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> Re CTS

Hi Mark
Carpal tunnel is a real thing, and median nerve compression can be quite
bothersome.   You should get a baseline EMG done (an electrophysiologic
test of the nerve function across the wrist).  The carpal tunnel is a real
tunnel, having bone on 3 ¼ sides, and a thick ligament (¼ inch thick) on
the top.  The ligament prevents the tendons from bow stringing outwards, so
it is very strong and thick.

 You can sometimes get good symptomatic relief by switching to ergonomic
keyboards, tables, and chairs  if you spend a lot of time at the computer
for work.  In general, you want to avoid having your wrist palmar flexed
(or extremely dorsiflexed) for prolonged periods.  The natural position of
the wrist with the least pressure within the tunnel on the palmar side of
your wrist occurs when the wrist is dorsiflexed in a natural position of
about 20 degrees, with the pressure increasing with either extreme palmar
or dorsal flexion.

 You can pick up a night time splint to wear to prevent you from flexing
your palm downwards in your sleep (we tend to assume a foetal position
during sleep.  Keeping your hand elevated when sleeping may also help (you
have to rig it so that if you had a drop of water sitting on the tip of
your index finger, it could roll down to your shoulder: in other words, you
want to make it more difficult for swelling to stay put.

In my own patients, the only ones who got better non surgically were those
who had treatment for a disease that was causative or those who really
changed their habits.  Everyone else generally failed to show
permanent improvement with conservative treatment.  Surgery was generally
effective with long lasting benefit.  Non surgical treatment, including
cortisone injections splinting etc typically only provided some temporary
relief unless habits were changed.  Untreated, this can cause permanent
damage in terms of sensibility of the finger tips of the radial 3 and a
half digits and impairment of thumb abduction, but this is unusual.  So you
can stabilize it with night splints, anti inflammatory meds, rest,
stretching, physio, etc, but permanent relief, in my opinion, comes from
surgery.

Cheers
Claudio