SURVIVING CARPAL TUNNEL SYNDROME:

MY STORY COULD BE YOURS

By

Carol Ann Wilson

I didn't know what was happening to me. I kept dropping my comb, brush, hair dryer, and rollers in the mornings. No control. When it began to keep me awake at night, I began to worry. (Thought it was an old injury from an auto accident acting up again.) It was so aggravating, all this numbness, tingling, and "dropsy." What was going on?

Well, I later learned what was going on was carpal tunnel syndrome ("CTS"). And had I recognized it earlier, I would have saved many a sleepless night. I'm a legal secretary and freelance writer, and I do a lot of keyboarding. I do many things with my hands. Actually, my hands are my livelihood (if not my life). And the thought of losing the use of my hands put a fear in me like I've never known.

The Basics About CTS

CTS results from repetitive motion–anything that involves repetitive motion with the hands, which includes typing (the main culprit, it seems), long hours at the adding machine, knitting and other crafting activities, even painting or assembly-line work. The key word is repetitive. Just working a lot with the hands won't cause it. It's the same motion, over and over and over, that causes it. Anyone–male or female–who performs long periods of the same hand motions will probably develop CTS. Carpenters have it as often as clerks. Can it be prevented? Yes–with very early awareness. But many of us won't take the time, or won't take our symptoms seriously, or we put ourselves in a state of denial, and the damage is already done and irreversible, short of surgery. But the effects can be lessened. Surgery can be postponed by presurgical, self- administered therapy. It still hinges on your personal awareness. You must be aware that CTS is developing, so that you can take frequent breaks from the repetitive motion and flex your fingers.

What can be done about it once it's diagnosed? For me the only treatment was surgery. From my experience and research, surgery will be the answer for most people. "Your case is too advanced," was the bad news from my orthopedic surgeon. I didn't take the news very well because I lead a very active life, and others depend on me. The thought of being laid up for anything was unacceptable–but so was the alternative.

The diagnosis was Carpal Tunnel Syndrome bilaterally, with triggering of both thumbs. (I was told that the triggering frequently accompanies advanced cases of CTS. It involved a separate corrective procedure at the base of the thumb.)

It's going to happen to a lot of you reading this article–if not to you, then surely to someone you know. It may be an employee or a family member. I hope you recognize it sooner than I did. More than that, I hope you prevent it. But if you type, use an adding machine, or play the piano, knit, paint, or do carpentry work, or arrange flowers, or do any activities involving the wrist and hands, you're probably going to fall prey to it.

The Onset

I first noticed this horrible tingling. My hands were not "dead" but they were about to "go to sleep." That made them feel creepy-crawly. I would sling my wrists, like I was trying to shake whatever it was out of there. It would give me momentary relief. The tingling would start after I had been typing for a few hours straight, with no break. I compose at the keyboard, so I frequently would type for hours and not know so much time had passed. I do the same thing at the piano. Hours can go by and I don't know it.

Many years ago I had knitted, and had recently taken it up again. I found some fast patterns for afghans, and decided to make some for Christmas presents. Every night I would knit. And, true to form, I would knit for hours without realizing how much time had gone by without taking a break. I wouldn't even think of taking a break. I'm a project-oriented, goal-oriented person. For me, the end of several rows of knitting, or of practicing on a new book of music, or of a new writing project, was more important to me than time–not to mention health and physical well being. If I had it to do over, I would take some breaks–even if for a couple of minutes.

A Faulty Self-Diagnosis

I stupidly didn't think anything about what could be causing the tingling. (It's amazing how blind we can be sometimes.) Then I was able to diagnose my own case. In the mornings when I would be getting ready for work, I began to drop my hairbrush or comb. I found it difficult to hold my hair dryer up for a long time. Aha! I had the answer. It was from my neck!

I had been rear-ended twice in car accidents, and always had neck and back problems. All soft tissue injury, but those problems stay with you forever. So I figured that some muscle spasm or something was pressing on a nerve root and causing this tingling. I knew there was little that could be done about that, so I just lived with it. Stupid, stupid me. Wrong, wrong, wrong.

While visiting my mother and experiencing this numbness, she said, "I think you've got carpal tunnel syndrome." Well, light bulb. That had never occurred to me. Maybe she was right. I regularly attend law-related seminars, and ergonomics, including CTS, is one of the "hot topics." It didn't sink in with me, though. It's one of those things that happen to "somebody else." I just wasn't affected by it (or so I thought), so it didn't compute. "That's something that happens to old ladies," I mistakenly told myself. (Ah, denial works in strange ways!)

What Is It?

What exactly is this "carpal tunnel syndrome" that has brought on my personal nightmare? We see billboards and TV commercials about it, but it's just another catchy phrase to many of us. Billboards all over Houston and commercials on UHF channels advertise clinics treating CTS. But until it hits you or a loved one, you don't really pay any attention to it. So just what exactly is it?

The carpal tunnel is an area in the center of the wrist, surrounded by a very strong ligament. That ligament forms a "tunnel," which is the passageway for the median nerve coming off the neck, down the arm, and to the fingers. The "wrist" is actually in the heel of the hand–not where we wear our watches.

What Causes It?

Repetitive motions cause the synovium around the tendons to become thickened and sticky. To picture this "synovium" business, think of the tendon as a cord and the synovium as a very fluid material, like olive oil. Then imagine that cord being covered with hot wax, which is beginning to cool and harden, instead of olive oil.

This thickened synovium causes the median nerve to press against the tunnel. The "syndrome" results when the median nerve, which supplies feeling and sensation to the fingers, is squeezed at the wrist by this mass of scar tissue and enlarged components inside the hand.

Other causes are bone fractures in the area, arthritis, fluid retention, and wear and tear from the aging process. But the problem manifests itself in the fingers. I suspect that people who complain of "painful wrists"–at the real wrist-watch area–have some problem in addition to CTS, although I'm told that some people have pain shooting up the arms with CTS. I experienced only the numbness in my fingers with my "advanced case."

The main symptom of CTS is a horrible tingling and numbness in the fingers. Creepy- crawly. It keeps you from sleeping, and when you finally succumb and just pass out from complete physical exhaustion, it wakes you back up! It's like something crawling inside your hands–only you can't tell if it's inside or outside. It just won't stop! It's worse than a nightmare–it's a daymare, too!

The Diagnosis

I first went to a plastic surgeon who happened to be listed under "Hand Surgery" in my PPO directory supplied by my medical insurance carrier. After convincing the appointments secretary that I needed help immediately, she worked me in quickly. He said he was pretty sure it was CTS, but wanted to get some nerve conduction studies done. They weren't able to schedule that until nine days later. Well, after thinking about that for about five minutes, I decided that was unacceptable. Nine more sleepless nights and not even any relief then, but merely confirming test results????? No, thank you.

I felt desperate and had to do something. I called a friend at one of Houston's legal "megafirms." I knew there had to be somebody there who had had the problem. That law firm is big enough to be a city and have zoning ordinances! Sure enough, I talked to a lady who had recently had the surgery. She told me she was off for three months with it!

Well, I didn't want to hear that! I'm one of those "women who do too much," and don't mind taking care of a physical problem if it can be done in a couple of hours. But three months????????? Nevertheless, in minutes I was off to see her orthopedic surgeon.

He performed a very short exam and diagnosed the CTS immediately. "No nerve conduction study?" I asked. he replied, "No need to spend that money. It's definitely carpal tunnel, and it's very advanced." With that, I had total faith in that man! No unnecessary tests!

The Actual Surgery

One nice thing about CTS is that the cure is instant. I was extremely fortunate that the doctor was able to do my surgery endoscopically, which meant small incisions and faster healing.

It's day surgery, as most procedures are nowadays. I was told I would not be getting a general anesthetic, but that I "wouldn't care." Well, I was out! Whatever they gave me, it worked! I remember being wheeled into the operating room and my hand being propped up at the elbow. Then someone started winding a piece of rubber very tightly around my fingertips, proceeding down my hand. This is to "push" the blood out of the hand, making it easier for the surgeon to work, and for a faster procedure, without all that blood in the way. I didn't stay awake long enough to finish my comment about it being uncomfortable.

For the procedure, a tiny incision is made at the wrist (the real wrist watch area), through which a tiny TV camera becomes the eyes of the surgeon, and another small incision is made near the middle of the palm, through which the surgeon cuts the ligament. (Otherwise, it's a two-inch incision inside the palm of the hand, requiring a much longer healing period.) The doctor cuts the transverse carpal ligament, thus allowing more room for the median nerve and flexor tendons to pass without pressure.

You should be aware that there is a drawback to having the endoscopic procedure. The doctor can't always see very well and he might clip the nerve. That would mean permanent disability (and probably a malpractice suit). The doctor must be highly reputable and recommended by someone you trust. Then you must have faith in him and think only positive thoughts.

If you have this problem, I do not believe that any conservative treatment will help. Just speaking from my own experience, I believe that surgery is the only answer, and the sooner the better. I see these "wrist rests" and other little props advertised, but I don't believe they are anything more than a placebo. Once the damage is done, it must be repaired, not coddled. Maybe by now you're thinking you might have CTS or be prone to it. I hope this article has made your "light bulb" come on in time for you to avoid surgery.

Do One at a Time

But if not, and the answer for you is surgery, don't let anybody tell you that you can have both hands done at the same time. Don't even think about it. (There's a TV commercial for a hand surgery center that shows a woman sitting in a chair with both hands all bandaged up. I can't believe they sell that idea. Forget it!)

I could do very little with my left hand while my right hand was all bandaged, but at least I could do some things (like personal hygiene, for goodness' sake!). Having both hands all bandaged up at the same time would mean having full-time help for the most menial and basic tasks.

For me there was a time that both hands were bandaged, but I could do some things with the first one. I still remember during the recuperation, telling my parents: "Every day it gets a little easier to squeeze the toothpaste tube. I lay it on edge of sink and mash it with my elbow." Milk had to be put into small containers which I could lift with my somewhat free hand and my elbow.

Post-Surgery Learning Opportunities

Of course, we never have problems. We have "learning opportunities." I had many new ones after this experience–ranging from mental to physical.

First of all, I had to have somebody to drive me home from the hospital. I live alone, and fortunately, I have a friend who does not work and was able to accompany me. I don't know what I would have done without her. But giving up control (the "C Word") was difficult. I remember thinking to myself: "Thank God I'm not paralyzed. It will pass." And it did pass.

The bandage is very large–looks sort of like a club hand. And it won't fit through any sleeves, so none of your clothes will work. You will need to find something to wear that will accommodate a large club at the end of your arm. That means no sleeves or big sleeves. Capes are wonderful.

You cannot–absolutely cannot–get the bandage wet. A couple of years ago I had surgery to both feet at the same time (caused, of course, by those wonderful shoes that look so great on our feet), and believe it or not, it was easier to take a bath with both feet hanging over the bathtub than trying to do everything with one hand this time!

Your first surgery will probably be to your dominant hand. Luckily, I thought of not being able to write checks for two or three weeks. I signed a whole book of checks in blank at the hospital, literally five minutes before being wheeled in to surgery! That made a really big difference, because I would not have been able to write a check for groceries, prescriptions, regular bills, or anything. This way, someone was able to fill them out for me, pay my bills, and get the things I needed.

What About After the Surgery?

The after-surgery pain was not unbearable for me, and I used very few of my prescription pills. As a matter of fact, I used the same prescription for all the surgeries and still had some left. My major problem was the inconvenience of being laid up, dependent on someone else for help, and not being able to do things like put on makeup or wear something nice. If you look awful, you feel worse.

A lot of pain is mental, anyway. I believe that if you want to tolerate it, you will. If you thrive on others' sympathy, you'll probably hurt a lot.

On the other hand, some people have a very low pain threshold. If you're one of those people, by all means, take the medication–whatever it takes. The Graedons (Joe and Dr. Teresa), who write a syndicated newspaper column, recently pointed out that "the war on drugs has done people in pain a terrible disservice by discouraging adequate treatment" because of fear of addiction. A number of studies show that people tend to use an appropriate dose to keep from being sidelined by pain and do not let the drug take over their lives. They conclude with "Suffering is not good for the body or the soul," and I concur.

My worst problems after surgery were the mental and emotional problems caused by the following:

–You can't get dressed, so you're really housebound. I was not able to put on makeup or do my hair or find any clothes to wear that looked decent. Pantyhose are OUT, so that means you wear pants. Even knee highs and socks are pretty difficult to pull up.

–I had to go to a beauty shop or have a friend come over and do my hair. Just washing it was a real challenge.

–If you're not able to admit you're helpless and let someone help you, you become very frustrated. If you are going to have this surgery, realize at the outset that you will need help with nearly every little thing and accept it graciously.

–You can't get any reading done, because it's impossible to hold up a book, or even a magazine, for more than a very few minutes.

–You can't talk on the telephone, because you can't hold the phone up, either. Before you have this surgery done, make sure you get a good shoulder rest for your telephone at home. Then ask your friends and coworkers to not call you unless it's absolutely necessary.

–You must faithfully do the post-surgery exercises. That takes discipline, but it is essential to complete recovery. In addition, on days when you do a lot of keyboarding, you will probably need anti-inflammatory drugs to keep internal swelling to a minimum.

–Even though I returned to work for a few days between the surgeries, and a week after the second one, it was to be about nine months before everything was really back to normal.

Some Good Things

But some really good things came from this experience.

(1) The surgery brings instant relief.

(2) The freedom of being able to sleep at night is like a Godsend. I seemed that I had slept a total of two hours during the last weeks before surgery. Now I really appreciate every wink!

(3) I learned to "listen to my body." The project I am working on is not more important than my well-being. I stop every hour or so and remind myself of my own importance.

(4) I have a great black cape now, that is more useful than any wrap I have ever owned. I was forced to find it when my super-bandaged hands wouldn't fit through any sleeve.

(5) I learned a lot from being able to watch afternoon shows on PBS and other educational channels.

(6) I have a greater appreciation of being able to work.

Post Script

A few months after I resumed work, it started to come back. The numbness and tingling started again. I couldn't believe it! The problem turned out to be with my hands turned upward from the wrist while keyboarding. A new product on the market from Proformix lowered my keyboard, making my hands work in a straight line down from my arm, and the problem completely disappeared and has not returned. I haven't had an anti-inflammatory in a year. The situation is being managed, successfully. And I'm still writing!