Self-Care Tips for Carpal Tunnel Syndrome and Other Repetitive Motion Injuries

Carpal tunnel and other repetitive motion injuries (RPI) are among the most common injuries doctors see, and although about half of these injuries are sports-related, the repetitive actions of everyday living and working can contribute to nerve damage, pain, and even a loss of manual dexterity. You may not be an athlete or perform a repetitive job daily, but you may still be at risk of joint injuries.

Using a manual screwdriver and other hand tools, long hours spent using a crochet hook or knitting needles, wringing out laundry, playing video games, typing for long periods on a keyboard, fine-finger activities that require you to make a pinching motion, and many other normal, daily activities can result in carpal tunnel syndrome and other repetitive motion injuries. The normal wear-and-tear of aging, arthritis, or being overweight can contribute to these conditions also.

I spent twenty-five years working in a small-parts production assembly job, and have experienced varying degrees and types of RPIs over the years. Even three years after leaving that job and reducing the daily strain on my hands, arms, and shoulders, I still find that doing certain chores at home, such as vacuuming or washing windows, can flare up those old injuries.

Over the years, I have learned various self-care techniques that are recommended to those who suffer from carpal tunnel, tendinitis, bursitis, and other repetitive motion injuries. Many of these techniques were taught during an injury-reduction workshop at my former place of employment, so I believe they are medically sound. Please understand that I am not a doctor, and these techniques may not help everyone, especially if you are already experiencing substantial RPI. If these exercises don't help or are too uncomfortable for you to perform, then it's probably time to see your doctor.

While RPIs may affect any part of the body, the hands, wrists, elbows, and shoulders are the most affected by our everyday life, so this article will concentrate on self-care tips for those parts of the body. This article will give a brief overview of some common repetitive motion injuries and self-care tips you can try before resorting to medical treatment.

Carpal Tunnel Syndrome

The median nerve in your hand (as well as ligaments and spongy tissue called the tenosynovium) pass through wrist in a tunnel made of bones on three sides and the transverse carpal ligament on the fourth side. This tunnel has a fixed amount of room, and if the tenosynovium swells for any reason, pressure is placed on the median nerve and you develop symptoms of carpal tunnel syndrome. The classic symptoms include numbness or tingling in the thumb, index, and middle finger, and an aching in the forearm which may radiate to the shoulder. The sufferer may have a weak or clumsy grip.

CTS is often the result of repeatedly twisting your wrist, holding your wrists in awkward positions, and/or gripping an object for long periods of time. It can also be an after-effect of accidental wrist injuries.

In our injury-reduction workshop, we were taught this exercise to increase the flexibilty of our wrists and associated ligaments to prevent (or at least reduce) further damage to the median nerve. Simply hold your arms in front of you, with elbows slightly bent. Splay your fingers and bend your wrists back toward you as far as you comfortably can, and hold the position for approximately ten seconds. Next, hold your wrists straight, and make a loose fist. Hold for another ten seconds. Next, while you still have your fist loosely made, bend your wrists downward toward the floor and hold for ten seconds. Repeat the exercise frequently during the day while you are working.

Use a wrist brace that also immobilizes your thumb (you can pick one up at a local pharmacy) when you sleep, and throughout the day when you aren't actively using your hands. Keeping your wrist splinted in a straight position will help the inflammation heal and soothe irritated nerves. In our workshop we were advised not to wear a wrist brace while we were working, unless we were having an uncomfortable amount of pain or numbness. By limiting the motion in the wrist, you create extra motion in the elbow and shoulder to compensate, which can cause RPIs further up the arm. Try to get by with OTC anti-inflammatory pain relievers if you must work with your hands while you are having carpal tunnel symptoms.

In severe cases, the pressure on the median nerve may be relieved with surgery, but this should be a last resort option. My personal opinion is that it's usually best to try non-invasive methods of treatment before resorting to surgery, which carries risks of its own. I worked with several women who had the CTS surgery; it seemed to help a few, but some said it didn't help much, or they had just as much pain, if not more, than before the surgery. Your doctor might also recommend steroid injections to ease the pain and inflammation; my informal survey finds that this treatment also has mixed results.

Ulnar Tunnel Syndrome

While the symptoms may resemble those of CTS or tendinits, ulnar tunnel syndrome (UTS) affects a different set of nerves in the hands and arms. The ulnar nerve runs along the pinky side of your hand, around the back of your elbow, and over the shoulder into the spine. The ulnar nerve is the one that gives you that tingly feeling when you hit your "funny bone."

As we bend our elbow, the ulnar nerve stretches over the bones, causing friction. This friction can eventually wear away the sheath that protects the nerve, and leave the nerve exposed. UTS can also result when ligaments that surround the ulnar nerve and give strength to the elbow become harden or inflamed, trapping and compressing the nerve. Typical symptoms of UTS include pain, burning, or numbness in the pinky and/or third finger, and a stiff, painful elbow. You may also experience pain just below the shoulder blade on the affected side.

You may be awakened at night with extreme pain and stiffness in the affected elbow. Sleeping on the side of the affected elbow can increase the amount of pain and potential nerve damage. Sleep on your back with your arms straight at your sides, instead of sleeping on your side, to avoid compressing the nerve. I'm a side sleeper, but trained myself to sleep on my back. It took a little getting used to, but I did notice a definite improvement in the pain and stiffness in my elbow. If you are one to toss and turn at night, consider wrapping your elbow in an ace bandage, or fasten a dish towel around your elbow, to keep it straight while you sleep. As with the wrist splint, this will allow the irritated nerves and/or inflammation in your elbow to heal while you sleep.

During the day, avoid further damage by not resting on your elbows, taking time to stretch your arms several times a day, and using an arm support when working at a keyboard or other activity where you must hold your arms in a bent position. Alternative repetitive activities that each use a different type of motion, if you are able.

Surgery can be done to relieve the trapped nerve if self-help techniques don't give adequate relief. Once the protective sheath is worn off the nerve, however, ulnar tunnel surgery may not relieve the pain. My unscientific poll of people I know who have had this surgery indicates that it is quite often successful, perhaps more so than the carpal tunnel surgery.

Tendinitis/Tennis Elbow

Tendinitis is an inflammation of the tendons in any part of the body, but the pain, tenderness, and inflammation of "tennis elbow" will occur in the forearm. Twisting the forearm or gripping an object will aggravate the pain. Rotator cuff tendinitis occurs when the tendons in the shoulder become inflamed.

Self-care tips include supporting the joint with wraps and gentle stretching to retain your range of motion. Avoid physical activity that aggravates the pain. Swimming is an excellent exercise to keep fit while reducing the stress and strain on injured tissues. Ice packs and OTC pain relievers may also be used to reduce swelling and pain while you're on the road to recovery.

Bursitis

Bursa are small fluid-filled sacs that cushion your tendons and muscles near your joints. When these small sacs become inflamed they create a dull ache or stiffness near the affected joint, and pressure on the joint may also cause discomfort. The area may feel warm or swollen, and there may be some skin redness over the affected area (more common in the arms and shoulders than in other parts of the body).

Self-care for bursitis is much the same as for tendinitis: pain relievers, compression with an ace bandage or splint, mild stretching, and resting the affected joint. Ice packs, heat packs, or alternating heat and ice, may bring some relief.

Rotator Cuff Injuries

Your rotator cuff consists of the tendons and muscles that connect your upper arm bone and shoulder blade, and firmly hold the ball and socket joint together. This set-up gives our shoulders the widest range of motion of any of our joints, but also makes them susceptible to injury. Repetitive arm activities, especially those done overhead (such as reaching up to work on a car, or lifting and placing items on a shelf above your head) or where you must repeatedly turn your elbows out (like a chicken flapping) can result in tendinitis or bursitis in the shoulder area.

Self-care (rest, ice, pain relievers) may be adequate unless you are in much pain, which could indicate a tear in the soft tissues and should be evaluated by your physician. Do gentle stretching exercises to keep the shoulder from becoming stiff and immobile; favoring the sore shoulder can result in a "frozen" shoulder joint.

To avoid undue strain on your shoulders avoid reaching over your head whenever possible. Place heavy objects, and the items you use most often, in a place where you don't need to reach up over the height of your shoulders to get at them. Use a stepladder to reach objects higher than your shoulders.

Exercises to Strengthen Arm and Shoulder Muscles

Keeping your shoulder muscles strong will help prevent RPI in the rotator cuff. "Push-aways" are an excellent exercise to keep arm and shoulder muscles toned. Place both hands against a wall, at shoulder height, and your shoulders' width apart. Gently lower yourself toward the wall, keeping the spine and neck straight, hold the position for a few seconds, then push yourself back into an upright position. Repeat as long as you comfortably can; start with a few reps and work your way up to more.

To relieve muscle tension in the shoulder area, grab the ends of a bath towel and hold the towel straight out in front of you with both hands. Slowly raise the towel above your head, then backwards as far as you can (comfortably, of course, don't push yourself and cause more injury). Don't arch your back while doing this exercise; keep your spine straight as you bring the towel behind you.

Relieving Tension In the Neck

Repetitive motions that involve the shoulders can also create muscle tension in the neck and trapezoids, especially if those motions include "winging" your arms or lifting them straight out to the side of your body.

Stretch your traps and relieve the tension by lifting one arm and reaching over your head to the opposite ear (with your palm toward your head). Gently pull your head to the side of the lifted arm, as if you were trying to touch your shoulder with your ear. Hold the position until you can feel a gentle stretch, then reverse hands and stretch the opposite side of your neck.

Next, tuck your chin down and turn your head slowly from side to side, as if you were trying to sneak a look over your shoulder. Hold the position until you feel a gentle stretch at the back of your neck, then turn the other way. Tell your co-workers you're not trying to spy on them, but doing some stretching exercises!

When To See a Doctor

Left untreated, repetitive motion injuries can result in chronic inflammation and weakening of the tendons and ligaments, making them more susceptible to tears and further injury. Nerves that have had their protective sheath worn away may cause chronic, inoperable pain. You may end up with a loss of function and/or permanent numbness in your hands, or immobile shoulder and elbow joints. Consult your physician if you experience any of the following conditions:

Self-care that does not relieve your RPI within two weeks.

Chronic, even if mild, RPI symptoms; self-care may temporarily relieve the problem, only to have it return again days or weeks later. Chronic conditions can degrade the soft tissues and make them more vulnerable to tears.

An inability to take care of normal daily grooming activities such as brushing your hair or taking a bath.

Extreme pain, redness, warmth, or swelling that may indicate a strain, tear, or infection in the soft tissues surrounding the affected joint.

Extreme stiffness or immobility of the affected joint.

Pain that migrates from one joint to another, or pain that is associated with fever, nausea, or other indications of infection.

You have a medical condition or are taking medications that may suppress your immune system and ability to fight infection.

This article is meant for informational purposes only and not meant to replace your physician's advice.