Blame it on the increase in use of computer keyboards or texting on your mobile - carpal tunnel syndrome (CTS) and repetitive strain injury (RSI) are two lifestyle conditions on the rise. Seriously debilitating, both affect the hands, wrists and arms and can be easily mistaken for one another. Here we explain their differences and the most effective way to treat them.
CARPAL TUNNEL SYNDROME (CTS)
Thought to affect around three people in every 100, CTS, like RSI, is characterised by attacks of pain and tingling in the fingers. Those with CTS, however, are more likely to suffer numbness.
Other symptoms include weakness in the thumb and pain in the forearm and the shoulder. Sufferers will commonly first feel the symptoms at night.
During the day they may struggle to grip small objects such as coins and buttons, and possibly drop objects, because of the numbness.
CTS is generally caused by the swelling of the tendons running through the carpal tunnel, an area of connective tissue found on the rim between the palm of the hand and the wrist. The median nerve, which conveys sensations to the thumb and first three fingers, runs through the carpal tunnel.
Nine tendons also share the same space, and if these swell up they increase the pressure on the carpal tunnel, effectively squashing the median nerve, causing CTS.
Mark Phillips, a hand and trauma surgeon at King's College Hospital, London, says that while repetitive work does not seem to bring on CTS for everyone, it can do for some. He points out that sports people rarely suffer from CTS, even though they engage in repetitive action.
'Carpal tunnel syndrome is most commonly seen in men who do heavy physical work and pregnant women,' he says. 'No one is quite sure why pregnant women get CTS, but the symptoms generally clear up when the baby is born.'
Diabetes, which interferes with blood flow to the hands, also increases the risk of CTS.
Despite some sufferers believing there is nothing that can be done, there are certain steps you can take to ease the discomfort. The simplest measure is to use a splint - a metal strip in an elasticated wrist support with Velcro straps - to hold the wrist in a neutral position at night.
If this does not help, steroids can be injected into the carpal tunnel itself, to give the nerve more room. The steroids will block the inflammation in the tendons sharing the carpal tunnel, reducing pressure on the nerve. You can expect the steroids to work for about three months.
If the injections do not provide long-term relief and after electro-diagnostic testing has confirmed CTS, then surgery may be the answer.
This is usually done under a local anaesthetic and involves releasing the transverse carpal ligament (the roof of the carpal tunnel) to make more room for the median nerves. It takes about ten minutes.
It would be wrong to assume surgery is a cure-all, however. 'Around ten per cent of people who have the procedure will continue to report symptoms two to three months after surgery,' says Mark Phillips.
REPETITIVE STRAIN INJURY (RSI)
While symptoms can certainly be triggered by stress, RSI - which is thought to affect 500,000 people in this country - is not simply a problem of the mind, as many believed until fairly recently.
The problem occurs, according to Anne Cruickshank, director of RSI Clinics (rsiclinics.co.uk), 'when the muscles in the neck and shoulders are overused, straining the muscles and the surrounding connective tissue.
'This produces adhesions - bits of the connective tissue that literally become stuck - and trigger points, where muscle fibres become permanently-contracted. These feel like hard lumps under the skin.'
If there are adhesions in the neck and shoulders, the muscles that should be anchoring the arm for the fine motor movements to take place are not able to work.
The areas of muscle further down the arm, therefore, have to take on that job, causing pain in the wrist and hands.
Early symptoms are tension in the neck and shoulders, accompanied by the odd shooting pain in the hand or wrist, and occasional tingling in hand or fingers. If untreated, these symptoms will probably increase in intensity and frequency.
Sufferers can be woken up regularly in the night with pain - one patient of Cruickshank's found himself stuck in his living room - the pain so great he was unable to open the door and had to wait for his girlfriend to return home to rescue him.
Once the symptoms are identified as RSI, a consultant will begin treatment with a detailed assessment of where in the neck, shoulder and arm the connective tissue adhesions are located.
Treatment involves a combination of stretching exercises, usually done by a massage therapist to release trigger points and adhesions, home exercises and lifestyle changes. Anti-inflammatory painkillers, such as aspirin or ibuprofen, can provide short-term relief, as can using a heat or cold-pack. Steroid injections will also reduce inflammation.
While sustained computer use - both keyboard and mouse work - is the most common trigger, there are others, too, such as repetitive movements at machinery and playing a musical instrument.
Stress is also a contributing factor. Stress causes us to raise our shoulders, causing tension in the neck, the very area we should, ideally, be keeping flexible and strong to anchor the arm and fingers.
It is not inevitable that you will get RSI through heavy computer work, says Cruickshank, 'as long as prolonged and sustained work is avoided and proper stretching and releasing exercises are done'.
