Conquering Carpal Tunnel Syndrome

For many people, the onset of carpal tunnel syndrome (CTS) has meant constant hand pain and reduced range of motion. Numbness and tingling in the thumb, index, and middle fingers, dropping things because of sharp pain in the wrist associated with gripping something tightly, and easily fatigued hands and arms are symptoms of carpal tunnel syndrome.

Unfortunately, nail technicians are in a profession that’s at high risk for developing CTS. This disorder can mean costly (and not always successful) surgery and can eventually cost a nail technician her career. For those who have yet to develop CTS, there is hope of never having to suffer from this disorder through exercises designed especially for CTS prevention. Nail technicians who are just developing carpal tunnel syndrome can do these exercises as well.

To learn more about these exercises, NAILS spoke with Dena Slonaker, O.T.R., M.S. Ed., C.H.T., a registered occupational therapist, certified hand rehabilitation specialist, and hand therapy program development coordinator at HealthSouth Rehabilitation Center in Van Nuys, Calif. Slonaker explains that CTS develops when tight muscles have to do more work than they can endure. “A person can use a muscle to do work for two minutes with no problem, but at two minutes 15 seconds, she may feel fatigue. This is the body telling her to slow down, that the muscle needs to catch up. If you are running, your body breathes faster to catch up. The fatigue you feel in your muscles is your body trying to catch up, but it can’t. If you keep going, it will create friction at either the muscle or the tendon. This will cause inflammation, which in turn will cause swelling. The swelling then compresses the nerves, which is what causes carpal tunnel syndrome,” says Slonaker.

The accompanying stretching exercises can be done between clients, or while your client selects a polish color or washes her hands. Remember a few important points when stretching:
• You don’t want to create pain, so stretch slowly and gently. You are preparing your muscles for work just as an athlete prepares before an event, and an athlete can’t perform well when in pain.
• Hold the end position of each stretch for 6-8 seconds.
• If a particular muscle feels tight, do three small stretches at the end of the motion, then proceed to your next exercise.
• Do these exercises one after another in sequence. It will take you 1-3 minutes to do them all, depending on how long you hold each stretch.
• In time you will find the areas of your body that are tighter than others, and you can spend more time stretching them out.

These exercises should be done before you begin work, says Slonaker, and during work when you feel your tissues need it. Fatigue and tightness in tissues and tendons mean some stretching exercises are in order. If you believe you have some symptoms of carpal tunnel syndrome, see your doctor. She may in turn refer you to an orthopedist for further treatment.

Exercise 1: Stretch the Arm Flexors
1. Sit with your arms at your sides, right elbow bent, and your right palm facing down. Use your left hand to pull the right hand back.
2. With the hand pulled back, straighten your elbow.
3. Sit with your arms at your sides, right elbow bent, and right palm facing up. Use your left hand to bend the right wrist down so fingers point to the floor.
4. With the fingers pointing down, straighten your right elbow.
5. Keep your right elbow straight, your palm facing up, fingers pointing to the floor, and reach behind you.
6. Repeat steps 1-5 for the other arm.

Exercise 2: Stretch the Arm Extensors
1. Sit with your arms at your sides, right elbow bent, and your right palm facing down. Bend the right hand toward the floor.
2. With the hand bent down, straighten your elbow.
3. With the hand bent down and your elbow straight, twist your hand toward the little finger.
4. Hold that position and swing your arm behind you, like you are swimming the butterfly stroke.
5. Repeat steps 1-4 for the other arm.

 Exercise 3: Stretch Both Shoulders
1. With your arms relaxed at your sides, bring your shoulders up to your ears. Hold for 6-8 seconds, then relax.
2. Pinch your shoulder blades together in back. Hold for 6-8 seconds, then relax.
3. Reach with your hands down toward the floor without moving your shoulders forward or backward. This is a very subtle motion but it is good for stretching shoulder and neck muscles.
4. Roll shoulders forward, rounding your upper back.
 4a. With shoulders rolled forward, clasp hands and pull arms forward even more.
 4b. Clasp hands behind your back and pull them down and back.
5. Sitting upright, tuck your chin inward and bring your head straight back (like making a double chin). Then roll your head down to your chest.

Exercise 4: Stretch the Shoulders and Neck, One Side at a Time
1. Reach to touch the shoulder on the same side of your body. Place your other hand on your elbow to push your arm straight back and up.
2. Reach to the opposite shoulder, crossing your arm in front of your body. Use your other hand on the elbow to push your arm farther across your body.
3. Reach to the opposite shoulder, crossing behind your head. Use your other hand to either push on the elbow or pull on the hand to extend the arm farther across your body.
4. Fix the same arm behind your back, keeping your shoulder down. Turn your head to the opposite side, keeping your head up straight. Use the hand that is not sixed to help twist your head slightly more. Push on your cheek, not your jaw.
5. With your head turned to the side, look up and over your shoulder.
6. With your head still turned to the side, look down, tucking your chin in front of your shoulder.
7. Tilt your head sideways to the opposite side and bring your ear toward the shoulder. Use the unfixed hand on the top of your head to help tilt the head more.
8. Reach one hand over your shoulder and the other hand behind your back. Try to touch your hands together in back. You can use towel stretched between your hands to pull up or down to stretch.
9. Repeat steps 1-8 for your other shoulder and the other side of your neck.

Exercise 5: Stretch the Tendons in Your Hand
Tendon gliding exercises are good to alleviate or prevent tendon adhesion. Overused or damaged tendons become inflamed and the body tries to repair them by laying down scar tissue along the tendon. In time, the scar tissue can become fibrous with repeated inflammation. You can do these exercises in a short amount of time.
1. Start with your fingers spread and straightened.
2. Make a hook fist by bending your fingers at the first knuckle so they double back on themselves without touching your palm.
3.  Spread and straighten your fingers again.
4. Make a straight fist by bending your fingers at the first knuckle but keeping the rest of the finger straight. The pads of your fingers shoud touch your palm.
5. Spread and straighten your fingers again.
6. Make a full fist by bending your fingers completely. Your nails should be inside the fist.
7. Spread and straighten your fingers again.
8. Make what is called an intrinsic motion with your hand by making the back of your hand vertical and your fingers horizontal. This exercise is to help the intrinsic muscles and their tendons in your hand glide with the rest between the long bones of the hand.