Carpal Tunnel Syndrome (CTS) Overview

Q: I use a computer five or six hours a day, five days a week. At the end of the day, my fingers and hands ache. Is this carpal tunnel syndrome? If not, how can I tell if I’m getting it? Will I? And what can I do about it?

A: Achy fingers are not a symptom of carpal tunnel syndrome (CTS) But tingling in the fingers, or burning, or numbness, or a pins-and-needles feeling may well be

If you spend more than a few hours a day staring at a computer screen and pounding on a keyboard, it’s a good idea to check in with your fingers daily. The symptoms just mentioned are all early warning signs of carpal tunnel syndrome (CTS), the leading occupational hazard of the Computer Age. Think of it as The Revenge of Overworked Fingers. And that revenge can be costly: If left untreated, CTS can progress to constant, severe hand pain, and disability. Imagine not being able to tie shoes, zip zippers, button buttons, sign checks, or do any of the other the myraid finger tasks we take for granted.

CTS is quite common. A recent survey of 2,466 Swedish adults showed that 3.8 percent had CTS. If Americans suffer CTS at the same rate, we’re talking 8.4 million people, with that number almost certain to increase as an more Americans spend more and more time at computer keyboards.

As fingers fly over keyboards day in, day out, they may suffer “repetitive strain injury.” The finger pads don’t get hurt, but the tendons that connect the finger muscles to the wrist bones (carpals) become overworked, irritated, and inflamed, and start to swell. Then the ligaments that connect the carpals swell, and things get very tight inside the carpal tunnel, the channel deep inside the wrist where all these tendons and ligaments come together. Their swelling pinches everything else in the carpal tunnel, notably, the median nerve, which controls sensation and movement in most of the hand. When the median nerve gets pinched, the result is CTS.

At first, CTS causes only occasional mild tingling, burning, numbness, or a pins-and-needles feeling, or loss of strength in the thumb, and first four fingers. (The pinky is spared because the median nerve doesn’t control it. But if you ignore those warning signs and keep pounding away at your keyboard, you can wind up suffering constant hand pain.

CTS pain is usually worse at night—goodbye restful sleep. It may extend up the arms, and seriously weaken the hands. In severe cases, CTS can leave hands permanently damaged, making keyboard work impossible—kiss computer jobs and Internet surfing goodbye.

Sometimes, only the dominant hand develops symptoms, but usually, CTS involves both hands, which makes sense because keyboard work is a two-handed gig.

Women at Risk for Carpal Tunnel Syndrome and RSI

Compared with men, women have about three times the risk of CTS. Women’s hormonal fluctuations—the menstrual cycle, pregnancy, and menopause—make your wrist tissue swell even more. (During pregnancy, CTS symptoms grow along with the baby, then usually subside after delivery. In addition, risk increases as weight does. Extra weight means excess tissue in the carpal tunnel with greater risk of CTS-inducing pressure on the median nerve.

No computer job? You can still develop CTS. In fact, it was first identified by a British doctor back in 1854 at the start of the Industrial Revolution when early factory workers found themselves standing in one spot and moving nothing but their fingers week in and week out. Then CTS turned up among pianists, and bookkeepers and supermarket check-out clerks who spent their days punching the buttons of mechanical adding machines and cash registers.

Any activity that demands constant finger or wrist motion can cause carpal tunnel syndrome (embroidery, knitting, playing some musical instruments, racquet sports, hammering). Finally, in addition to women’s health concerns, several other conditions can cause or aggravate CTS, among them: diabetes, rheumatoid arthritis, and thyroid conditions. But CTS didn’t become a household word until the 1980s when millions of workers became chained to computers at work.

Now, CTS is so common that computer users who experience tingly fingers often jump to the conclusion that they have it. But other things can cause CTS symptoms. One evening, I not too long ago, I developed finger tingling and thought the worst—until I realized that I’d spent the day pruning the holly tree in my yard and getting my fingers stuck by its spiky leaves. By the next morning, my fingers felt fine. So before you race off to your doctor, or consult your company’s employee assistance program, or union health rep, take this simple test: With your hands in front of your chest and your elbows pointing out to your sides, bend your wrists so that your fingers point straight down. Press the backs of your hands together. If this positon causes CTS symptoms within a minute or so, you have it.