by Marcin Gornsiewicz, M.D.
It is definitely a strange sensation to wake up in the middle of the night unable to move an arm or to sit with legs crossed then be unable to walk, due to a loss of sensation, as if the legs are not there anymore. This is called temporary paresthesia. When pressure is applied for a prolonged period of time either by sleeping on an arm or sitting on a foot, nerves are compressed and kept from sending massages back to the brain properly. The communication from the brain to other parts of the body os basically cut off. Once the body moves again, the pressure is off the arm or leg. The feeling comes back slowly, however, there is re-adjustment time. There may be an itching, pricking, tingling “pins and needles” sensation before the body part finally returns to normal. We all go through this once in a while, and it is completely benign and normal, but if tingling and numbness occurs on a regular basis, it may be a sign of a certain medical condition. The most common condition affecting over 8 million Americans each year is Carpal Tunnel Syndrome (CTS).
The tunnel is not made of bricks and cement, we can’t drive through it. It is under the skin in our wrists at the palmar side. The bottom and walls of the tunnel are formed by wrist bones, and the top (roof) is covered by a ligament, a strong band of tough, flexible connective tissue. Nine tendons and one nerve pass through this tunnel. The tendons allow us to bend our fingers. The nerve is called the median nerve and is the only nerve that passes through the carpal tunnel. It provides feeling to the thumb, index and middle fingers, and half of the ring finger.
It is pretty tight inside the tunnel, and if anything takes up extra space, the median nerve gets pinched or squeezed. This might happen when tendons get swollen, tissues surrounding the tendons harden or when hands are held in a position that makes the tunnel smaller. Symptoms often affect both hands, but usually one hand is worse then the other. There is tingling, burning or numbness especially in first three fingers that worsens with wrist movement. Pain and tingling may extend to the whole hand or even up to the forearm. There may be loss of grip strength, difficulty making a fist, and one can frequently drop objects. Symptoms are usually worse at night, but somewhat better after waking up in the morning. Driving, typing, holding a phone, using a mouse or joystick can make things worse.
Carpal Tunnel Syndrome is no longer an adult disorder. The number of children with CTS is growing. It is believed, that hours of sitting in the same position using finger muscles over and over again by playing video games contribute to the problem. Kids can also develop CTS upon playing a stringed instrument or flute and in certain sports like tennis and gymnastics. Diabetic children are more susceptible.
Though not many kids get CTS, it is important to learn good habits now to prevent this problem in the future. Here are some tips to minimize traffic in the tunnel:
- Schedule regular breaks when working on computer or playing games.
- Keep wrists in neutral position for typing or using the mouse, don’t bend them up.
- The angle at the elbows should be 90 degrees.
- Keep your back straight and feet flat on the floor.
- Use a chair that can be adjusted for your height.
- Consider ergonomic keyboard, wrist pad and trackball instead of mouse.
- Keep your hands warm to promote adequate circulation.
- Place things you use a lot within close reach.
- Forget Minecraft for a while, read a book.
Dr. Marcin Gornisiewicz graduated with an MD degree from the Medical School of Warsaw in Warsaw, Poland. He completed residency training in internal medicine at Saint Barnabas Medical Center in Livingston, New Jersey. He completed fellowship training in rheumatology at the University of Alabama at Birmingham in Birmingham, Alabama. He joined Rheumatology Consultants, PLLC (rheumatologyconsultants.org) in 2002. He is board certified in Rheumatology.