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Surgery Beats Splints For Carpal Tunnel 42

Rio writes: "A local6.com article tells us about a study that suggests surgery may be more effective than splints for treating carpal tunnel syndrome. In the study, 87 patients underwent open carpal tunnel release surgery, in which ligaments surrounding the median nerve are cut to relieve pressure on the nerve, compared to 89 patients who wore a splint for their wrists, which reduced movement. The researchers found that the surgery left 80 percent of patients significantly improved after three months. Splints left only 54 percent significantly improved."
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Surgery Beats Splints For Carpal Tunnel

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  • by Otter ( 3800 ) on Tuesday September 10, 2002 @05:40PM (#4232484) Journal
    Be careful with the splints. In my experience (anecdotal, obviously) people who tried splints for tendonitis or carpal tunnel problems quickly found themselves going from bad to worse, and improved when they abandoned the splints in favor of being careful.

    My impression is that they can cause your muscles to atrophy and fall out of balance. Anyway, be careful with them.

    • CTS is caused by the (SPELLING ALERT) Carpal Tunnels swelling after being made sore by being repeatedly rubbed by the tendons. ANYTHING that pushes the together is going to make it worse!

      The BEST thing to do is NOT TYPE! I know it's difficult, but you can quickly do real damage.

      Now firstly - you can help to stop yourself from getting CTS (there other kinds of RSI) by not leaning on your wrists when you type, of you can get a desk without a sharp corner at the edge that's good too. The worst thing for CTS is the mouse - (probably true for other RSIs) the repeated action of clicking coupled with the odd postures you get into (arm outstreched clicking something on the extreem right) make the mouse even worse than typing.
  • try exercising (Score:3, Insightful)

    by Kraft ( 253059 ) on Tuesday September 10, 2002 @06:27PM (#4232937) Homepage
    I started using one of these [repetitive-strain.com] two weeks ago, and I am experiencing an improvement. I don't know if it's CTS I have, but I have problems sleeping due to swelling. Check them out.
    • Re:try exercising (Score:2, Insightful)

      by Nohea ( 142708 )
      I has tendinitis years ago, and the things that helped me were proper positioning (without any brace things), and exercise.

      If your muscles are strong enough, there's less stress on the tendons and ligaments. Within a month of easing into weightlifing, i could feel the pain going away.
  • by Tom7 ( 102298 ) on Tuesday September 10, 2002 @06:36PM (#4233013) Homepage Journal
    What do you know? A more drastic and invasive procedure has a greater effect. Except, splints cost $6, and surgery costs thousands and leaves you without the use of your hands for weeks.

    • Yeah, but they make less for the medical industry.

      I thought the finding that surgery "should be the first rather than the last option" was pretty egregious.
    • What do you know? A more drastic and invasive procedure has a greater effect. Except, splints cost $6, and surgery costs thousands and leaves you without the use of your hands for weeks.

      A drastic procedure does not necessarily mean greater (as in better) effect. For instance, it is has been shown in recent years that surgery for severe ulcer does not have an effect, contrary to what has benn believed for a long time. If people have been "cured" by such procedures, it has been a pure placebo effect! In fact, without reading the article (hey this is /.!), I am thinking that the very fact that people have to rest their wrists after surgery could have something to do with the better results!

      Lars

    • This is pretty encouraging. It also draws a terrible conclusion.

      Seems to me that better than 50% odds means that splints help most people. Surgery continues to be an option after using splints, but I'm not sure how much use splints are once the surgical recuperation is over.

      I also suspect that people who have surgery have little choice but to really not use their wrists.

      I don't think most people have any idea how seriously to take RSI. I think the words "permanent" and "crippling" should be used more often. I've seen both.

      I'm surprised by the conclusion suggesting surgery as a first resort before splinting too. That violates the medical principle the parent was implicitly referring to, of using the least invasive and drastic procedures first when they show promise.

      Sounds to me like we need to do a better job of encouraging people limit their typing once they start to suffer (or worse, as I've seen, taking splints off because they make typing hard.)

      As the admin, I get the requests for ergo gear. I do my damndest to encourage use of whatever we can make available. Ergo keyboards, keyboard trays, trackballs, tablets, and ultimately rest. I also think excercise and variety are important. If all you use your fingers for is typing, you'll use them up.

      Now, it also sounds like I have a book to read & put on the shelf for my people. Is the RSI handbook by Quilter well regarded by the Slashdot Science readers? Lots of people have lots to say, but it isn't all right.
    • Actually, you should never automatically assume that doctors actually know what they are doing. They usually don't. There's lots of treatments that they no longer do when somebody actually measured whether it works or not, and there's plenty of treatments they haven't checked yet ;-)

      I also consider it interesting that they missed out the treatment that works better than splints- exercise!

      Wonder why doctors would ever do a study that is likely to show that an expensive treatment involving lots of doctors is better than one that involves hardly any, or only physiotherapists. Hmmm. Tricky.

  • by one9nine ( 526521 ) on Tuesday September 10, 2002 @09:18PM (#4234155) Journal
    Funny this article should appear today, last night I couldn't get to sleep because of a really sharp, throbbing pain in my wrist.

    Does anybody use ergonomic keyboards at home or work? Which ones are the most recommended? I had a Microsoft ergonomic keyboard at work and thought it worked fairly well. In particular, I was hoping to get some feedback on the Kinesis Contour keyboard [kinesis-ergo.com]. It's way more expensive ($239 to start) than the Microsoft keyboards so I wanted to see if anybody had success with it (or even liked typing with it since it is so different) before I purchased one.

    Oh, and does anybody use the Dvorak layout?
    • I've been living with this sort of pain for a couple of months now. At first, I thought about getting an ergonomic keyboard. When I started doing some research, however, the view held by almost everyone (including my doctor) was that ergonomic keyboards are a waste of money. It's much more important to be aware of how you type and not keep your hands in a dangerous posture etc., than to use a specially-shaped keyboard.

      The RSI page [unl.edu] has a lot more info on the subject. Good luck!

    • The best keyboard you can get is the one you use correctly. Get your wrists off the desk, back away from the keyboard until your arms are at length and sit up straight. If your posture looks like a concert pianist you probably won't have pain.

      Also, don't forget to look at your other activities. Your pain might occur while you are typing, but it might be caused by something you do after work that strains your wrists. I tried lots of things before I found out that my pain was caused by how I was playing racquetball, and not by my typing. Now I can type all day again.
    • As a sufferer of CTS (fortunately, early stages, meaning I can still recover fully if I don't keep pissing my median nerve off too badly), I looked into quite a lot of the various "ergonomic" crap on the market.

      First of all, realize that, while "experts" say these will help, unlike any real FDA approved medical device, these have NO EVIDENCE WHATSOEVER that they will help. Not one whit. A few manufacturers include some "studies" that carry no more weight than anecdote. Do not mistake that for actual clinical trials.

      Mind you, I looked into this issue about three years ago and have not repeated it, for the reason I will now give:

      You don't need "special" equipment to reduce strain on your wrists/back/neck/whatever. Just rearrange your environment to better accomodate you.

      For example, I have personally found that the single most effective (and cheapest, and easiest) way of making my hands hurt less at night requires nothing more than lowering my chair's arm wrests and placing the keyboard in my lap. Yup, nothing more, and it means the difference between waking up in pain, and sleeping well with nary a tingle (or none strong enough to bother me).

      I prefer typing to using a mouse, so for the opposite sort of person you might find it works better to putthe mouse in your lap and leave the keyboard on the desk.

      Another simple change - place your monitor so if you look straight ahead, your eyes fall approximately 3/4ths of the way up the screen (I've seen suggestions to line your eyes up with the very top of the screen, but that made me *more* uncomfortable in terms of neck and eye strain).

      As the only other "important" point, try to arrange yourself so your knees and elbows form an obtuse angle. Sharp bends decrease blood flow to the ends of your limbs, and increased blood flow correllates HIGHLY with increased rate of tissue repair.

      Finally, a note on drugs... Believe it or not, most doctors use naproxen (Aleve) as the first-line drug of choice for early CTS. This helps some people, and does nothing for others. Personally, I use it when I *know* I've done too much during the day (or will have to for a big project or the like) and my wrists *will* hurt, and it seems to help somewhat. Some people seem to believe that it will let you damage yourself more by "hiding" the pain. In the case of CTS, that does not hold true... The cause of the pain, the pain itself, and the resulting long-term damage all result from the same thing - inflammation. Reducing that (which naproxen does) reduces the pain *and* long-term damage. Only if you use an opiate painkiller, like Vicodan, do you need to worry about the drug letting you cause more damage to yourself by ignoring the pain (in the case of CTS only... I don't mean that to apply to *all* sources of pain, obviously).

      Disclaimer: I do not have a license to practice medicine. I only offer this as an example of what worked for me. It might screw you up even more, for all I know.
  • by TheOnlyCoolTim ( 264997 ) <tim.bolbrock@noSpAm.verizon.net> on Tuesday September 10, 2002 @09:31PM (#4234212)
    I started to get the slight tingling and tightness in my wrists, so I found this exercise which I do a little bit and has made this go away.

    1. Start with your arms straight out in front of you, the wrists roughly in a line with the arms, and the fingers relaxed.

    2. Bend the wrist upwards as far as possible while also extending the fingers as far as possible. Hold for a count of 5.

    3. Return the position in step 1.

    4. Make a tight fist, then bend the wrist downwards as far as possible. Count to 5.

    5. Return to the position in step 1, and this time hold it for a count of 5.

    6. Repeat.

    Tim
  • by ClintJCL ( 264898 ) <(clintjcl+slashdot) (at) (gmail.com)> on Tuesday September 10, 2002 @11:42PM (#4234861) Homepage Journal
    There is an external adapter that allows you to use a Microsoft Ergonomic Keyboard on a SparcStatin/Sun Solaris Box.

    You can even mess with xmodmap and invert caps lock and control, the way it is supposed to be on those boxes.

    It's $80. I think most of the money is the fact that Sun beeps come from the KEYBOARD not the pc speaker, so the adapter has to intercept ^G and beep itself (it does). Freaky stuff.

    It also allows you to use a normal serial mouse (Crystal Trackball!!!!!!).

    I forget the part number but if people email me and ask me I can look it up, and maybe even supply my xmodmap file if you're that lazy.

    But it exists!

    You will hold the envy of your crippled coworkers.

  • I learned when I was a kid taking piano lessons to keep the wrists up, and let the fingers fall naturally to the keyboard. Interestingly enough, I heard the same message when I took a typing class.

    Do you think maybe the experience of millions of people who have been using keyboards for hundreds of years may be right?

    Everytime I find my wrists hurting, it is due to bad form, and practicing good form is what makes the pain go away.

    Happy hacking!
  • by mildness ( 579534 )
    Surgeons have expensive habits to support.

    Know this. If you seek medical advice each doctor will recommend his speciality. It's whatever tool is handy. Surgeons think they can cure anything with a knife.

    Do your own research by talking to actual patients. If you talk to a few people that have had CTS surgery you will soon be talked out it.

    Look into ergonomic solutions, massage therapy, abstinence from computers (that or stop masturbating, your pick), exercise, etc.

    Cheers,

    Beal

  • "ligaments surrounding the median nerve are cut to relieve pressure on the nerve" Sounds like a case like the cure being worse than the disease to me
  • Since the unnatural contortions and stresses that lead to carpal tunnel seem to stem from typing while resting your wrists in front of the keyboard the absurdly simple solution would be, hey, don't do that.

    I've often pondered how it happened that I've managed to use a computer continuously for the past decade without developing CTS while I've had friends have to quit after three years in similar jobs.

    The answer? I had shitty computer furniture early on. It was too small. I hated the fucking thing. But, because the keyboard was forced right up to the edge of the desk, I got in the habit of hovering over the keyboard rather than resting my wrists in front of it.

    Now, even though I could get a good four inches of desk in front of the keyboard, I still have my hands floating above the table top as I type. Plus, I suppose I get some small amount of exercise by supporting the weight of my arms... heh.

    I am not a doctor, o' course, so don' go tryin' this jus' cuz I sez it works fer me.

  • From my own experience (and everyone else that I've shared this with) taking Manganese works better than anything else out there. The medical logic behind it is that it will strengthen the ligaments, which will then hold the tunnel in a more open and rounded position, relieving the pressure that causes the problem. You know, solve the problem not the symptoms and all that. My personal (and definitely non-medical-professional, after all I don't even play a doctor on television) suggestion is that you go out and get a bottle of Manganese (NOT Magnesium, Manganese is a little harder to find but any health food/vitamin store should have it) and take twice whatever they say is the suggested dosage for the first week or so and than just take the regular dose every day after that. It'll probably cost you less than $10 to give this a shot.
  • Other things like thoracic outlet syndrome can masquerade as carpal tunnel. The RSI handbook by Quilter has lots of good information and exercises. The posture and blood flow in your entire body are important for reducing computer RSI. In my case it was tight pectoralis minor muscles impinging on the nerves higher in the arm.
  • Yeah, but the 46% of patients who weren't helped by the splints can then go and get the surgery. What do you do if you're the 20% of people who the surgery doesn't work for?
    • >20% of people who the surgery doesn't work for
      That's the statistic for outcome at 3 months, but the original research article says that by 18 months, 90% of the surgery subjects were improved. And, 41% out of the splint group went on to get the surgery during that time.
      An interesting statistic that doesn't make it into the popular press is this one, quoting the JAMA article,
      " After 18 months, only 29 of 79 patients indicated to be improved by splinting alone, resulting in a final success rate of 37% for the splint group."
      So, your point about the people who are not helped by splints going on to get surgery is a good one, but in the slightly longer term, the choice looks like 90% chance of cure vs 37% chance of relieving symptoms.
  • and got the results of my nerve test back. (They stick needles in ya and zap you with juice to see if your nerves are pinched). I left after being told that my nerves were perfectly fine, and that I need to stop or lessen to a considerable extent what I do. (Graphic Design)

    I now work 6 hours a week (ordered by doctor) with an option for more, if the pain doesn't go away.

    My suggestion would be to make sure you have good posture (back straight), that you are above the keyboard and in front of it (you'd be surprised how people type) and make a point of stopping and stretching every 5-10 min. (for 30 sec to a min or two.)

    All these things have helped, but YMMV.

    Oh I also stopped playing drums and guitar for 4-5 day. (though those didn't hurt...hmmm)

    Rock more, work less. That'd be swell.

  • So, I haven't run into this problem yet (hopefully never will) but if I do and require surgery, what kind of effect will this have on the overall strength of my wrists? I rock climb and lift weights on a regular basis. In both of those, I need strong forearms and strong wrists, is cutting the tendons in there holding everything together going to negatively affect my other pursuits?

    Also, just a comment for those who haven't developed it yet, I suggest start working the muscles in your arms and forearms. Strengthen your fingers. I don't know if it helps, but I know every programmer I climb with, has not had any problems w/ carpal tunnel.

  • You've just inspired me for my next article! I'm a fitness trainer and I can't tell you how many people ask me about how to relieve the unpleasantries of carpal tunnel syndrome. Well, I also produce a web site called www.fitnessmarker.com and needed some fresh fodder for my next article. Please look for it off of the Tricks and Truths section, give it a day or so. Thanks for your inspiration! Rich Certified Personal Trainer

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