Light at the end of the tunnel?

Although first described half a century ago and rarely diagnosed during the next 40 years, carpal tunnel syndrome has suddenly become fashionable, with an estimated 5-10 percent of today's adults now becoming afflicted with it at some time in their lives.

The condition takes its name from a tunnel of sorts in the wrist, created by the carpal (wrist) bones and ligament through which the median nerve passes. Anything that causes this tunnel-like space to narrow (such as injury or inflammation of bones or ligament) puts pressure on the median nerve. The symptoms thus produced may go almost unnoticed at first - just some intermittent numbness or tingling. In time, however, this increases to the point of interfering with work or sleep - and the eventual outcome is pain.

The enormous increase in the use of computers has been blamed for the problem, but any activity that involves excessive use of the wrist and hand can lead to the disorder. Injury to the hand or wrist can also be a factor, as can such diverse conditions as infection, pregnancy, obesity, and hypothyroidism, all of which can produce swelling in the wrist.

Unfortunately, there are no reliable able tests to distinguish median nerve compression from such things as arthritis, bursitis, and a host of other conditions that can produce similar symptoms. Pressing and manipulating the hand and wrist is often a reliable determinant, but there is a tendency to overdiagnose carpal tunnel syndrome. Some experts find it often confused with myofascial dysfunction, a condition with similar symptoms arising from overuse or improper proper use of muscles, rather than pressure on the nerve.

When correctly diagnosed, carpal tunnel syndrome first demands rest of the affected hand and wrist. Splints and soft casts may be used to restrict motion but still permit the patient to carry on his or her regular work. The work situation must be evaluated, with correction or elimination of anything contributing to hand and wrist stress. Such devices as wrist pads, posture-improving proving chairs, etc., may be useful.

Surgery is a last resort, when other approaches fail to bring improvement. Using open surgery or an endoscope, the surgeon cuts into the ligament to relieve pressure on the nerve. Thus far, there is no clear-cut evidence that one technique is superior to the other. Although some surgeons report 100 percent success, some patients have an eventual recurrence of symptoms after surgery. Clearly, accurate diagnosis is important, for if it isn't carpal tunnel syndrome, the surgery won't relieve the symptoms.

GET A SECOND OPINION

BEFORE YOUR CHILD

GETS EAR TUBES

A recent article in the Journal of the American Medical Association reports that there was no clear indication for the use of plastic tympanostomy tubes in 58 percent of kids under age 16 in whom they were used.

The insertion of these plastic tubes through the eardrum to drain out fluid and allegedly prevent recurrent infections has had wide acceptance in recent years. In the above review of cases, it was determined that 23 percent of patients definitely did not need them, and their use in another 35 percent was questionable, at best. Children with ear infections causing fluid to accumulate behind the eardrum for less than 30 days, or who had no recurrence of infections while taking prophylactic antibiotics should not be treated with the tubes. In such cases, said the authors, youngsters are needlessly put at risk of scarring of the eardrum and other complications that can lead to permanent hearing loss.

AN EFFECTIVE NEW DRUG

FOR MIGRAINE

Having invalidated the age-old concept that migraine headaches are caused by constriction and dilation of cerebral arteries, medical research has led to new approaches to treatment. The latest and perhaps most effective of these is the drug sumatriptan (Imitrex). A recent report in American Family Physician claims that 80 percent of those taking it had their headaches reduced or eliminated in 90 minutes or less.

Its side effects are few, but it is expensive, must be given by injection, and is short-acting, with recurrence of the headaches in as little as 12 hours. It is anticipated, however, that oral sumatriptan will be available within a year, making it easier to use and less expensive. Longer-acting drugs are in the works, but will probably not be available for several years.