Carpal Tunnel Syndrome

July, 2006

What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is a disorder of the hand that is caused by pressure on the median nerve, usually resulting from swollen tendons in the wrist. The “carpal tunnel” is actually a narrow tunnel formed by the bones and other tissues in the wrist. Nerves, tendons, and ligaments pass through this tunnel to the hand. Repetitive motions, vibration, or stress day after day can cause the tendons to swell, become inflamed, and compress the median nerve.

Dimensions of the Problem
Carpal tunnel syndrome (CTS) results in the highest median number of days of work loss among all major work-related injury or illness categories (Repetitive Motion Disorder/Carpal Tunnel Syndrome, 2001). In the past ten years, the medical literature has reported increasing numbers of cases of working people afflicted with CTS. Reasons for the increases of cases seem to be largely due to job automation and specialization (NIOSH).

There were 849,000 cases of 3.4 million doctor office visits for CTS in 20040 and approximately 260,000 carpal tunnel release operations were performed in 2000, with approximately 47% of these being work related (NCHS).1, It is estimated that the economic burden of CTS to industry in the United States currently exceeds $2 billion per year (Palmer and Hanrahan, 1995).

Treatment for CTS
Standard medical treatment usually begins with a wrist splint, resting the affected hand, and anti-inflammatory medications. Sometimes, the workplace can be modified to avoid repetitive motion, undue stress, and strain. Surgery is recommended if these initial treatments or steroid injections fail to relieve the pain, numbness, or weakness. Full use of the hand usually returns approximately six weeks after surgery. As with any surgical procedure, there can be complications such as infection, bleeding, or unintended injury to other tissues.

Mind/Body Treatments for Pain and Other Symptoms
Mind/Body effects are part of almost every health-related issue. Patients with pain symptoms can clearly benefit from relaxation techniques, hypnosis, cognitive-behavioral therapy, and meditation (Berman and Swyers, 1999; Carroll and Seers, 1998; Diette, Lechtzen, et al, 2003). Imagery has been shown in dozens of research studies to affect almost all major physiologic control systems of the body, including heart rate, blood pressure, metabolic rates in cells, and even immune responsiveness. Imagery has been shown to be especially helpful in working with pain.

In a study involving patients with another repetitive motion injury were treated with biofeedback, relaxation training, or a combination of both. Patients in all three treatment groups showed significantly greater reductions in pain than the control group. Patients receiving relaxation training showed the strongest short-term benefits on measures of pain, distress, interference in daily living, depression, and anxiety (Spence, Sharpe, et al, 1995).
In another study treating repetitive strain injuries, patients using hypnosis with biofeedback showed significant increases in hand temperature, with significant reductions in pain, compared to the control group (Moore and Wiesner, 1996).

Used as a complementary treatment, a low-cost guided imagery program can help patients cope better with their CTS, reduce their CTS symptoms, and save healthcare resources.

Berman BM, Swyers JP. Complementary Medicine Treatments for Fibromyalgia Syndrome. Baillieres Best Pract Res Clin Rheumatolog. 1999 Sep;13(3) :487-92.

Carroll D, Seers K. Relaxation for the Relief of Chronic Pain: A Systematic Review. Journal Adv Nursing, 1998 Mar;27(3) :476-87. Moore LE, Wiesner SL. Hypnotically-induced Vasodilation in the Treatment of Repetitive Strain Injuries. Am Journal of Clinical Hypnosis. 1996 Oct;39(2) :97-104.

Diette GB, Lechtzin N, Haponik E, Devrotes A, Rubin HR. Distraction Therapy With Nature Sights and Sounds Reduces Pain During Flexible Bronchoscopy. A Complementary Approach to Routine Analgesia. Chest. 2003 23:941-948.

National Center for Health Statistics, cited in National & International Statistics for Carpal Tunnel Syndrome and Other Associated Repetitive Strain Injuries of the Upper Extremity. Balance Systems, Inc.
Accessed July, 2006September, 2003.

NIOSH Facts – Carpel Tunnel Syndrome. National Institute of Occupational Safety and Health. 1997. June. www.cdc.gov/niosh/ctsfs.html
Accessed July, 2006

Moore LE, Wiesner Sl. Hypnotically-induced vasodilation in the Treatment of Repetitive Strain Injuries. Am Journal of Clinical Hypnosis. 1996 Oct;39(2) :97-104.

Palmer DH, Hanrahan LP. Social and Economic Costs of Carpal Tunnel Surgery. American Academy of Orthopaedic Surgeons, Instructional Course Lectures. 1995 44:167-72.

Repetitive Motion Disorder/Carpal Tunnel Syndrome. Handbook of Disabilities. Curators of the University of Missouri & RCEPT7. 2001 http://www.rcep7.org/projects/handbook/repetitive.pdf
Accessed July, 2006Sept. 2003.

Spence SH, Sharpe L, Newton-John T, Champion D. Effect of EMG Biofeedback Compared to Applied Relaxation Training with Chronic, Upper Extremity Cumulative Trauma Disorders. Pain. 1995 Nov;63(2) :199-206.