2024-03-27 09:45:59
Repetitive strain injuries are injuries to the musculoskeletal system caused by repeated use, long-term stress, or fixed postures. It is not a disease but a syndrome that encompasses a variety of symptoms, such as those in the neck, shoulders, forearms, and hands. Damage to muscles, tendons, and nerves, causing discomfort, pain, weakness, or paralysis.
(Kuala Lumpur News) Carpal Tunnel Syndrome (also known as Carpal Tunnel Syndrome) is one of the most common Repetitive Strain Injury (RSI). It most commonly occurs in office workers who use computers for long periods of time, musicians who often practice playing musical instruments, or ball players are also high-risk groups. Tendonitis elbow is also one of the RSIs.
Dr Ng Eng Seng, consultant in orthopedics, hand and microsurgery, pointed out that the principle of RSI is mainly related to three points, namely time, posture and force. If used for too long and repeated movements without interruption, the muscles and bones cannot bear this heavy load, resulting in strain.
Secondly, the correct posture for using a computer (see Figure 1) requires a straight back, shoulders back and feet close to the ground. You should not hunch your back or stretch your neck forward. The size of the computer also has an impact. When the keyboard is smaller, the hands will be “squeezed” when typing, causing the wrists to be in incorrect postures. When the keyboard position is too high, the wrists bend excessively and swing up and down, which not only affects the wrists, but also tightens the shoulder and neck muscles.
“Improper strength is less common. Some people use excessive force when typing, which not only causes fatigue, but also easily leads to tendon injuries.”
He said carpal tunnel syndrome mainly occurs in people who have to perform repetitive movements with their hands. Compared with 10 years ago, the number of cases has increased and is getting younger. In the past, it usually occurred in women over 50 years old, but now it is more common in young white-collar workers, and even children have sought medical treatment for this problem. It is undeniable that this trend toward younger people is closely related to the use of modern electronic technology products.
“The eight bones of the Carpal Bone are arranged neatly.
Fixed to form a ‘U’ shaped ‘trench’,
The upper covering is called the transverse carpal ligament
（Flexor Retinaculum / Transverse Carpal Ligament）
‘ditch cover’,
Forming a space like a small tunnel,
This is called the Carpal Tunnel” (see Figure 2).
There are 9 tendons that control finger movement and 1 median nerve (Median Nerve) in the carpal tunnel.
The carpal tunnel space is only 20 cents in size.
So everything is in “just right” position.
Any condition that causes compression of the median nerve,
Will block nerve conduction,
And cause symptoms of abnormality, numbness or pain.
“To put it simply, there are two causes of carpal tunnel syndrome: compression or traction of the median nerve. When using the keyboard, ordinary people may press their wrists on the table. In addition to directly affecting the speed of nerve conductance, In the long run, it will cause insufficient blood supply to the nerves, causing scarring of nerve tissue, just like scarring when a skin wound heals.
Due to scarring, the tendons in the carpal tunnel have no room to stretch, which in turn affects the conductance of the median nerve.
Numbness and pain in 3 and a half fingers
He revealed that when using a mobile phone for a long time, the tendons of the fingers will become inflamed due to repeated flexion, extension and friction. In this case, although the median nerve is intact, the surrounding aponeurosis is swollen due to inflammation, which will also cause compression of the median nerve in the carpal tunnel. In addition to office workers who type on keyboards, people with their heads down who never leave their phones are also prone to carpal tunnel syndrome, especially when watching TV shows or playing games, where their wrists remain in unnatural postures for hours on end. Therefore, doctors will recommend using a holder to place the phone on the table to avoid holding it in your hand for a long time.
Unappropriate treatment following fracture causes bone malunion (Malunion) to reduce the space of the carpal tunnel, and carpal hygroma (Cyst) of the wrist are relatively rare causes that can compress the median nerve. In addition, pregnancy and diabetes are also risk factors for carpal tunnel syndrome. The former is prone to edema, which increases the pressure in the carpal tunnel, but it usually gets better 2 to 3 months following delivery; and high blood sugar in diabetics can damage nerves and Causes inflammation of the tendons in the carpal tunnel.
Because the median nerve innervates half of the thumb, index finger, middle finger, and ring finger, discomfort, numbness, and pain in these three and a half fingers are typical symptoms of carpal tunnel syndrome. These symptoms occur intermittently at first, often feeling heavy and numb in the morning or at night when sleeping, or numbness in the hands following working for a long time, but they are relieved following resting.
“If no action is taken, the disease will continue to progress. Symptoms will gradually increase in frequency and continue to become severe. You may also feel weak in your wrists. I have seen patients stay up at night due to tingling in their fingers, resulting in mental breakdown and depression. In the later stages of carpal tunnel syndrome, such as following 5 or 10 years, it may even cause chronic atrophy of the thumb muscles. At that time, the patient’s grip strength will become worse and objects in the hand will often fall off, which is an irreversible consequence.”
Assess the severity of illness
The diagnosis of carpal tunnel syndrome mainly relies on clinical examination. The nerve conduction test (Nerve Conduction Test) can confirm the conduction speed of nerve signals when passing through the wrist, if there is any slowdown or delay, and evaluate the severity of the condition.
However, he also said that not all patients need nerve conduction testing. For example, if the patient is over 50 years old and has three and a half fingers paralyzed, which clearly points to carpal tunnel syndrome, there is no need to perform this nerve conduction test; if the patient is young, the symptoms are not very typical, such as only one finger or For paralysis of the tail finger innervated by the ulnar nerve (Ulnar Nerve), it is recommended to confirm the condition through examination to avoid treatment errors. This is because everyone’s constitution is different, and even if the symptoms are not very typical, doctors still cannot rule out this possibility.
Open ditch covers to release nerves
Cure Carpal Tunnel Syndrome in 15 Minutes
Treatment for carpal tunnel syndrome includes non-surgical treatments or surgical treatments.
Surgery to incise the “sulcus cover” transverse carpal ligament and release the compressed median nerve is the most effective treatment method.
Huang Yingsheng pointed out that this is a simple operation with the option of local or general anesthesia. The wound on the wrist is regarding 3 centimeters long and takes regarding 15 minutes. The patient is discharged from the hospital on the same day and it is a daycare surgery.
Non-surgical treatment to relieve symptoms
Non-surgical treatment focuses on relieving symptoms, such as oral painkillers, sleeping pills, or antidepressants as appropriate. Supplementing with B vitamins can also help promote nerve repair. In addition, patients can also try to change their daily habits through physical therapy, such as wearing a wrist brace to limit wrist movement, reducing hand time, or using ergonomic tools. However, these methods can only treat the symptoms but not the root cause.
“In any case, whether to perform surgery mainly depends on the symptoms and severity. Doctors will still respect the patient’s wishes because everyone has different pain thresholds. If the symptoms have affected daily life or work, or are confirmed to be moderate or severe by nerve conduction testing, For this condition, surgery is generally recommended because it can solve the problem once and for all.”
The sooner you have surgery, the faster your recovery will be.
In addition, the earlier the surgery is performed, the faster the nerves can recover. Compared with mild cases, the numbness in the hands of severe patients may take several months to disappear. If you wait until the thumb muscles atrophy before performing surgery, the symptoms of paralysis will gradually ease, but the muscles will not regenerate.
There are also clinical treatments for carpal tunnel syndrome through local steroid injections, but they are not suitable for all patients. Steroids mainly help reduce inflammation, so they are only effective for patients with tendon friction and inflammation that compresses the median nerve.
Wong discourages this method because injecting steroids into the wrist carries the risk of tendon rupture. “If the tendon ruptures, surgery will be required to reconnect the ruptured tendon. After surgery, the flexibility of the fingers will not be as good as before, so it is not worth taking the risk.”
Get up and walk following sitting for 2 hours
Question 1. How to avoid RSI such as carpal tunnel syndrome?
Answer 1.It is important to maintain correct posture, and you can also try to use ergonomic electronic tools, such as detached keyboards or upright mice. Some people will put a wrist pad when typing, but be careful not to compress the median nerve. You can move it upwards and do not place the pad directly on the carpal tunnel of the wrist.
As for the length of use, you may need to discuss it with your respective employer. Usually we recommend not to maintain the same posture for too long. For example, following using the computer for 1 hour, rest your eyes and hands for 5 to 10 minutes. After sitting for 2 hours, it is better to get up and walk around for a while.
The possibility of recurrence cannot be ruled out
Question 2. Will carpal tunnel syndrome recur following surgery?
Answer 2.Generally speaking, carpal tunnel release (CTR) surgery has good results and recurrence is rare. Although the possibility of future recurrence cannot be completely ruled out, it may take a long time to occur.
Use your hands normally the next day following surgery
Question 3. How long will it take before I can use my hands normally following surgery?
Answer 3.You can use your hands normally the next day following the operation. Typing and daily use are no problem. Of course, you need to avoid moving heavy objects. As for the wound, it will take regarding 2 weeks to heal, so avoid touching the water. Symptoms such as numbness or pain in the hands will gradually subside, possibly over several months, depending on the severity.
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