Emma (not her real name) came to see me this week. She had pain in her hands and forearms which she described as an aching type of pain that started in the wrists, and spread to the hands or up into her arms. She also gets numbness, tingling in her fingers and weakness in her grip. All of this is worse after a long practice session with her instrument.
As I examined her, I asked her to press the backs of her hands together with her fingers pointing down, dropping her elbows so her wrists were at right angles. After a few minutes of this, her fingers were tingling. The reason for this will become clear as you read.
Emma has carpal tunnel syndrome, which is a common condition. You don’t have to be a musician to get it — anyone who uses their hands a lot can suffer. Students with smartphones and keyboards, tennis players, assembly line workers, and the like are all at risk. My favorite barista struggled with carpal tunnel from pulling espresso shots, back in the days when making espresso was an art.
Because I like words, I researched the word origin of “carpal,” hoping to find that it was related to “carpe diem” or at least to “carp,” but to my disappointment, “carpal” comes from the Greek “karpos,” which means, simply, “wrist.” No seizing the day with a fish. “Tunnel” is a bit more interesting, being related to an old French word for a liquids cask.
The carpal tunnel is a passageway in the wrist. Turn your hand so the palm is facing up. Now wiggle your fingers. You might be surprised to learn that most of the muscles you are using to do this are actually in your forearm. The tendons that attach those muscles to the finger bones run from the main part of the muscle in the forearm, through the wrist, and into the hand. There are nine of them. If you put your other hand around your forearm about two thirds of the way up, you can feel those muscles working as you wiggle your fingers.
There are eight little bones in your wrist between the long bones of the arm and the long bones of the fingers. These bones, which allow the wrist to move around in all directions, are scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate and hamate. Yes, there is going to be a test. Just kidding. I only told you those because I thought you’d enjoy the mnemonic we used in medical school to remember these eight bones: “Someone Lowered Tilly’s Pants: Twins Today Came Home!” Another is “Scared Lovers Try Positions That They Can’t Handle.”
Aside from nine tendons and eight little bones, the wrist also contains blood vessels and nerves. The radial artery, where you feel your pulse, goes through there, as does a key nerve called the median nerve. This big fellow is what flexes those wiggling fingers. It also brings sensation to much of your hand, especially on the thumb side. Holding it all together is the transverse carpal ligament. This is a thin but very tough band of tissue that stretches across the palm side of the wrist from the end of one of your long arm bones to the end of the other.
All the stuff in there leaves little room for anything else. Repetitive movement of the fingers, hands and wrists can cause swelling of the tendons within the carpal tunnel. With no room to spare, and tunnel walls too tough to expand, the swelling causes pressure on the median nerve. Nerves under pressure cause pain, tingling and numbness.
When Emma bent her wrists into 90-degree flexion, that squashed her carpal tunnel and put sudden pressure on her median nerve, bringing on her symptoms. This test is not foolproof, but it is helpful. Other tests that might be done include x-rays and nerve conduction studies.
The main treatment for carpal tunnel syndrome is to rest the joint. This is accomplished by wearing a brace on the affected wrist or wrists. The brace holds the wrist in a straight position that minimizes pressure on the carpal tunnel and immobilizes the wrist so the swelling can go down. The brace is initially worn only at night. You can also rub an ice cube on the area for five or 10 minutes three times a day. Anti-inflammatory medication might help as well, but don’t overdo; I don’t recommend more than a week of ibuprofen at a time. Some people have found acupuncture or specialized neuromuscular therapy helpful.
If these conservative measures don’t work, sometimes a steroid injection into the area can help reduce the swelling. In severe cases, surgery may be performed. The surgeons make a cut in the transverse carpal ligament to open up the tight tunnel and provide more room for all the structures passing through.
To prevent carpal tunnel syndrome, minimize repetitive wrist motions if possible. Use proper tools for the job you are doing.
Optimize your wrist position while you work on a keyboard. Don’t let your wrists be bent backward or rest on anything while you work. Get a split keyboard or a keyboard tray if need be. If you get pain or tingling, stop and take a break. If it doesn’t get better, come see us at SHAC. Call (505) 277-3136 for an appointment.
Peggy Spencer is a student-health physician. She is also the co-author of the book “50 ways to leave your 40s.” Email your questions directly to her at firstname.lastname@example.org. All questions will be considered anonymous, and all questioners will remain anonymous.