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Ada Byron King (1815 to 1852) has the dubious distinction of being the first programmer. Daughter of the tormented Lord Byron, Ada, like her poetic papa, exhibited some peculiar leanings, but among her more prosaic pursuits was a love of mathematics. When her professor Charles Babbage designed the first punch card-controlled machine for doing calculations, Ada wrote the instructions for his famed “analytical engine.” Although history does not record it, she was probably also the first IT unfortunate to suffer from carpal tunnel syndrome.

Carpal tunnel and related pain or numbness in the hand, forearm, shoulders, neck, head, and back is caused by repetitive motion. In medical literature, these symptoms are bundled under categories of complaints described by various sober-sounding, billable euphemisms such as Cumulative Trauma Disorder (CTD) or Repetitive Strain Injury (RSI). If you are a sufferer, you are not alone. A study of Harvard students revealed that nearly one-third sought assistance from the Student Disability Resource Center for symptoms of CTD. A great many more, we can assume, suffered in silence. Over at MIT, 80 percent of the staff at the brain and cognitive science lab complained of CTD.

Odds are, if you spend enough time in front of a computer screen, ergonomic doodads notwithstanding, you will eventually exhibit symptoms. Naturally, people with carpal tunnel find that their workplace productivity suffers: Pain not only makes it difficult to concentrate but also provides a loud disincentive for repeating the motions that are its source. For many, however, even off-work hours provide little relief. Leisure activities, such as playing the guitar, knitting, or golf, can also be compromised, and in advanced cases the pain is almost constant and especially cruel at night.

For those who have never experienced the debilitating discomfort, an invisible wrist injury must seem slightly histrionic. But if recovery time is any indication of severity, consider the following: A typical patient with carpal tunnel will miss 30 days of work while recuperating from surgery, but an amputee will only miss 22 days.

Medical treatment for carpal tunnel is predictably expensive. At minimum, a severe case requiring surgery will cost $30,000. Nationally, carpal tunnel exacts a whopping $7 billion in workers’ compensation annually. Millions more are spent on ergonomic workstations.

With so many people seeking relief, carpal tunnel has become wildly lucrative for those hawking remedies. There are, therefore, a lot of folks in and out of the medical community marketing promises of relief. A subset of available treatments includes the

following: creams, gloves, braces, and splints (all virtually worthless); ice and heat therapy, acupuncture, and cold laser therapy (the “cold laser” in this case is a device that looks suspiciously like an oversized flashlight); magnetic therapy (basically gloves fitted with magnets, probably not the brightest thing to wave around your computer); drugs (America’s cure-all); injections and surgery (these are the AMA’s favorite options, not as warmly embraced by your HMO). There is even a foot-operated mouse!

At the very least, most of these remedies can claim a placebo effect, and, at best, some do provide temporary relief. One need not be unduly skeptical, however, to reason that if any of this stuff worked as well as advertised, carpal tunnel would not be epidemic. Not even those who undergo surgery necessarily find relief: An acquaintance of mine recently selected to have surgery and reports that her condition has worsened.

To treat the condition with the best probability of success, you should know a bit about the workings of the wrist. The carpal tunnel is an opening into the hand that consists of the bones of the wrist on the bottom and the transverse carpal ligament on the top. Through this opening pass the median nerve, which supplies sensation to the thumb, index finger, middle finger, and half of the ring finger; the ulnar nerve, which supplies sensation to the rest of the hand; and the flexor tendons. The opening also serves as the protective gateway for an assortment of blood vessels.

As the name suggests, the flexor tendons allow you to move your fingers and hands and to grasp objects. The tendons are covered with a double-layered sheath that surrounds the tendons with synovial fluid. The fluid provides vital lubrication that allows the tendons to glide smoothly as the hand is being used. Any condition that causes irritation or inflammation of the tendons can result in swelling and thickening of the synovial fluid. Such conditions include prior injury, surgical scarring, or habitually poor mechanics, any of which can create a low tolerance for repetitive movement. When subjected to prolonged irritation, the connective tissue undergoes chemical change, growing more dense and fibrous. Since the tunnel is made of bones and ligaments, it cannot expand; therefore, the tendons cannot glide smoothly and effortlessly. Eventually, the median nerve, the softest element in the tunnel, is squeezed against the transverse carpal ligament, impeding normal impulses. The result is inflammation, numbness, debilitating pain, and weakness.

Two characteristics of carpal tunnel are often misunderstood, contributing to the proliferation of cures that address the symptoms, not the underlying cause. By the time a person feels acute pain, the condition is already well advanced. In these cases, the autonomic nervous system is actually contributing to the problem by shortening the muscles in the forearm, further stretching already inflamed tendons in an attempt to stop you from using your hands. This stretching is why gloves, braces, and splints are generally ineffective: They are designed to immobilize the wrist but allow the fingers to continue the movements that cause pain.

Second, carpal tunnel is a condition seldom limited to the mechanics of using the hand. If you are anything like me, when you work at a computer you may begin by sitting up straight; but in no time at all, you start to slouch, your shoulders roll inward, and your head juts forward and tilts up at the screen. A quick survey of people in your office will reveal many workers modeling that position.

The rolling of the shoulders pinches the brachial plexus, a collection of nerves and arteries at the shoulder girdle. This pinching reduces blood flow and compromises the nerves to the arm and hand. The condition often produces numbness, particularly at night. Upper back pain between the shoulder blades is another common symptom. Poor posture, specifically the jutting forward and lifting of the head, also puts pressure on the neck where the nerves to the hand and arm originate in the spinal column. Some cases diagnosed as carpal tunnel are actually postural problems.

Any treatment that addresses only the site of the symptom will not provide lasting relief. Acupuncture is designed to restore the chi, the flow of energy to the constricted area, but will not stretch the muscles that cause the constriction. Drugs are prescribed for pain and inflammation and, absurdly, for depression because people with severe cases of carpal

tunnel are disheartened about having to limit their activities. This, I suspect, is modern medicine’s version of treating the whole person: prescribing drugs to help you feel numb about feeling numb. Drugs may alleviate anxiety, but generally fail as treatment for carpal tunnel because they solely address symptoms. Although they may provide temporary relief, all too often drugs are used as masking agents to override the body’s messages and allow the damaging activity to continue. Cortisone injections work well for inflammation and pain, but too much cortisone depresses the immune system and prolonged use causes deterioration of tissue and inhibits the body’s natural healing ability. Creams are of dubious benefit; most of the relief is probably a result of the massaging action of application. Surgery, of course, is the last resort. It is sometimes effective, but even doctors don’t agree on its advisability. Like other treatments, the goal of surgery is to eliminate symptoms; the problem in the musculature persists. A surgical legacy may also include unanticipated new symptoms produced by additional scar tissue.

The basic problem is that the flexors—the muscles on the palm side of the forearm—are overused and, therefore, shorten and pull on the tendons, causing irritation and inflammation. The solution is to lengthen those muscles. Although treatment by a professional massage therapist intimately familiar with the musculature of the arm and hand is preferable, there are some easy exercises that can be done in the home or office that will help reverse the condition. For best results, do them several times each day.

• With your forearm resting on the desk, grasp your fingers and gently pull them back. Hold the stretch for five seconds. Relax and repeat three times on each side.

• Stand with both hands pressed flat on the desk, perpendicular to your arm. Gently stretch your fingers and wrists and hold for five seconds. For an advanced stretch, point your fingers toward your body. Relax and repeat three times.

• Tightly clench both hands and release, fanning out the fingers as far as possible. Hold the fan for five seconds. Relax and repeat three times.

• Using both hands, make a fist with your thumbs tucked inside your fingers. With your arms held in front of you (thumbs up), bend your fist downward and hold the stretch for a count of five. Relax and repeat three times.

After completing the exercises, relax your arms and shake your hands for ten seconds.

Because carpal tunnel-like symptoms can originate in the shoulder or the neck, do the following:

• Shoulder stretch: Stand in an open doorway with one foot in front of the other, hips tucked under, and forearms resting vertically on either side of the door (a “stickup” pose). Take a deep breath and exhale slowly while leaning gently through the doorway. Relax during the inhale and stretch a little further with each exhale. Hold the stretch for five seconds and repeat three times.

• Neck stretch: Hold your left arm behind your back at waist level. Grasp your left wrist with your right hand. Tilt your head forward and toward the right shoulder. Hold for five seconds. Relax and repeat three times on both sides.

That should do it. But if, for some reason, it doesn’t work, take two aspirins and call me in the morning.



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