When the hands and wrists are held in an unnatural position for long periodsduring repetitive workinflammation, tendon damage and pain can result. Typing and fine manual work are risk jobs. This 15 called overuse syndrome or repetitive strain injury (RSI).

Two frequently occurring problems
are tenosynovitis and carpal tunnel syndrome. In tenosynovitis the forearm tendons or their protective sheaths . become swollen and are unable to slide easily past each other. Carpal tunnel syndrome affects the nerves as they pass through the wrists .

The usual treatment is immobilization of the joint (in a splint for several weeks) and steroid injections followed. by physiotherapy to encourage gradual movement and ensure blood flow to the area. The condition may take a long time to correct, and in some cases surgery may be necessary.

Repetitive strain conditions tend to recur. It is important to recognize the signs. Make sure your workplace environment complies with health and safety practice and take frequent breal

Carpal tunnel syndrome

The carpal tunnel is formed by the first row of carpal bones in the wrist and a ligament (the flexor retinaculum) that runs across and over them. The mediannerve, which supplies the thumb, first two fingers and the thumb side of the third finger, passes through this tunnel, with various muscle tendons. ln carpal tunnel syndrome (CTS), the median nerve becomes . compressed, causing a numbing pain in the hand (often at night or on waking), clumsiness when using the hand (holding a needle or pen is difficult), pins and needles or tingling in the fingers (except the little finger) and, sometimes, pain in the arm and when trying to push the thumb against the little finger.

You can find some relief by massaging or shaking the hand. Carpal tunnel syndrome often has no identifiable cause, although it may be associated with trauma of the wristand chronic inflammation of the tendon sheaths as a result of RSI. CTS is seen during pregnancy and in patients with an inflammatory autoimmune disorder such as rheumatoid arthritis. lt can also be associated with diabetes and hypothyroidism Treatment may involve a wrist splint, exercises to stretch the wrist muscles, steroid injections, and, as a last resort, surgery to release the trapped nerve. Usually, before surgery is attempted, a test called a nerve conduction study is performed.

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