint with a metal bar that restricts wrist movement while allowing finger movement. By providing the median nerve with a break, splinting can help reduce swelling and facilitate the healing of mild to moderate nerve damage. The splint can be worn during sleep and as frequently as possible throughout the day.
Another treatment approach is through physiotherapy, which may involve exercises to improve wrist and finger range of motion and strengthen the affected area. Lastly, medication can be considered. Pain relief injections containing a combination of steroids and a local anaesthetic injected around the median nerve may benefit some patients. However, Dr Raymond stresses that prescribing steroids during pregnancy is generally avoided to prevent potential side effects.
For mothers, Dr Maria advises that they should remain vigilant about their wrist health even after giving birth. The frequent lifting of the baby and engaging in repetitive motions can potentially contribute to tendinopathies caused by overuse. Therefore, it is important to maintain awareness and take necessary precautions to prevent any strain or injury post-delivery.
In conclusion, carpal tunnel syndrome is not confined to old age or a single cause. It can affect people of all age groups and is often influenced by our daily habits. By cultivating awareness of the potential risks linked to repetitive hand movements, we can take proactive measures to prevent and effectively manage conditions such as carpal tunnel syndrome and trigger finger. By doing so, we empower ourselves to prioritise hand health and overall well-being.

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