ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Tuesday, March 5, 1996 TAG: 9603070007
SECTION: EXTRA PAGE: 3 EDITION: METRO
COLUMN: Personal Health
SOURCE: JANE BRODY
Carpal tunnel syndrome has plagued workers for more than 100 years, but not until it struck the nation's reporters and editors with a vengeance did this debilitating disorder of the wrist, hand and arm become a household word.
It is now recognized to afflict nearly 2 million workers and to cost American business an estimated $20 billion a year.
And with millions of schoolchildren growing up using computers, more and more jobs being done on computers, millions of adults using E-mail and growing numbers of people signing on to the Internet, there is a pressing need for preventive attention and simpler correctives.
Carpal tunnel syndrome began to get attention when hundreds of reporters and editors who spent almost their entire workday on a computer were suddenly afflicted.
Caused by repetitive physical stress, the syndrome, previously had been known mainly among blue-collar workers: meat cutters, construction workers, assembly-line workers, upholsterers and sewing machine operators. More recently, it has become a problem for supermarket cashiers who use scanners.
It also occurred among dental hygienists, musicians, knitters and crocheters, baseball pitchers and bank tellers. But not journalists - not, at least, when they pounded out their copy on typewriters.
The first symptoms are tingling and numbness in the fingers, which progresses to aching or shooting pains and weakness in the hand and forearm. A common early warning sign - awakening at night with numbing, tingling pains engulfing the hand and arm - is rarely recognized for what it is because it seems unrelated to the daytime stress.
The syndrome results from pressure on the median nerve where it, nine tendons and a number of blood vessels pass through a narrow tunnel in the wrist created by bones and a ligament.
Anything that causes the tissues in the tunnel to swell can compress the nerve.
It was hard at first for writers and editors to believe they could get hurt sitting at a desk and typing. Many ignored the early symptoms until it became so bad they could no longer do their jobs. Many required rehabilitation or surgery. Some had permanent damage.
But the enormous amount of attention the condition then received spawned intense medical interest and a new industry of computer ergonomics.
Physical therapists, orthopedic surgeons and ergonomics experts have wasted no time in coming up with alternatives to abandoning the computer. They start with posture. Never has sitting up straight, with good back support, been more important. Feet should be flat on the floor, elbows close to the body, forearms parallel to the ground, wrists unbent and not resting on anything and hands in a straight line with the forearm. The computer screen should be at eye level or require no more than a 15-degree downward bend of the head.
Frequent short breaks from the computer are crucial. Get up, walk around, stretch. Massage the palm side of each hand and fingers with the thumb of the other hand.
At the recent annual meeting of the American Academy of Orthopaedic Surgeons in Atlanta, Dr. Houshang Seradge of the University of Oklahoma Health Sciences Center suggested that a five-minute series of simple exercises be done at the start of each work shift and after each break. Each is done for a count of five and the series is repeated 10 times.
Start by bending the wrist and fingers upward (as if in a handstand position), then straighten the wrists and relax the fingers. Next, make a tight fist with both hands, then bend the wrists down while keeping the fists, then straighten the wrists and relax the fingers.
More general preventives include maintaining a normal body weight, getting regular exercise and avoiding sleeping with wrists flexed or with a hand under the head, which puts pressure on the median nerve.
Even surgeons now agree that conservative therapy is the best approach, with surgery reserved for the small percentage of patients who do not improve sufficiently without it. Seradge advises against any use of the injured hand in the first week to 10 days of treatment. Even ringing a doorbell, pushing a shopping cart or holding a cup delays healing.
Standard conservative treatment, which lasts at least several weeks, involves wearing a wrist brace and splint, especially at night, and taking an anti-inflammatory medication.
Some therapists also say that supplements of vitamin B6 can sometimes relieve the symptoms, particularly in women who are pregnant or taking birth control pills.
For the small percentage of patients who fail to get adequate relief from conservative treatment, more direct measures are needed. Dr. J. Lee Berger, who is affiliated with Seton Hall Graduate School of Medicine in West Orange, N.J., describes a minimally invasive procedure in which he inserts a balloon catheter through a quarter-inch incision under the ligament of the carpal tunnel. The balloon is then inflated, stretching the ligament and making more room for the nerve.
Earlier this year, Dr. Michael I. Weintraub, a neurologist from Briarcliff Manor, N.Y., described a noninvasive laser treatment to stimulate the nerve and relieve symptoms of carpal tunnel syndrome.
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