Friday, 11 August 2017 17:03

Carpal Tunnel Syndrome – Get a Handle on It Early to Prevent Long-Lasting Damage Featured

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The sooner carpal tunnel syndrome is diagnosed and treated, the better the chances for symptom relief, according to experts at Hospital for Special Surgery (HSS) in New York City. Unfortunately, some people go undiagnosed for years, and by the time they see a doctor, it’s more difficult to reverse the damage.

cts“When you think of carpal tunnel syndrome, it often brings to mind someone working on a computer keyboard and wearing a wrist splint. In reality, it can affect just about anyone,” says Dr. Daniel Osei, a hand surgeon at HSS who has seen the condition in adults of all ages, with all kinds of jobs. Symptoms can range from relatively mild to quite severe and include pain, numbness, tingling and weakness in the hands and fingers. In many cases, it’s difficult to pinpoint a specific cause.

The condition arises from too much pressure on the median nerve - one of the main nerves in the hand that travels from the forearm to the palm through a narrow passageway in the wrist known as the carpel tunnel. The compression of this nerve causes symptoms. It usually affects the thumb, index, middle finger and ring finger. Sometimes the pain travels up the arm. Women are affected two to three times as often as men, and many people experience symptoms in both hands.

“It’s not uncommon for me to see patients who’ve had subtle pressure on their median nerve for decades, but the symptoms previously weren’t severe enough for them to pay much attention,” he says. “When the condition goes on for that long and is finally diagnosed, it’s more difficult to restore normal hand function.”

In advanced stages, people can lose feeling in their fingers, experience severe weakness in their hands and lose grip strength. They may feel clumsy and start dropping things; their handwriting may have gotten worse; they’re no longer able to button a shirt; they have trouble picking up coins or a glass of water.

Fortunately, most patients don’t get to that point. One of Dr. Osei’s patients, who received a timely diagnosis and treatment, described her symptoms: “My fingers were getting numb and tingly, and my forearm hurt, especially at the end of the day. Sometimes it felt like I had stuck my finger in a light socket. The pain even went up my arm into my shoulder. It was really, really uncomfortable and very hard to sleep.”

Her medical history, physical exam, and EMG testing, which measures the electrical activity of nerves and muscles, confirmed the diagnosis of carpal tunnel syndrome. Other conditions were also ruled out. Her first line of treatment included wearing a splint and receiving a cortisone injection, which helped.

She ultimately opted for surgery to seek permanent relief. A common outpatient procedure, it entails removing the “roof” of the carpal tunnel to make more space and relieve pressure on the nerve. Hand surgeons do this by cutting a ligament in the wrist through a one-inch incision. The procedure takes about a half hour and is performed under local anesthesia. Just one week after surgery, she said her hand was feeling better.

“With timely diagnosis and treatment, we find that there’s a high level of patient satisfaction,” Dr. Osei notes. “The pain often gets better quickly after surgery, and symptom relief is expected to be long-lasting.”

It’s more challenging to reverse damage in patients who’ve gone undiagnosed for an extended period, according to Dr. Osei. Over time, pressure on the median nerve causes muscles at the base of the thumb to waste away. This in turn causes weakness, leading to a loss of grip strength. People generally don’t notice that their hand looks different due to muscle atrophy until the doctor points it out to them.

Once an individual starts losing grip strength, surgery is often considered so the damage and disability don’t get worse. Without treatment, normal activities of daily living can become increasingly difficult as the nerve and muscles deteriorate further. The ability to bathe, to get dressed and to use utensils may be affected, and quality of life will suffer.

“For these patients, surgery will relieve the pain and prevent carpal tunnel syndrome from causing additional damage,” says Dr. Osei, “although the loss of sensation and numbness in their fingers will likely take some time to get better.”

Risk Factors for Carpal Tunnel Syndrome

While anyone can develop carpal tunnel, it’s more likely to occur if there’s an injury or other medical condition that causes pressure on the median nerve. People who have diabetes, an underactive thyroid, a disease that causes inflammation such as rheumatoid arthritis, or a very small wrist are at greater risk. Frequent use of a computer keyboard, manual labor and other repetitive activities using one’s hands can make carpal tunnel worse. There’s no firm evidence that texting causes it, but it can exacerbate symptoms in susceptible individuals, according to Dr. Osei.

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  • Postgrad course on exercise as medicine is being proposed

    Dear prospective applicant,

    A proposal for a postgrad course on physical activity (PA) as a therapy for non-communicable diseases is currently being evaluated. Hereunder, a two-question survey is being forwarded for your attention in order to assess whether the idea sounds appealable or not.

    Proposed award

    M.Sc in Therapeutic Physical Activity (TPA), with postgrad certificate (PgC) and postgrad diploma (PgD) exit routes

    Proposed specialisation titles[1]

    Holders of PgC, TPA can claim the title of: ‘Clinical exercise prescriber’.

    Holders of PgD, TPA can claim the titles of: ‘Advanced exercise prescriber’ or ‘Clinical and public health exercise prescriber’.

    Holders of M.Sc, TPA can claim the title of: ‘Physical activity - health specialist’.

    Are you sure you know why physical activity is so important?

    Everyone is aware that physical inactivity is a major health concern but, do you know that through the right type of exercise you can prevent or treat at least 35 chronic conditions? In 2007 the American College of Sports Medicine officially declared an important statement: ‘Exercise is medicine’. Moreover, health-enhancing physical activity (HEPA) is important in today’s world not only in view of improving health and wellbeing but also for its economic values. For example, a lifestyle intervention involving 150 minutes of weekly PA was scientifically shown to be significantly more effective than the administration of metformin.

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    Exercise prescription, that is, being qualified to professionally recommend the right type of exercise for health does not stop on a one-to-one basis. Do you think you are qualified to: (a) conduct research on PA interventions, and (b) develop, implement and evaluate community or population programmes involving PA strategies? Unfortunately, many wide-scale programmes that are implemented undergo no evaluation to determine how they have worked or what their effects may be. Have you ever imagined the possibility of attending a tertiary course which would be designed to: (a) give you the ability to design a project for the generation of new knowledge and be able to publish it internationally, or (b) train you on how to evaluate wide-scale interventions and how to apply strategies to sustain their continuities?


    A glimpse of the proposed programme of studies

    Intended for:

    The programme of studies is aimed at a wide and diverse cohort of students wishing to pursue any careers in HEPA sectors mainly: exercise prescription; health promotion (policies and practice); general health and fitness industry; and to further their studies (e.g. PhD). It can also serve as an adjunct to enrich one’s knowledge of his / her established profession or career. Examples include: medical practitioners; pharmacists; nurses; physiotherapists; nutritionists; public health specialists; sport medicine specialists; sport psychologists; teachers of physical education (PE); coaches; gym instructors; and personal trainers. Fitness and sport enthusiasts are also encouraged to apply.

    Duration:

    Three years part-time leading to an M.Sc in PA as an effective therapy, with postgrad certificate and postgrad diploma exit routes after the first and second years respectively.

    Mode of delivery:

    Seventy per cent will be delivered online and the rest of the thought units will be offered on a once weekly two-hour evening basis starting at 18.00hrs.

    Admission criteria:

    You should provide evidence of higher educational qualification(s) - normally, a diploma or a degree related to health and / or PA / sport. An award in PE is also ideal. Mature students without these basic qualifications would be required to present evidence of experience related to PA and health.

    Mode of assessment:

    Units will be assessed through the submission of coursework. These will vary from short assessments to long essays. If you would like to progress at Masters’ level, a traditional dissertation or paper in the format for journal publication and a final presentation (in the form of slides or poster) of your research findings will have to be undertaken.

    Round-up

    Unlike other under- and postgrad courses which only cover a fraction from the whole science of HEPA, this comprehensive programme of studies would lead to a specialization specifically on TPA. For careers in promotion, prescription and research of PA, the proposed programme of studies is a must.

    Important notice

    All the above information is subject to change and would eventually have to be approved by the Programme Validation Committee of the University of Malta. Needless to say, your feedback in the next two questions is extremely important.

    Yours in health & exercise,

    Charles Micallef B.Pharm (Hons), M.Sc PAPH (Staff)                                                8th August 2017

    The two questions hereunder.

    1. In view of the above information, would you be interested in applying for this particular postgrad course leading to a specialisation in physical activity with respect to health, that is, a qualification that gives you the right to prescribe exercise for health, even at population levels?

    Yes or No: 

    1. What would you change from or suggest to what is being proposed?

    Please state your name & surname:

    Your current job / profession:

    Please save your changes and forward your reply to Charles Micallef on: This email address is being protected from spambots. You need JavaScript enabled to view it.

    Your cooperation is greatly appreciated.


    [1] In order to professionally recommend exercise for health, you may need to be registered in the appropriate regulatory board and be in possession of a warrant to operate with the respective titles.

    University of Malta

    Written on August 19, 2017
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