For software engineer T Ashok, it all started with a tingling sensation in the fingers. Initially, the 38-year-old Mumbaikar shrugged off the feeling as tiredness, caused from working long hours at office, and then driving home every day. But soon, the pain became impossible to ignore, forcing Ashok to see his doctor. He was then told he was developing carpal tunnel syndrome, and advised a wrist splint. After weeks of wearing it, Ashok found the tingling sensation began to diminish. "Now, I’m very careful about not spending long hours on the computer," says Ashok.
It all starts in the wrist, where there is a carpal ligament below the skin. The median nerve is beneath it and supplies the thumb, index and middle fingers with nerve supply. The ulnar nerve, located above the carpal ligament, supplies the other two fingers. Therefore, when the carpal ligament gets thickened, it presses the structure beneath it, namely the median nerve, while the ulnar nerve is spared. When only the median nerve is affected, doctors diagnose carpal tunnel syndrome.
If a patient suffers from a nerve disease, generally all the nerves get affected. However, in the case of carpal tunnel syndrome, only the median nerve is impacted. Such sufferers generally complain of a tingling sensation in the wrist and hand, numbness or a burning sensation. These are more common in the night during sleep. Patients may also find it difficult to use the thumb and index fingers to perform any tasks.
In case of mild symptoms, certain simple measures are advised. The patient’s wrist is immobilised via a wrist splint, so that they do not keep moving the wrist. This is because every time they move their wrist, the ligament kinks the nerve again and again. Sufferers are also asked to not indulge in any work that involves lots of wrist movement, such as rinsing clothes etc. They are also given vitamin D12 and nerve pain medication.
In advanced cases, where the muscles of the thumb slowly start getting wasted and the nerve is getting badly pressed, surgery is advised. This involves slitting the transverse carpal ligament so it is released and does not press the median nerve down.
People who are obese, suffer from thyroid problems and have diabetes are more prone to carpal tunnel syndrome. Also, people who make heavy use of a mouse may suffer from borderline carpal tunnel syndrome. The best way to tackle the problem is to use a wrist splint, which ensures you cannot move your wrist. Special carpal wrist splints that cover the thumb can be found at chemist shops.
One myth is that doing exercises to strengthen the wrist can help carpal tunnel syndrome sufferers. However, if you suffer from carpal tunnel syndrome, you need to relax the wrist as much as possible, and so exercise is actually counterproductive in this case.
(Inputs by Dr PP Ashok, consultant and head of neurology, Hinduja Hospital, Mumbai)
From HT Brunch, December 4
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