Tuesday, November 13, 2012

A New Cause of Carpal Tunnel Syndrome

     Yesterday I saw a patient, Ms. B., age twenty-seven, with carpal tunnel syndrome.  She wanted a referral for surgery.
     You know the symptoms:  numbness and tingling over the palm of the hand, worse at bedtime; weakness, especially when picking up small things. 
     Carpal tunnel syndrome was first recognized as a medical problem when factories multipled during the Industrial Revolution, employing lots of workers to do repetitive jobs with their hands on assembly lines.  The snapping motion of the wrist being flexed and extended causes tissues to swell where the forearm and wrist meet, clamping down on a tunnel through which the median nerve passes.  The median nerve supplies sensation to the palm, thumb and two and a half fingers, and innervates some of the muscles as well.
     When I first opened a clinic in Hawthorne there was a sewing factory in town, and many of the workers came to me with carpal tunnel syndrome.  Georgia Pacific had a timber mill there, too, and some of the workers had the same symptoms.  These days I diagnosis it more often in patients who make a living at the computer.
     Tapping her wrist over the median nerve--known as Tinel's sign--caused a tingling, electric sensation across the hillock of muscle at the base of her thumb.  Putting the backs of her hands together for a minute, knuckles over knuckles--known as Phalen's test-- made her hands numb.  These confirmed her diagnosis.
     Ms. B. didn't have a job, and wasn't a computer junkie.
     Her problem was too much texting.
     "Show me how you use your phone to text," I requested.
     She picked up the iPhone with her non-dominant right hand and began texting singlehandedly, rotating her wrist repeatedly in order to reach various places on the keyboard.  She was really fast.
     "Whoa!" I said.  "You're pretty skillful there.  How much time do you spend texting each day?"
     "I text all day long," she said, sort of proudly.   
     She was an expert at the keyboard.  In fact, the text she was sending to a friend, as an example for me, was several paragraphs long, and took only a minute or so to create.
     I began to realize that texting, and being texted to, must mean people really care about one another.  It's proof of love, I guess.  It's a way of saying, all day, "I'm here! I'm here!  Can you hear me?" and getting messages back from the huge, dark, empty-looking universe--from other life-forms who are somewhat like us.  It's an appeasement of loneliness.  But there are downsides to this.form of self-comfort.
     Lesson:  Excessive iPhone texting can lead to carpal tunnel syndrome.
     I taught Ms. B. how to do stretches to distend the carpal space and release compression on the nerve it allows to pass through.  She experienced immediate relief of the pain. 
     I gave her a wrist-forearm splint to use at night, when reversion to the fetal position puts the human hand in the worst possible configuration for those who suffer with this form of neuropathy.  The splint will prevent her from folding her wrists down.
     Then, to reverse the condition and stop her symptoms, I suggested a carpal tunnel corticosteroid shot.  It's a simple treatment, usually painless, and side-effect free.  One study showed that it was superior to surgery--more patients who under go surgery have recurrence of the problem than those who get a shot.
     Any patient who will agree to have a needle stuck into her wrist must be suffering a lot.
     Ms. B. said, "Go get the shot, please."
     So I measured the medication into a syringe, sterilized the skin over Ms. B.'s wrist with Povidone-iodine and alcohol, asked a nurse to freeze-anesthetize the area using ethyl choloride spray, and deposited the medication straight into the carpal tunnel. 
     Ms. B., didn't even flinch.
     I don't think she'll need that referral to a surgeon. 
     But I did tell her to stop texting so much. 
     Fat chance.


  1. Hello,
    In the human body, the carpal tunnel or carpal canal is the passageway on the palmar side of the wrist that connects the forearm to the middle compartment of the deep plane of the palm.
    acupuncture in sacramento

  2. You might be eligible for a complimentary Apple iPhone 7.