Carpal Tunnel Syndrome: What is it and how do you treat it?

Anatomy of the hand

article reprint from FamilyDoctor.org

What is carpal tunnel syndrome?

Carpal tunnel syndrome is 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 median nerve helps you move your thumbs and the first 3 fingers on each hand.

Carpal tunnel syndrome occurs when other tissues in the carpal tunnel (such as ligaments and tendons) get swollen or inflamed and press against the median nerve. That pressure can make part of your hand hurt or feel numb.

What causes carpal tunnel syndrome?

Doing the same hand movements over and over can lead to carpal tunnel syndrome. It’s most common in people whose jobs require pinching or gripping with the wrist held bent. People at risk include people who use computers, carpenters, grocery checkers, assembly-line workers, meat packers, musicians and mechanics. Hobbies such as gardening, needlework, golfing and canoeing can sometimes bring on the symptoms.

Women are more likely to develop carpal tunnel syndrome than men. It also tends to be hereditary (which means it runs in families).

Carpal tunnel syndrome may also be caused by an injury to the wrist, such as a fracture. Or it may be caused by a disease such as diabetes, rheumatoid arthritis or thyroid disease. Carpal tunnel syndrome is also common during the last few months of pregnancy.

Symptoms of carpal tunnel syndrome

  • Numbness or tingling in your hand and fingers, especially the thumb, index and middle fingers.
  • Pain in your wrist, palm or forearm.
  • More numbness or pain at night than during the day. The pain may be so bad it wakes you up. You may shake or rub your hand to get relief.
  • Pain that increases when you use your hand or wrist more.
  • Trouble gripping objects, such as a doorknob or the steering wheel of a car.
  • Weakness in your thumb.

How is carpal tunnel syndrome diagnosed?

Your doctor will probably ask you about your symptoms. He or she may examine you and ask you how you use your hands. Your doctor may also do these tests:

  • Your doctor may tap the inside of your wrist. You may feel pain or a sensation that feels like an electric shock.
  • Your doctor may ask you to bend your wrist down for 1 minute to see if this causes symptoms.
  • Your doctor may have you get 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 serious is carpal tunnel syndrome?

Carpal tunnel syndrome usually isn’t serious. With treatment, the pain will usually go away and you’ll have no lasting damage to your hand or wrist.

How is carpal tunnel syndrome treated?

If carpal tunnel syndrome is caused by a medical problem (such as rheumatoid arthritis), your doctor will probably treat that problem first.

Your doctor may ask you to rest your wrist or change how you use your hand. He or she may also ask you to wear a splint on your wrist. The splint keeps your wrist from moving but lets your hand do most of what it normally does. A splint can help ease the pain of carpal tunnel syndrome, especially at night.

Putting ice on your wrist to reduce swelling, massaging the area and doing stretching exercises may also help. An over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve swelling and pain. These medicines include aspirin, ibuprofen (brand names: Motrin, Advil) and naproxen (brand name: Aleve). In more severe cases, your doctor might inject your wrist with a corticosteroid, which reduces inflammation and pain.

Tips on relieving carpal tunnel syndrome

  • Prop up your arm with pillows when you lie down.
  • Avoid overusing the affected hand.
  • Find a new way to use your hand by using a different tool.
  • Try to use the unaffected hand more often.
  • Avoid holding your wrists in a downward bent position for long periods of time.

What if these treatments don’t help?

In some cases, surgery is needed to make the symptoms go away completely. The surgery involves cutting the ligament that may be pressing on your median nerve. You’ll usually get back the normal use of your wrist and hand within a few weeks to a few months after surgery.

Doing the hand, wrist and finger exercises that your doctor tells you to do after surgery is very important. Without exercise, your wrist may get stiff and you may lose some use of your hand.

Can I prevent carpal tunnel syndrome?

Yes. See the box below for some tips on preventing carpal tunnel syndrome.

Many products you can buy — such as wrist rests — are supposed to ease symptoms of carpal tunnel syndrome. No one has proven that these products really prevent wrist problems. Some people may have less pain and numbness after using these products, but other people may have increased pain and numbness.

Things that may help prevent carpal tunnel syndrome

Lose weight if you’re overweight.

Get treatment for any disease you have that may cause carpal tunnel syndrome.

If you do the same tasks over and over with your hands, try not to bend, extend or twist your hands for long periods of time.

Don’t work with your arms too close or too far from your body.Don’t rest your wrists on hard surfaces for long periods of time. Switch hands during work tasks.

Make sure the tools you use aren’t too big for your hands.Take regular breaks from repeated hand movements to give your hands and wrists time to rest.Don’t sit or stand in the same position all day.

If you use a keyboard a lot, 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.

Walking: Trim your waistline and improve your health!

Walking is a low-impact exercise with numerous health benefits. Here’s how to get started.

By Mayo Clinic staff

Walking is a gentle, low-impact exercise that can ease you into a higher level of fitness and health. Walking is a form of exercise accessible to just about everybody. It’s safe, simple and doesn’t require practice. And the health benefits are many. Here’s more about why walking is good for you, and how to get started with a walking program.

Benefits of walking

Walking, like other exercise, can help you achieve a number of important health benefits. Walking can help you:

  • Lower low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol)
  • Raise high-density lipoprotein (HDL) cholesterol (the “good” cholesterol)
  • Lower your blood pressure
  • Reduce your risk of or manage type 2 diabetes
  • Manage your weight
  • Improve your mood
  • Stay strong and fit

All it takes to reap these benefits is a routine of brisk walking. It doesn’t get much simpler than that. And you can forget the “no pain, no gain” talk. Research shows that regular, brisk walking can reduce the risk of heart attack by the same amount as more vigorous exercise, such as jogging.

Click here for the complete Mayo Clinic article

.

After finishing the article you can click on the video below to learn about “Power Walking.”

Weight control: What the research says

Weight Control – Mayo Clinic nutritionists

Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D.


Anyone who has begun or is on a weight loss journey knows that weight control — losing weight and keeping it off — can be a daily challenge. Weight control is a complex. It’s about living a healthy lifestyle and making smart choices, despite the many hurdles life throws at you, whether they’re physical, emotional or social.

It’s easy to feel overwhelmed when you’re looking for advice on weight control. Every week a new diet appears on bookshelves, magazine racks or online. Even when you go to the scientific and medical journals, there’s debate about which diet is best for weight control. Teasing out all the variables can frustrate even the most dedicated researcher. So I thought I’d cut to the chase and offer some practical advice on weight control.

The bottom line really is that you must control calories through portion control, appropriate food choices and physical activity. However, there are few weight control tricks that can be culled from the diet research:

  • Eat some protein. Protein is cited as the most satiating nutrient. No need to overdo it, but include 1 to 3 ounces (28 to 85 grams) of a protein-rich food at meals. Protein, beyond its basic function of building and repair, moderates the rise of blood glucose. This steadies your hunger and energy levels.
  • Go low on the glycemic index. Foods with a low glycemic index — most fruits, veggies and whole grains — are part of any healthy diet. They contain fiber and water that give them bulk without the calories, making them filling foods. These properties also play a positive role in your body’s metabolism and insulin response.
  • Choose the right carbs. Carbs are packed with nutrients that are essential to feeling good each day, and they likely play a strong role in disease prevention. Most of your choices here should be whole foods or as close to it as possible.
  • Be selective about fats. Fat plays a key role in our health. Fat also aids hunger control because it is slowly digested. Moderating the amount you eat will reduce your calories. Choosing healthier fats — nuts, oils and avocado, for instance — instead of saturated fats can improve your heart health and may have a role preserving good mental and physical health.

Study ties blood protein ApoE to Alzheimer’s brain abnormalities

In NIH-supported Alzheimer’s study, blood test in symptom-free volunteers links levels of specific protein with beta amyloid deposits

Scientists are seeking ways to detect the earliest stages of Alzheimer’s disease, since harmful changes may be taking place in the brain years before symptoms appear. Now, researchers report that a blood test detecting a specific protein in blood samples from cognitively normal older people may reflect the levels of beta-amyloid protein in the brain — a hallmark of the disease. Supported in part by the National Institutes of Health, the findings may eventually lead to a blood test that helps predict risk for Alzheimer’s disease and who may be a good candidate for participating in clinical trials.

Madhav Thambisetty, M.D., Ph.D., of the Intramural Research Program at the National Institute on Aging (NIA), part of the NIH, was the lead author on the study with collaborators from the Institute of Psychiatry at King’s College, London, and the Department of Radiology at Johns Hopkins University, Baltimore. The study appears in the Dec. 20, 2010, issue of the Journal of Alzheimer’s Disease.

“Recent advances in imaging and biomarkers that help track the onset and progression of Alzheimer’s disease show promise for early detection of the disease process, and for tracking the effectiveness of early interventions,” said NIA Director Richard J. Hodes, M.D. “This is critically important in streamlining and conducting trials more efficiently so that we can find out about possible therapies that much sooner.”

Using proteomics technology, a method of studying hundreds of proteins from a small blood sample, the researchers analyzed blood samples of 57 older and symptom-free volunteers to determine whether specific proteins were associated with amyloid burden in the brain. They measured brain amyloid using PET (positron emission tomography) scans with Pittsburgh Compound B, a tracer that binds to amyloid plaques. The volunteers are participating in the NIA’s Baltimore Longitudinal Study of Aging (BLSA), America’s longest-running scientific study of human aging.

The researchers found the amount of a specific protein called apolipoprotein E, or ApoE, in the blood samples was strongly associated with the level of beta amyloid in the brain. Those with high blood levels of the protein had significantly greater deposits of amyloid in the medial temporal lobe, the region of the brain important to memory function.

“These results are especially intriguing as this protein is made by the APOE gene, the most robust genetic risk factor for late-onset Alzheimer’s,” Thambisetty said. Late-onset Alzheimer’s is the most common form of the disease and occurs around age 65 or later.

He now plans to test these findings in serial blood samples collected every year in BLSA volunteers to determine how changing blood levels of ApoE protein may relate to pathological changes in the brain over time.

“If the results are equally positive, we may be able to develop a blood test that provides a less invasive, inexpensive method that helps to detect the early pathological changes of Alzheimer’s disease,” he said.

The NIA leads the federal government effort conducting and supporting research on aging and the health and well being of older people. For more on health and on aging generally, go to www.nia.nih.gov. The NIA provides information on age-related cognitive change and neurodegenerative disease specifically at its Alzheimer’s Disease Education and Referral (ADEAR) Center at www.nia.nih.gov/Alzheimers. To sign up for e-mail alerts about new findings or publications, please visit either website. To learn more about the BLSA, go to http://www.grc.nia.nih.gov/branches/blsa/blsanew.htm.

Obesity patients are not victims

by David Gratzer, MD

Call it the McVictim syndrome. Too many pundits, public health experts and politicians are working overtime to find scapegoats for America’s obesity epidemic.

In his latest book, former FDA Commissioner David A. Kessler argues that modern food is addictive. In it, he recounts how he was once helpless to stop himself from eating a cookie. In a paper in this month’s Journal of Health Economics, University of Illinois researchers join a long list of analysts who blame urban sprawl for obesity. In November, former Carter administration advisor Amitai Etzioni argued that it’s so hard for Americans to keep weight off that adults should simply give up and focus attention on the young instead.

The peak of the trend: A recently released Ohio study, using mice, suggests “fine-particulate air pollution” could be causing a rise in obesity rates.

How long before we’re told that the devil made us eat it?

The McVictim syndrome spins a convenient — and unhealthy — narrative on America’s emerging preventable disease crisis. McVictimization teaches Americans to think that obesity is someone else’s fault — and therefore, someone else’s problem to solve.

The truth: In the vast majority of cases, obesity is a preventable condition. So those of us in the medical community must be candid with overweight patients about the risks they face and the rewards of better health choices. But it’s also time for American policymakers to show the same level of candor.

All things being equal, the simplest explanation is often the right one. And the simplest explanation for the dramatic rise in obesity rates — roughly doubling as a percentage of the total population in just a quarter-century — is the surge in our daily caloric intake. Excess food now, excess weight later. And Americans won’t make better choices if the McVictim syndrome provides a convenient excuse to carry on as before.

Obesity is preventable, but its consequences seem difficult to avoid. Consider that the cost of treating resulting conditions such as diabetes is about 7% of all U.S. healthcare spending — and a significant drain on federal and state budgets. Obesity is a national security threat because it severely limits the pool of military recruits; in 2009, the Pentagon indicated that since 2005, 48,000 potential troops had flunked their basic physical exams because they weighed too much. Most important, obesity is a human threat, destroying otherwise healthy lives and increasing personal health costs, all for the sake of a few daily moments of instant gratification.

For these reasons, there is a role for government to play in attacking obesity. Public policy can help. School lunch programs shouldn’t push our children toward obesity at taxpayers’ expense. We should stop subsidizing agribusinesses; many are using taxpayer dollars to produce and market unhealthful foods. We should promote insurance reforms that support preventive medicine.

But we must also launch a direct attack on the philosophy behind the McVictim syndrome. Policymakers must accept the fact that a poor diet is almost always a poor personal choice.

Yes, it’s fair to say that many Americans try to choose better — and fail because they’ve chosen quack drugs or crash diets as the solution. Yes, it’s fair to say that losing weight solely for appearance’s sake isn’t a healthful choice. Yes, it’s fair to say we shouldn’t crush the self-esteem of those who’ve tried, and failed, to keep off excess weight. In other words, our society makes healthful choices tougher.

But even so, encouraging Americans to cut their dietary health risks is a responsible act of citizenship. And it’s absurd to pretend that Americans are helpless to make that choice — or that it’s too late for them to reap the benefits. Contrary to claims like Etzioni’s, even a modest, voluntary improvement in the average American diet could pay huge dividends.

Just as a little more weight causes more damage over time (to joints, to cardiovascular systems, to organs), a little less weight can produce dramatic health benefits. To take one example, a study cited in the Journal of the American College of Cardiology found that obese patients on a program of mild weight loss and modest exercise cut their odds of getting diabetes by as much as 60%. Imagine the benefits that would flow from keeping millions of future Medicare recipients from ever needing an insulin prescription.

The McVictim syndrome is far too prevalent, which promotes the notion that regulations and laws are the primary solution to the problem. But governments can’t micromanage your waistline for you. Even if governments could magically walk you to work, ban food advertising, regulate sugar out of food and suck those fat particles out of the air, in a free society you would still have the power to drive to the nearest restaurant, shake your salt shaker and order a second piece of pie.

That’s why understanding — and rejecting — the McVictim culture is crucial to obesity reduction policy. And the first step in that process is to reject the temptation to find an easy scapegoat.

David Gratzer is a physician and senior fellow at the Manhattan Institute. He is author of The Cure: How Capitalism Can Save American Health Care.

Cholera in Haiti Outbreak

Cholera in Haiti
Cholera in Haiti - news.nationalpost image

An epidemic cholera strain has been confirmed in Haiti, causing the first cholera outbreak in Haiti in many years. Cholera is a potentially fatal bacterial infection that causes severe diarrhea and dehydration.

The disease is most often spread through the ingestion of contaminated food or drinking water. Water may be contaminated by the feces of an infected person or by untreated sewage. Food is often contaminated by water containing cholera bacteria or because it was handled by a person ill with cholera.

The majority of cases have been reported in the Artibonite Departmente, approximately 50 miles north of Port-au-Prince. Affected hospitals are being strained by the large number of people who are ill.

This outbreak is of particular concern given the current conditions in Haiti, including poor water and sanitation, a strained public health infrastructure, and large numbers of people displaced by the January earthquake and more recent flooding.

The World Health Organization, along with a number of international agencies, is mobilizing to assist local and national response efforts.

Advice for Travelers


At this time, CDC and the U.S. Department of State maintain travel warnings for Haiti. These warnings recommend that U.S. citizens avoid all nonessential travel to Haiti. For more information, see Travel Health Warning: Major Earthquake in Port-au-Prince, Haiti on the CDC website.

Most travelers are not at high risk for getting cholera, but people who are traveling to Haiti should still take their own supplies to help prevent the disease and to treat it. Items to pack include

  • A prescription antibiotic to take in case of travelers’ diarrhea
  • Water purification tablets*
  • Oral rehydration salts*

*In the United States, these products can be purchased at stores that sell equipment for camping or other outdoor activities.

Although no cholera vaccine is available in the United States, travelers can prevent cholera by following these 5 basic steps:

1) Drink and use safe water*

  • Bottled water with unbroken seals and canned/bottled carbonated beverages are safe to drink and use.
  • Use safe water to brush your teeth, wash and prepare food, and make ice.
  • Clean food preparation areas and kitchenware with soap and safe water and let dry completely before reuse.

*Piped water sources, drinks sold in cups or bags, or ice may not be safe. All drinking water and water used to make ice should be boiled or treated with chlorine.

To be sure water is safe to drink and use:

  • Boil it or treat it with water purification tablets, a chlorine product or household bleach.
  • Bring your water to a complete boil for at least 1 minute.
  • To treat your water, use water purification tablets, if you brought some with you from the United States, or one of the locally available treatment products, and follow the instructions.
  • If a chlorine treatment product is not available, you can treat your water with household bleach. Add 8 drops of household bleach for every 1 gallon of water (or 2 drops of household bleach for every 1 liter of water) and wait 30 minutes before drinking
  • Always store your treated water in a clean, covered container.

2) Wash your hands often with soap and safe water*

  • Before you eat or prepare food
  • Before feeding your children
  • After using the latrine or toilet
  • After cleaning your child’s bottom
  • After taking care of someone ill with diarrhea

* If no soap is available, scrub hands often with ash or sand and rinse with safe water.

3) Use latrines or bury your feces (poop); do not defecate in any body of water

  • Use latrines or other sanitation systems, like chemical toilets, to dispose of feces.
  • Wash hands with soap and safe water after using toilets or latrines.
  • Clean latrines and surfaces contaminated with feces using a solution of 1 part household bleach to 9 parts water.

What if I don’t have a latrine or chemical toilet?

  • Defecate at least 30 meters away from any body of water and then bury your feces.
  • Dispose of plastic bags containing feces in latrines, at collection points if available, or bury it in the ground. Do not put plastic bags in chemical toilets.
  • Dig new latrines or temporary pit toilets at least a half-meter deep and at least 30 meters away from any body of water.

4) Cook food well (especially seafood), keep it covered, eat it hot, and peel fruits and vegetables*

  • Boil it, cook it, peel it, or leave it
  • Be sure to cook shellfish (like crabs and crayfish) until they are very hot all the way through.
  • Do not bring perishable seafood back to the United States.

* Avoid raw foods other than fruits and vegetables you have peeled yourself.

5) Clean up safely—in the kitchen and in places where the family bathes and washes clothes

  • Wash yourself, your children, diapers, and clothes at least 30 meters away from drinking water sources.

Before departing for Haiti, talk to your doctor about getting a prescription for an antibiotic to treat travelers’ diarrhea. If you are traveling in Haiti and have severe watery diarrhea, seek medical care right away. Remember to drink fluids and use oral rehydration salts (ORS) to prevent dehydration.

Medical care facilities are strained with the high number of people who are ill. If you will be traveling to Haiti, CDC recommends that you purchase medical evacuation insurance in the event that you become ill while in Haiti. (See the U.S. Department of State list of U.S.-Based Air Ambulance or Medical Evacuation Companies.) If you are in Haiti and need medical care and you do not have access to medical evacuation, you can contact the Embassy of the United States in Port-au-Prince, Haiti, (American Citizens Services Unit office hours are 7:00 a.m. to 3:30 p.m., Monday through Friday. The Consular Section is closed on U.S. and local holidays.):

Boulevard du 15 October, Tabarre 41, Tabarre, Haiti
Telephone: (509) (2) 229-8000
Facsimile: (509) (2) 229-8027
Email: acspap@state.gov

Advice about Cholera for Travelers Arriving in the U.S. from Haiti

Five Basic Cholera Prevention Messages

Info for Healthcare Professionals

Acute Watery Diarrhea & Cholera: Pre-decision Brief

Cholera Outbreak in Haiti

General Cholera Info

Haiti Earthquake and Travel