Putting the wrist at risk

Gerald W. Deas M.D., MPH | 4/26/2018, 2:46 p.m.

My mom was a laundress. Yes, she washed and ironed clothes for the elite for a living. I can recall how she would stand over a tub of hot water filled with suds from a soap named Duz. She would also use OK soap to remove stubborn stains. She would scrub the clothes repeatedly against a washboard until they were snow white. She would then wring them with a forceful twist to get out excess water before hanging them out on the line stretched from the second floor to a pole in the backyard. The wringing of the clothes put a strain on her wrists. Those beautiful hands that prepared meals, sewed on missing buttons and performed a host of other household duties began to experience numbness and pain, but she never complained. I used to see her sitting and rubbing one hand over the other repeatedly.

I know now, as a doctor, that she was experiencing a common condition known as carpal tunnel syndrome. This condition is caused by a compression of the median nerve. The nerve leaves the spinal cord and travels down the arm. When it gets to the wrist, it has to go through a tunnel, which is made of tissues. The nerve is distributed to the palm of the hand, thumb and three fingers next to the thumb. If this tunnel becomes inflamed and filled with fluid, compression of the nerve occurs, which leads to symptoms. CTS is caused by repetitive movements of the wrist, such as wringing out clothes as my mom had done, typing, excessive use of the keyboard with computers, excessive use of screwdrivers and other tools, piano playing, shucking oysters and clams and a host of other wrist movements.

CTS has been associated with diabetes, hypothyroidism, pregnancy, oral contraceptives, alcoholism, smoking, obesity and lack of exercise. Women are more affected than men, and the condition is rare among children. It is easily diagnosed with the use of electro diagnostic studies. That’s just a study to see whether a nerve is conducting an impulse adequately from the wrist to the hand.

The treatment of CTS varies as to its severity. Often, a wrist splint (which keeps the wrist from moving) combined with a painkiller such as Tylenol or Motrin, can reduce the symptoms. This treatment, however, does not cure the condition. It has been found that vitamin B-6 (299 mg per day) can help. The injection of corticosteroids into the tunnel often helps to reduce the inflammation, thereby reducing compression of the nerve. If all medical approaches fail, surgery can be the answer. CTS surgery is done to reduce the compression on the nerve.

My mom didn’t have all of these options and therefore had to live with the condition. On reflection, I don’t know how the old folks did it. Imagine, with knee pain from standing and numb hands from wringing clothes, my mom could still smile, cook, sew and hug her grandchildren.