Wrist twist: the common disorder called carpal tunnel syndrome can disable a worker if not treated early.

The common disorder called carpal tunnel syndrome can disable a worker if not treated early.

Maneuvering her red Subaru through the crush of rush-hour traffic, Angie finds that her fingers have become numb right on the steering wheel - how disconcerting! She shakes her left hand vigorously, then the right. As she keeps moving her fingers in various ways, the lost sensation gradually returns.

At home, Angie goes straight to her sewing machine. This hardworking grandmother has brought the makings of several choir robes home so she can help meet a deadline at the factory where she is a valued seamstress. Skillfully she makes long seams in heavy fabric until almost midnight. She's so tired that as soon as she hits the bed she falls asleep. Unfortunately, around 3:00 a.m. she wakens with sharp pains shooting through her fingers.

Angie thinks about Lois, her friend and fellow worker who fears losing her job because at times her hands seem almost paralyzed. Afraid of developing the same condition, Angie decides to see her doctor right away.

Jack is a genius at solving programming problems. As he sits at his computer terminal, ordinarily he doesn't even notice the hours moving past. However, lately his fingers have been burning and aching. At first the discomfort started toward the end of the day, but now sometimes numbness hits in the morning. What you can't feel, you can't control-Jack sees himself losing accuracy and productivity, besides being annoyed with the pain. He finds himself looking at his watch and wishing for 5:00. He wonders if he should tell someone--but at the age of 35 it seems embarrassing to have to acknowledge this minor physical problem ! Angie, Lois, and Jack represent an increasing number of people in the workplace who suffer from carpal tunnel syndrome (CTS). The most prevalent member of the family of repetitive motion disorders (also termed cumulative trauma disorder), CTS is growing at an alarming rate in the American workplace. The disorder can be experienced by construction workers, musicians, and truck drivers, as well as people who sew and operate computers.

What causes CTS? The carpal ligament stretches across the wrist to form a small tunnel. Through the tunnel pass tendons going to the thumb and fingers and the median nerve, which serves the thumb, the first two fingers, and half the third finger. Everybody has a carpal tunnel. It's a normal anatomical structure. The tunnel itself is not the problem. The difficulty, the syndrome, arises when tendons swell inside the small space of the tunnel. Hand surgeon Dr. Richard Milford compares the tendons passing through the tunnel to strong ropes, while the median nerve has the consistency of a piece of overcooked spaghetti. When the tendons swell, they compress the softer nerve. This causes burning, tingling, numbness, muscle spasms, and pain in the hand(s) and affected fingers.

What causes the tendons to swell? For Angie, Lois, and Jack, as for hundreds of typists, auto assembly line workers, and chicken pluckers, the primary culprit is repetitive motions. A person who spends the entire working day knitting, reaching up and over hundreds of times to install wiring in capers, or grabbing thousands of handfuls of feathers from fowl is a prime candidate for carpal tunnel syndrome.

The classic CTS patient is female, around 50 or older. However, in occupational cases the incidence can be as high among men as women, with ages sometimes in the 30s or even 20s.

Arthritis, diabetes, thyroid disorders, and pregnancy are among the conditions that can cause swelling of tendons and, consequently, CTS.

Treatment varies. What can be done for the person experiencing carpal tunnel syndrome? For Angie and many others with mild to moderate symptoms, the first line of treatment is wearing a splint at night on the affected hand or hands. The splint positions the hand for maximum space in the tunnel, preventing curling the hands and wrist in sleep (a common contributor to the problem). For many patients, the splint is the only treatment needed.

Because Jack's pain had become troublesome by the time he sought help, his doctor prescribed splints and also another frequently recommended type of remedy, oral anti-inflammatory medication. Occasionally a doctor may inject cortisone into the carpal tunnel. This might be prescribed for a patient for whom it is best to avoid surgery, such as a pregnant woman.

In addition to splints and medication, a change in lifestyle or working patterns is often needed to keep the disorder from recurring. Jack's condition and that of several other workers with CTS led management to adopt significant innovations. Workers have been provided with hinged computer keyboards, allowing for variety of hand positions. Programmed reminders notify employees when it's time to change position or activity, and taking breaks is now mandatory.

Angie's supervisor changed her daily schedule, breaking up stretches of sewing with intervals of designing robes and telephoning customers. In addition, Angie no longer takes work home at night.

Jack and Angie were pleased to find that their employers' concern to provide a more healthy workplace, along with following their doctors' recommendations, brought relief. Angie's friend Lois, however, had neglected her problem and had to have surgery to prevent an irreversible paralysis. This type of surgery is not something to be particularly dreaded.

The surgeon makes an incision at the base of the palm, an inch and a quarter to an inch and a half long. Then the carpal ligament is cut, freeing the median nerve from the pressure that causes the symptoms. The skin of the hand heals, usually leaving a scar hardly more noticeable than one of the creases in the hand.

A nontraditional approach to surgery, called endoscopy, is now sometimes being used. A tiny television camera is inserted through a small incision into the wrist. Guided by the camera, the surgeon cuts the ligament.

Dr. Bruce Wolock, an instructor in hand surgery at Johns Hopkins Hospital, uses the endoscopic method if there are no predisposing causes of CTS such as diabetes. It means a smaller incision and, consequently, less scarring.

However, since the surgeon cannot see the nerve with endoscopic surgery, there is a greater chance of cutting it, which is why many prefer the traditional method.

Endoscopic surgery at present is done "mainly at university hospitals, by surgeons with a great deal of experience," Dr. Wolock explains. That way, if complications such as cutting the nerve arise, the surgeon can make the necessary repair.

Physical therapy is recommended for the month following surgery.

Katrina Darnell, a specialist in outpatient hand therapy, uses exercise as a part of the treatment of carpal tunnel syndrome. She sees patients following surgery and those wanting to avoid surgery. In some cases a conservative exercise program makes surgery unnecessary. Darnell teaches stretches and gentle exertion, such as tendon gliding exercises and gentle fisting patterns.

The American Physical Therapy Association says early intervention combining an individualized exercise program with changes in the workstation and work habits can relieve pain and halt the progress of CTS in the majority of cases.

For me, certain kinds of exercises have proved an excellent means of controlling CTS. I've found that jogging won't do it, but participating in an aerobic exercise class helps. I regularly do a series of exercises that provide relief such as sit-ups, toe touches, twisting to the left and right with arms extended, and opening and closing my fists.

But before trying to combat CTS with exercise, consult your physician.

I'm fortunate to be fully functioning despite encounters with carpal tunnel syndrome. However, the crippling condition is still on the rise and is a significant health concern for workers in the 1990s.

Employees and employers working together to modify tools, workstations, and schedules can make a major impact on reducing the incidence of cumulative trauma disorders.