Don’t Lose Your Grip With Carpal Tunnel Syndrome

The next time you feel tingling or numbness in one or both of your hands, don't ignore it. Any long-term, repetitive motion task can lead to carpal tun­nel syndrome (CTS). And since nail technicians heavily rely on their hands to do their work, they are at high risk of developing CTS.

According to the American Academy of Orthopaedic Sur­geons, more than 2.18 million visits were made to physicians in office-based practices in 1996 because of CTS. Of these visits, more than 1.3 million were made to orthopedic sur­geons. CTS doesn't have to mean the end of a career in nails, however—provided the proper precautions are taken and it is detected early on.

Know the Symptoms

At the base of the palm is the carpal tunnel through which tendons and the median nerve have to pass to get into the hand. Repeated hand and wrist motions make the protective membranes around the wrist tendon thicken. As the tendons swell and thicken they start to place pressure on the carpal tunnel itself. Since the carpal tunnel is made up of bones and ligaments and is not able to stretch, it can't in­crease in size with respect to the swelling and inflammation of the tendons.

The median nerve is also the only nerve that passes through the carpal tunnel. It provides the sensation of feel­ing to the thumb, index, and middle fingers and half of the ring finger. It also controls the working of some of the thumb muscles that permit you to pinch.

At first, symptoms of CTS are slight and usually infrequent. A pins-and-needles sensation and numbness in the hand is common. These feelings usually go away, especially in the early stages of the condition. But if ignored, the sensation can ac­celerate into excruciating pain that can even keep sufferers awake at night. Grip strength, coordi­nation, and dexterity of the hands and arms diminish. In advanced stages, the impaired nerves and tendons can cause the fingers to contract to the point of re­sembling claws.

And it's not just repetitive motion that produces the problems. Slumping or hunching over a workstation puts tension on the nerves around the neck and above the collarbone, making the nerves in the hands more sensitive since there is irritation in the area above.

Another factor is the way the wrist is flexed. "There's more of a risk of devel­oping CTS when you do things with your wrist flexed," says Dr. Vincent Russo, an orthopedic surgeon based in Scottsdale, Ariz.

If left untreated, CTS can lead to ir­reversible muscle loss of those hand muscles that are involved in gripping and pinching.

Cathy Henderson, a nail technician at Mitchell Anthony Salon in Mission Viejo, Calif., is one who ignored her symptoms for too long and is now suf­fering the consequences.

Henderson began having problems in 1987. "Both of my hands started swelling and my wrists hurt," she re­members. However, she ignored the pain and it was only about three years ago that she paid more attention to the problem. By then, she'd begun working longer hours and was busier than ever, so the pain was getting worse.

After making an appointment with her doctor, he suggested surgery. But Hender­son has yet to have the procedure done because she is afraid of greater damage being done during surgery.

Her CTS has gotten so bad that Hen­derson says her hands frequently swell up and she's even lost sensation in some of her fingers. "There's always some de­gree of pain present," she says. And it doesn't help that she suffers from aller­gies, preventing her from taking med­ication that would alleviate her pain.

When Surgery Is Needed

If a doctor catches it early enough, re­lieving CTS can be as simple as getting a wrist rest and an ergonomic glove. If those don't seem to be alleviating the problem, a doctor may prescribe anti-­inflammatory medication, as was the case with Henderson.

Once you head off to the doctor, she will perform a physical examination. If additional information is needed, elec­trical studies of the nerves of the wrist may be done.

If CTS is caught too late, however, surgery may be needed to avoid perma­nent damage to the carpal tunnel itself. The surgery, also known as a carpal tun­nel release, is relatively quick. In fact, it is often done on an outpatient basis, which means patients won't spend a single night in the hospital. "It only takes about 15 minutes, and the success rate is about 95%," Dr. Russo says.

After making a small incision at the base of the palm of the hand, the doctor cuts the ligament over the carpal tunnel area to ease the pressure against the me­dian nerve. If the area in the nerve that is responsible for motor function has been damaged, the patient won't be able to recover the lost strength in that hand—another reason why prompt medical attention is important.

Dr. Russo tells patients who've had the surgery they can return to work in about three weeks, although he stresses that the healing time varies by doctor.

A second surgical approach is rela­tively new and takes advantage of fiber-optic technology. The surgery is performed using a small operating scope through two incisions. The incisions are less than a centimeter in diameter and are located in the palm and wrist area. All together, this procedure can take less than 15 minutes.

Although this procedure is less inva­sive than the traditional approach, it may not always work on patients with more advanced symptoms.

After suffering from CTS for 11 years, Simmy Bredal-Bell, a nail technician at Nails By Simmy at La Posh Salon in Clearwater, Fla., found some relief from her pain. “I just remember waking up one day with pain that had radiated all the way up to my shoulder,” she says. She went to an orthopedic surgeon, who gave her a nerve test and said she did indeed have CTS.

"He gave me a wrist brace to wear at night and encouraged me to wear it as much as possible during the day as well," she says. He also suggested surgery, which made her decide to get a second opinion.

After getting a referral from a client, Bredal-Bell made an appointment with a renowned hand and plastic surgeon.

Her doctor didn't want to do surgery right away. Bredal-Bell received an in­jection of cortisone, which provided some relief. "In the meantime, he sent me to occupational therapy, where they taught me nerve-gliding and hand-strengthening exercises," she says. "We decided to do therapy on both the right and left sides because I was having early symptoms in my right hand and arm. And I started to wear a brace on my right wrist as well."

Her CTS had turned into an irrita­tion of her ulnar nerve (more commonly known as the funny bone) and the thoracic outlet, which is a compres­sion of nerves in the arm that lead into the shoulder.

Bredal-Bell had four months of com­fortable results, and her right hand had taken to the exercises well, but her left hand was a different story. "My left hand was too far gone and it became evident that surgery was a must," she says.

In August 1998, Bredal-Bell had surgery performed on her left hand and she was back to work within two weeks. "If I were to do it all over again, howev­er, I'd take at least three weeks," she says.

Prevention Is Key

So should you rush off to the doc­tor if you think you have any CTS-re­lated symptoms? Not necessarily. Dr. Russo says that going to the doctor right away isn't always the answer be­cause many times the problem can be corrected at home.

He suggests taking frequent breaks throughout the day—especially between clients.

Henderson does take frequent breaks and also does a number of exercises to minimize her discomfort. She does heat and ice therapy that reduces the pain and inflammation with bouts of hot water and ice on the affected areas, and she also wears wrist braces regu­larly. "I wear the braces a lot at night because they keep me from clenching my hands—and bringing on more pain," she says.

At times, she says she's had to cut back on work because of her discom­fort, which unfortunately, has resulted in lost clientele.

Besides taking frequent breaks and doing exercises, it's also important to have good posture and a comfortable work area, especially when sitting at a workstation. When sitting in any chair, the back should be straight, the head up, and the wrists flat, while elbows, thighs, knees, and feet should be at a 90" angle to the bone above the joint.

"I can't emphasize enough the impor­tance of having a good armrest and a good, properly adjusted chair,” Henderson says. “Make sure you’re not too stooped in your chair, and have your client in the perfect position so that you don’t have to reach out too far to work on her hands.”

If the pain doesn’t seem to go away after taking all the proper precautions, then Dr. Russo suggests seeing a doctor to rule out other causes and explore treatment options.

Dr. Russo stresses that having CTS is not the end of a career. "You can work around it," he says. "It's the rare case that someone has to leave her occupation because of carpal tunnel syndrome."