a special program of the National Emergency Medicine Association (NEMA) 

Week: 523.2 Guest: Neal Zimmerman, M.D. Topic: Carpel Tunnel Syndrome - Part One Host: Steve Girard Producer: Ed Graham

NEMA: People have had jobs involving repetitive movements for generations, meat packer, hat makers, seamstresses and pressers...and these are just some of my family members who experienced aches and pains, and eventually limited range of motion after years on the job. Today, one specific form of repetitive stress injury has surged beyond the rest to near epidemic levels...carpal tunnel syndrome...aided by the proliferation of computer oriented jobs. We're with Dr. Neal Zimmerman, a hand specialist....

Zimmerman: "Typically, people will notice numbness in their hand, primarily involves the thumb , the index finger and the middle finger, and usually one side of the ring finger. They have numbness that can occur during the day, and also occurs at night, sometimes wakes them up from sleep. A lot of people also have a discomfort in their hand that's associated with the numbness in this area that occurs when they do repetitive activities such as typing and activities such as power gripping such as using a tool."

NEMA: Some traditionalists may remain skeptical about carpal tunnel and repetitive stress injuries.....

Zimmerman: "I think there's a lot of data at this point to support the fact that these are real injuries. And instead of being one major accident or injury, these repetitive stress injuries, also called cumulative trauma disorders, occur as small injuries over time. And these activities, whatever they may be, outstrip the body's ability to heal from them, so the damage slowly accumulates until you have a problem such as carpal tunnel syndrome."

NEMA: How do you evaluate the condition?

Zimmerman: "I look at the different muscles in their hand, the carpal tunnel involves compression of a nerve at the base of the palm and into the wrist, that's pinched in this problem. That muscle gives feelings to the thumb, index, middle and part of the ring finger, like I said, and also connects to some of the small muscles in the hand. If that nerve is pinched, either severely or over a long period of time, some of the muscles in their hand can atrophy or shrink, so I look for that. I also look to see how their hand is working and I carefully talk to them about their activities, their hobbies, the positions that they even do their jobs at work."

NEMA: What is the usual course or treatment for carpal tunnel.....?

Zimmerman: "The thing to keep in perspective is that surgical treatment of carpal tunnel is used for only a minority of people. The first thing that I look at is activities that can cause this problem, such as...riding their bike in an inappropriate position, or having their wrist in an over-bent position at work, or excessive typing....things like that. If there's any of those things that can be modified by changing the keyboard or the way that their chair is adjusted, that's the first step. When those things are exhausted, the next thing is to start with a splint which will rest the wrist in a position to take some of the pressure off the nerve. Additionally, I often use medications which will decrease some of the swelling in and around the nerve area and give the nerve more room. After that, I frequently give people an injection which can either work for quite a long period of time and sometimes even permanently. Once I've exhausted those options, then surgery is definitely something to begin to think about."

NEMA: Dr. Zimmerman says the bottom line in treating repetitive stress injuries, including carpal tunnel syndrome, is getting to them early, while damage can be prevented or reversed. If you have job or activity that involves repetitive motion, and your having symptoms, call your doctor and get his opinion....I'm Steve Girard.