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Monthly Archives: April 2011

What is this ‘carpal tunnel syndrome’ everyone keeps talking about?

First, a little anatomy: You’ve got several long, spindly bones in your arms.  There’s the humerus (from shoulder to elbow), then the radius and ulna (parallel from elbow to wrist), then your metacarpals (between wrist and first knuckles), then your phalanges, which make up your fingers.  But right in the middle, with your radius and ulna above and your metacarpals below, you’ve got 8 small bones that aren’t long or spindly.  They’re called your carpals, they make up your wrist, and they’re more cubical, wedge-shaped, or spherical, depending on which one we’re talking about.  My favorite is the Pisiform, but I really like saying ‘Triquetrum.’  Any other anatomy nerds out there with a favorite carpal?  Sorry, back to the task at hand.

So I know what carpals are; what’s with the tunnel?  Well, the carpals form an arch.  If you put your right hand flat on the table in front of you, palm down, your carpals form two rows going from the thumb side of your wrist, up, over, and back down to the pinky side.  On the underside, there’s a ligament, called the transverse carpal ligament, that acts as the bow string to your carpal bow.  It pulls each end (pinky and thumb) toward the other, forming this nice little tunnel for nerves, arteries and veins, and muscle tendons to pass through on their way from your arm to your hand, and back again.

I get the tunnel.  What’s the syndrome?  If you hold your wrist straight (like you’re pointing at something far away) your carpal tunnel is very comfortable.  Plenty of room for everything inside to do what it needs to do.  If you curl your hand towards you (like you’re pointing at your own chest), there’s still lots of room.  Maybe even a little extra room.  If, on the other hand, you flex your wrist (Stop In The Name of Love style), your carpal tunnel gets flattened a bit, and everything inside (again, that’s nerves, arteries and veins, and muscle tendons) gets a bit squished; which is no big deal once in a while.  But if you’re doing it all day, every day (flexing your wrists to type is the most common culprit, but too many pushups or too much time on the mountain bike can cause strain as well), that adds up to some cranky wrists.  And that, my friend, is basically carpal tunnel syndrome:  cranky, over-flexed wrists.

What to do about it
Stop flexing your wrists so often, for one.  Go ahead, sing and dance along with Diana, it’s not a problem.  But take a look at your keyboard at work and at home; is there a way (with a pad or a different keyboard) that you can have your wrists in a more neutral (straight) position?  What about the way you drive?  Can your wrists be straighter as they meet the steering wheel?  There are push-up devices out there and some of them may help your wrists stay in a more tunnel-friendly spot.  You’ll have to find the one that works for you.

Curl your wrists after flexing for a while.  Maybe some of your wrist flexing is unavoidable.  If that’s the case, remember to open up that tunnel after all the squishing.  Just curl your wrists (pretend you’re a T-Rex for a while) and give those nerves and blood vessels some room to breathe.

If you’ve still got pain or numbness, seeking outside help may be the way to go.  There are lots of different options out there, as I’m sure you’ve seen and heard advertised.  Surprise, surprise, Rolfing can help.  There are splints that don’t let you flex.  There are surgeries that cut into the tunnel to open it up.  An ounce of prevention can go a long way when in comes to Carpal Tunnel Syndrome, but if you’re past that point, just make sure you do your homework before jumping into one route or another.