the body. These factors can alter the cytokine chemicals emitted by white blood cells to regulate and facilitate healing of injured tissues. As fluid builds within a region, several items may result in the carpal tunnel region: Formation of ganglia cysts, increased edema causing pressure upon carpal tunnel structures, inflammatory responses, and the potential for blocked lymph nodes. Arthritis Arthritis refers to general inflammation in joint spaces. There are numerous types of arthritis, all of which ultimately weaken joint structures. As tension loads change and bones are unable to adapt adequately to new tension loads, neighboring boney structures also weaken. The top four types of arthritis linked with a considerable inflammatory response are: rheumatoid, gout, psoriatic, and arthritis that is linked to systemic lupus erythematosus (SLE). These conditions all result in targeted inflammation within joint Ergonomic factors Individuals who type on computers or who regularly use smart phones to complete work tasks are at higher risk for acquiring carpal tunnel syndrome. The angles and torque produced by using electronic devices is enough to shift carpal bones and place unnecessary stress on the carpal tunnel region structures. Some helpful ergonomic-friendly suggestions to provide to clients include: 1. Changing one’s desktop item arrangement every week to avoid repetitive motions in same direction with desk tasks. This includes the placement of one’s computer keyboard, monitor, desk pads, telephones, and décor. 2. Obtaining a standing desk set-up. Typically, the height of one’s keyboard is adjustable with the standing desk set-up. Further, a client may elect to stand or sit on an exercise ball to encourage healthier posture. 3. Obtaining a computer monitor screen that decreases glare: Not only will this reduce adverse effects of the monitor’s light on the eyes, it will ease myofascial stress of facial muscles, which in turn leads to the softening of myofascial tension of the neck and shoulders. The aggregate effect is then
Certain medications’ side effects contribute in increased fluid retention. These medications include drugs that contain estrogen, such as birth control and hormone replacement therapy, non-steroidal anti-inflammatory drugs (including aspirin, ibuprofen and naproxen), and beta-blockers used to treat heart arrythmias and tachycardia.
spaces. Rheumatoid arthritis and SLE are especially burdensome: These autoimmune diseases tax the body heavily, including bone and joint tissue structures. Anti-inflammatory pain relievers, corticosteroids, and disease- modifying treatments are medications used to treat arthritis conditions and may cause significant side effects that may negatively impact bone. If the carpal bones are affected, their smaller stature makes these bones more prone to fracture. experienced with freedom of myofascial tissue along the upper limbs. Usage of tools Machinery or fine-tool use may impact the arms and carpal regions tremendously. Vibrational tools, such as a massage vibrational device, will cause a consistent shock to bone and can weaken structures over prolonged periods of time. Tools that require dexterity, such as sewing needles and computer keypads, can also cause carpal bones to misalign due to repetitive stress on the joint structures. If one often uses these tools for his/her occupation, a healthy recommendation is to take breaks every 15 to 20 minutes. Tools are not limited to occupation: Recreational sports and hobbies may also include tool use. A golf club, for example, can have a similar impact on the body as a gardening tool—if it is used repetitively. The average golfer may take over 300 swings a day, which places tremendous torque factors on the wrist region. Golf gloves are designed to ease the burden; however, their impact is limited. Any golfer can eventually swing a club one too many times, causing injury—no matter how effective the gloves are in easing stress. and published in the May 2007 edition. It indicated frequency rates caused by numerous factors such as age, gender, pregnancy, and body mass index (BMI). This research piece was selected to fill this section because of the vast array of variables presented within this study. This broad perspective allows the learner to consider multiple factors of CTS epidemiology. a common causative mechanism of CTS is sleeping in a lateral position. Study findings include the following: ● Age: The development of CTS is related to age. Phalen reported the number of cases increased for each decade of age to 59 years, after which, the number of cases in each decade decreased. Atroshi et. al observed a similar age distribution with the highest prevalence of CTS in men of 45 to 54 years and in women of the age 55 to 64. Bland and Rudolfer found cases of CTS had a bimodal distribution for age with a peak of age 50 to 54 and a second peak of 75 to 84 years. Similarly, Mondelli et al reported “The age specific incidence for women increased gradually with age, reaching a peak between 50 and 59 years, after which it declined. In men, there was a bimodal distribution with peaks between 50 and 59 years and between 70 and 79 years.” ● Gender: Phalen noted in 1966 that the gender distribution was CTS was two-thirds to one-third female to male. The increased presentation of women with CTS was also noted
EPIDEMIOLOGY
Research published in the medical journal Hand , a publication of the American Association for Hand Surgery, provides great insight into the frequency of carpal tunnel syndrome. The study, entitled “Epidemiologic Associations of Carpal Tunnel Syndrome and Sleep Position: Is there a case for Causation” was conducted by McCabe, S., Uebele, A., Pihur, V., Rosales, R., and Atroshi, I., Abstract Carpal tunnel syndrome (CTS) is thought to be due to compression of the median nerve in the carpal tunnel. It is known that carpal tunnel pressures are elevated in wrist postures of flexion and extension in those patients with CTS. Classic symptoms of CTS include night waking with pain, tingling and numbness. These classic symptoms stimulated our interest in the relationship of sleep to the development of CTS. We reviewed the literature surrounding the epidemiology of CTS and the literature regarding sleep disturbances. Through careful distillation of these studies and a process of reasoning, we have developed a hypothesis for a casual mechanism of CTS. Epidemiologically, it has been shown that CTS is associated with age, gender, general body mass index (BMI), diabetes, pregnancy and is more common in some populations. The same associations noted above for CTS are strongly associated with sleep disturbances. Sleep disturbances due to age, gender, BMI, pregnancy and population variations are all associated with sleeping in the lateral position supporting the hypothesis that
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Book Code: MLA1224
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