By Kermit B. Fernander, Guardian Lifestyles Reporter

kermit@nasguard.com

What is carpal tunnel syndrome? If you have tingling, numbness or pain in your wrist, hand and all your fingers except your little finger, you may well have Carpal Tunnel Syndrome, a painful disorder of the wrist and hand.

The carpal tunnel is a narrow tunnel formed by the bones and other tissues of your wrist. This tunnel protects your median nerve — the nerve which gives you feeling in your thumb, and index, middle and ring fingers — but not the little finger. When other tissues in the carpal tunnel, such as ligaments and tendons, get swollen or inflamed, they press against the median nerve and this pressure can make part of your hand hurt or feel numb or weak, and even cause pain to radiate up your arm.

What causes carpal tunnel syndrome?

Carpal tunnel syndrome is the most well known of all the forms of repetitive strain injury (RSI), and is caused by doing the same hand movements over and over. The condition is most common in people whose jobs require pinching or gripping with the wrist held bent and these include people who use computers, carpenters, grocery checkers, assembly-line workers, meat packers, musicians

like guitarists, and mechanics. Hobbies such as gardening, needlework, golfing and canoeing can also bring on the symptoms.

Carpal tunnel syndrome is associated with other factors, as well. It may be caused by an injury to the wrist, such as a sprain or fracture. Or it may be caused by a disease such as diabetes, rheumatoid arthritis or thyroid disease — all of which are disorders that affect the body's nerves.

Carpal tunnel syndrome may also result from fluid retention during the last few months of pregnancy, or hormonal changes during the menopause. Some persons are genetically disposed to the disorder simply because they have a carpal tunnel that is particularly narrow. In some cases, however, no cause can be identified.

One study points out that "women are three times more likely than men to develop carpal tunnel syndrome, perhaps because they have small carpal tunnels. The dominant hand is usually affected first and produces the most severe pain ... Carpal Tunnel Syndrome usually occurs only in adults."

Symptoms of carpal tunnel syndrome

* Numbness or tingling in your hand and fingers especially the thumb and index and middle fingers.

* Pain in your wrist, palm or forearm.

* More numbness or pain at night than during the day since many people sleep with the wrist flexed or bent. The pain may be so bad it wakes you up and you may shake or rub your hand to obtain relief.

* More pain when you use your hand or wrist more.

* Trouble gripping objects.

* Weakness in your thumb.

How is carpal tunnel syndrome diagnosed?

After asking you about your symptoms, your doctor may examine you and ask how you use your hands. In addition your doctor may perform the following tests:

* He or she may tap the inside of your wrist, in which case you may feel pain or a sensation like an electric shock.

* Your doctor may ask you to bend your wrist down for 1 minute to see if this causes you symptoms.

* Your doctor may order a nerve conduction test or an electromyography (EMG) test to see whether the nerves and muscles in your arm and hand show the typical effects of carpal tunnel syndrome.

How is carpal tunnel syndrome treated?

If caused by a medical problem like diabetes or rheumatoid arthritis, your doctor will probably first treat that problem. You may have to wear a splint to rest your wrist. The splint keeps your wrist from moving and can help ease the pain, especially at night. Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen may ease symptoms associated with conditions like arthritis. Diuretics or "water pills" will decrease swelling; corticosteroids like prednisone can be taken by mouth and the drug lidocaine (or cortisone) can be injected directly into the wrist.

If symptoms last for six months, surgery may be considered and involves cutting the band of tissue around the wrist to reduce pressure on the median nerve.

Surgery is done under local anesthesia and does not require an overnight hospital stay. You'll usually get back the normal use of your wrist and hand within a few weeks to a few months after surgery. Following surgery, it's very important to practice the wrist and finger exercises prescribed by your doctor. Without exercise, your wrist may get stiff and you may lose some use of your hand.

How can carpal tunnel syndrome be prevented?

* Give your hands and wrists a break every 15 to 20 minutes by gently stretching and bending them. If you use equipment that vibrates or requires you to exert a great amount of force, taking breaks is even more important.

* Avoid bending your wrist all the way up or down. If you use a keyboard, keep it at elbow height or slightly lower. It's also advisable to adjust the height of your chair so that your forearms are level with your keyboard and you don't have to flex your wrists to type.

* Since you're more likely to develop hand pain and stiffness if you work in a cold environment, you may find it helpful to wear fingerless gloves that keep your hands and wrists warm.