Hands shackled

'SIT straight. Keep your elbows close toyour body.' How often one has beenadmonished and hated it all along. Butthis is what was suggested by expertswho met at the annual meeting of theAmerican Academy of OrthopaedicSurgeons. If you are consistently usingyour hands for your work, you are liableto suffer from what is known as thecarpal tunnel syndrome, a debilitatingdisorder of the wrist, hand and arm.

The disease was known to affectworkers involved in repetitive physicalactivity like carpenters and jackhammeroperators for many decades now. Butnow, -supermarket cashiers and evenjournalists have joined the ranks. And itis because of the latter that the diseasehas now become a household word, atleast in the us. Reporters and journalistsinitially had a bad time coping with therealisation that pounding out stories ona typewriter or computer 6n have suchdire consequences.

Tingling and numbness of fingersare the first symptoms of-the disease,which then leads to aches, shootingpains and weakness in the hand andforearm. One of the common earlywarning signs is, awakening at night withshooting pain or numbness and tinglingfeeling in the arms and hand. Most people do not connect the pains felt at nightwith their activities during the daytime.

The syndrome is a result of pressure on the median nerve, which along withnine tendons and a number of bloodvessels passes through a narrow tunnelin the wrist, made of bones and a ligament. Carpal tunnel syndrome can leavepeople without jobs as they loose manual dexterity and strength of their hands.Many require long rehabilitation periods and others have to undergo surgeryto relieve the pressure on the nerve.Some really bad cases 6d. up with permanent nerve damage.

Physical therapists, orthopedic surgeons and ergonomic experts suggestgood posture for people working oncomputers. Straight back with goodsupport, feet flat on the ground, forearms parallel to the ground and in linewith the hand. Unbent wrists withoutsupport, elbows close to the body allmake a good posture. A computerscreen placed at eye-level or a maximumof.15 degree below the eye, could beallowed. Short breaks of at least 15 minutes after every two hours are also veryimportant. They also advice getting up,moving around and stretching.Massaging the palms, fingers andthumbs of both the hands helps to relaxthe tension on the nerves.

Conservative therapy according tosurgeons is the best treatment, withsurgery reserved for a small percentage of patients. Once the conservative therapy starts, the patient is advised againstthe use of the injured hand even forringing the doorbell or holding a cup for-a period of 7-10 days. The therapyrequires the patient to wear a wrist braceand splint, particularly at night and taking anti-inflammatory medication. Inthe case of pregnant women and thosetaking birth control pills, 150-200 mg ofVitamin B6 per day is also said to behelpful.

Patients who do not respond to thetherapy are administered more directtreatment. A new treatment was prescribed by J Lee Berger, affiliated withthe Seton Hall Graduate School ofMedicine in West Orange, New Jersey,us. This minimally invasive procedureto reduce pressure on the median nerveinvolves insertion of a balloon catheter.Similar to the one used in angioplastyfor opening blocked arteries, thecatheter is slipped through a quarter-inch incision under the ligament of thecarpal tunnel. Once inside the balloon,it is inflated to make more room for thenerve. Eighty five per cent of Berger's120 patients have shown markedimprovement after the treatment.

Earlier this year of non-invasive lasertreatment was introduced by Michael IWeintraub, a neurologist from BriarcliffManor, New York, us, which stimulatesthe nerve and relieves the symptoms ofthe syndrome. The response rate of this treatment was over 70 per cent. While'Daniel I Nagle of NorthwesternUniversity Medical School found fromhis multicentre study on 500 patientsthat operating through a scope ratherthan making an incision in thewrist reduces the recovery time andallows the patient to return to normalactivity earlier.