Sunday February 25, 1996

Exercising at the start of work, during breaks helps prevent carpal tunnel syndrome

A team of orthopaedic surgeons has developed special exercises that can help prevent carpal tunnel syndrome (CTS).

The exercises, which should be done at the start of each work shift and after each break, decrease the median nerve pressure responsible for CTS, according to the results of a study presented Sunday in poster exhibit D 29.

In addition, the research also determined that newly-diagnosed carpal tunnel syndrome patients should not do everyday activities such as ring a doorbell, hold a coffee cup, or push a shopping cart with the affected hand for the first seven to 10 days of conservative, nonsurgical treatment.

These simple activities were found to substantially increase intra-tunnel pressure on the median nerve of the wrist, thus worsening the condition, said senior author Houshang Seradge, MD, clinical assistant professor of orthopaedic surgery, University of Oklahoma Health Sciences Center. Oklahoma City.

"Any hand/wrist movement will actually reduce the benefit obtained by wearing a wrist brace/splint," said Dr. Seradge.

Dr. Seradge said that for optimal effect, the CTS patient's hand must be immobilized completely-except for regimented hourly exercises-for at least one week. Then the patient can slowly go back to simple activities.

In the study, orthopaedic researchers measured the pressure on the median nerve in functional positions of 102 hands (92 people). A total of 81 hands had documented carpal tunnel syndrome; the remaining 21 served as controls.

"The median tunnel pressure in the resting position in CTS patients was nearly double that of the control group-43.8 mm/Hg. versus 24 mm/Hg.," said Dr. Seradge.

Whenever a participant made a fist, pointed a finger, or pushed an object, the pressure increased significantly. "For workers with carpal tunnel syndrome, these simple actions could influence their outcome," he said.

The orthopaedic surgeons then gave the patients the special exercises and measured the pressure again. "After just one minute of active or passive exercise of the wrist and fingers, the pressure dropped and remained below the resting intra-tunnel measure for over 10 minutes of continuous measurement."

Dr. Seradge said that workers with hand-intensive jobs should do a five-minute exercise warm-up before starting work, just as runners stretch before a run to prevent injury. The exercises are:


Extend and stretch both wrists and fingers acutely as if they are in a hand-stand position. Hold for a count of 5.


Straighten both wrists and relax fingers.


Make a tight fist with both hands.

Then bend both wrists down while keeping the fist. Hold for a count of 5.


Straighten both wrists and relax fingers, for a count of 5.


The exercise should be repeated 10 times. Then workers should let their arms hang loosely at their side and shake them for a couple of seconds.

Depending on the type of work, employees should also do a slow isometric and isotonic exercise for posturing and toning of neck and arms, Dr. Seradge said.

In addition to keyboard operators, factory workers, and typists, also at risk for carpal tunnel syndrome are workers whose jobs require holding actions, such as barbers and bus drivers.

"In the long run, daily exercises, combined with job modification, will save employers money that they would have had to spend on carpal tunnel syndrome surgery for workers," said Dr. Seradge.

Co-authors of the study with Dr. Seradge are Medhi N. Adham, MD, and Wilafred L. Parker, P.A., both of Oklahoma City.

Exercises

(at the start of each shift and after each break)

  1. Extend and stretch both wrists and fingers acutely as if they are in a hand-stand position. Hold for a count of 5.
  2. Straighten both wrists and relax fingers.
  3. Make a tight fist with both hands. Then bend both wrists down while keeping the fist. Hold for a count of 5.
  4. Straighten both wrists and relax fingers, for a count of 5.

Repeat exercise 10 times, then hang arms loosely at side and shake them for a couple of seconds. Total exercise time: 5-10 minutes.

Source: Poster exhibit D-29, annual meeting, American Academy of Orthopaedic Surgeons, Feb. 25, 1996.

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