Back behind the wheel: The truth about carpal tunnel syndrome
June 1, 2007
Have you ever been driving down the road and felt numbness or tingling in your hand and wrist or have you ever been chaining down a load and felt a sharp shooting pain that starts in the wrist and goe...
Have you ever been driving down the road and felt numbness or tingling in your hand and wrist or have you ever been chaining down a load and felt a sharp shooting pain that starts in the wrist and goes up your arm? Well, like many other truck drivers you may have carpal tunnel syndrome (CTS). I am sure you have heard of this condition before but much of the information that you will come across will be misleading and inaccurate. Carpal tunnel syndrome occurs when the median nerve, which runs from your neck down your arm and into your hand, is compressed or squeezed as it passes through the wrist.
The median nerve controls sensations to the palm side of the thumb and the first four fingers excluding the little finger, as well as carries impulses to small muscles in the fingers and thumb that allow them to move. The carpal tunnel itself is a narrow passageway consisting of ligaments and bones and the base of the hand through which the median nerve passes. In some cases, swelling or thickening of irritated tendons can lead to narrowing of the tunnel leading to compression of the median nerve. Due to this interruption of nerve flow, one may feel pain, weakness or numbness in the hand and wrist, radiating up the arm. A simple analogy is to think of a garden hose lying on the ground representing the median nerve, with the water running through it representing the nerve impulses.
If you were to step on the hose near the middle, it would greatly reduce the amount of water exiting at the end of the hose. Essentially this is what is occurring at the wrist, a decrease in the flow of nerve impulses.
CTS is often due to a combination of factors that increases the pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself.
As far as truck drivers are concerned, work stress such as chaining, tarping and hand bombing as well as the constant vibration of the truck may contribute to the development of CTS. Another very common cause of CTS-like symptoms is driving your truck with your wrist resting on the steering wheel or the shifter.
The symptoms of CTS usually begin very gradually, with burning, tingling or numbness in the palm of the hand and fingers, especially in the thumb and index finger. In most cases, symptoms first appear at night while sleeping. Many people will wake up and feel the need to “shake out” their hand or wrist. As the condition worsens, people may experience symptoms during the day. As the condition progresses it may lead to decreased grip strength making it difficult to form a fist, grasp small objects or perform other manual tasks such as folding tarps. If left untreated, the muscles at the base of the thumb may waste away.
Women are three times more likely than men to develop CTS, which is most likely due to the fact that the carpal tunnel itself may be smaller in women.
The dominant hand is usually affected first and produces the most severe pain. In addition, metabolic disorders such as diabetes that affect the body’s nerves make them more susceptible to compression. In almost all cases CTS only occurs in adults.
Early diagnosis and treatment are very important to avoid permanent damage to the median nerve. Typically, your physician would take a detailed history about your condition making note of risk factors and patterns. Next, a physical exam which consists of orthopedic and neurological testing will be performed. The goal of the physical exam is to reproduce your symptoms using specific tests. Often it is necessary to confirm the diagnosis by the use of electrodiagnostic tests. The most common is a nerve conduction study, in which electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed at which the nerves transmit the impulses is measured.
Treatment for CTS should begin as soon as possible. Initial treatment consists of resting the hand and wrist for at lest 14-16 days, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. Ice therapy is also common to reduce any inflammation that might be present.
If this is not successful your doctor my prescribe medication to help with pain relief and inflammation control. In addition, you will be given specific stretching and strengthening exercises focused on the wrist and hand. Finally, if all else fails decompression surgery is an option.
How do you prevent CTS? Prevention of CTS mainly consists of task modification. Workers can perform stretching exercises, take frequent rest breaks, wear splints to keep wrists straight, and use correct posture and wrist position. Modification of workstations, tools and tasks can also enable the worker’s wrist to maintain a neutral position during work. Many factories rotate their workers among several different jobs.
Next time you are driving down the road and you feel pain or numbing in your hand or wrist, keep in mind these remedies.
– Dr. Christopher Singh, B. Kin., D.C., runs Trans Canada Chiropractic at 230 Truck Stop in Woodstock, Ont. He can be reached at 888-252-7327.