Girl relaxing outside with laptop

As a board-certified musculoskeletal specialist physician, one of the more common conditions that I diagnose through nerve-testing, especially in patients who keyboard extensively, is carpal tunnel syndrome (CTS). This condition is due to a pinching of the median nerve as it courses through a bony tunnel in the wrist.

The symptoms of CTS are fairly constant across patients. Affected individuals tend to complain of numbness, tingling, pain, and swelling, usually in the index, long, or ring fingers, but sometimes also in the thumb. Frequently, they experience worsened symptoms while putting on make-up, doing their hair, and/or driving. Occasionally, they complain of symptoms radiating up into the forearms, and a small minority of patients even complain of shoulder pain.

Though CTS can occur in healthy individuals, it is even more likely to occur in those who are diabetic, hypothyroid, or heavy consumers of alcohol. At the outset, the numbness, tingling, and pain are usually worse at night, often waking the patients from sleep, but sometimes the symptoms are worse first thing in the morning or later in the day.

Patients sometimes accidentally drop small objects, like pens, spoons, and coffee cups. Eventually, the symptoms may become constant and/or severe.

The main diagnostic test for CTS is called an Electrodiagnostic study, sometimes abbreviated as an "EMG." I've personally performed many thousands of these tests and I can assure you they're an unpleasant but necessary part of your medical work-up. The first part of the EMG involves a series of quick and strong electrical zaps over the nerves being tested, and the second part involves a fine wire that is inserted through the skin for the purpose of measuring the muscles’ electrical irritability.

Early treatment for CTS generally consists of wrist splinting at night, along with non-steroidal anti-inflammatory medicines. Carpal tunnel steroid injections may be utilized, and, if they don’t work, surgery is usually the last option.

Like with many other conditions, an ounce of prevention is worth a pound of cure. Optimize your chair and desk height so that your wrists remain in “neutral” position (i.e. straight) as you keyboard, maintain tight control of your blood sugar if you’re diabetic, minimize alcohol consumption, work with your physician to optimize your thyroid hormone levels, avoid bending your wrists at night by wearing wrist splints, and take frequent rest breaks from keyboarding—like I’m going to do right now!

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