Letter: ‘Proof’ about Carpal Tunnel Syndrome Published on Saturday, August 18, 2007 Dear Sir, I would like to respond to Ms Christina Dumal’s letter of August 2, 2007 in which she asked for “proof” of my statement that repetitive activities, such as using a computer keyboard, are not the cause of carpal tunnel syndrome. Her concern allows me to elaborate on certain points which were not addressed in the series, The Truth About Carpal Tunnel Syndrome (CTS) which recently appeared in your newspaper. No, we don’t yet know what causes carpal tunnel syndrome. We don’t know exactly what causes the diffuse tendon sheath thickening in the carpal canal that then compromises the median nerve. However, we do understand the pathophysiology and know that certain medical conditions predispose patients to developing CTS: rheumatoid arthritis, diabetes, thyroid conditions, even menopause. It is entirely possible that future research will determine that in certain patients, obesity, genetics (inherited traits such as the structure of the carpal tunnel canal) and even today’s often poor, high fat diet, or excessive alcohol and caffeine consumption may be contributing factors that produce metabolic changes leading to CTS. We already suspect a strong metabolic connection. I’d like to make the analogous comparison to our knowledge of cancer. We understand the histology, cell types and progression of the disease, but we don’t really know the cause—likely aberrant genes, perhaps triggered by undiscovered viruses or prions—and certainly not some simple activity. Ms. Dumal asked for proof that carpal tunnel syndrome is not “work related” and by that I assume she means caused by jobs that require repetitive motion activities. That proof can be found in findings of numerous scientific studies conducted during the past 15 years, many of which have been published in leading medical journals, including the Journal of the American Medical Association (JAMA). One of the leaders in CTS research is Dr. Peter Nathan of the Portland Hand Surgery and Rehabilitation Center in Portland, Oregon. His landmark 11- year study, involving of hundreds of subjects representing a very diverse range of ages, was one of the first definitive studies that found no relationship between repetitive activity and the compression of the median nerve within the carpal canal. That compression of the nerve is what causes the symptoms of CTS. Another often cited study conducted by Oregon State University’ medical department reinforced this finding, as Dr. Richard Kinston, working with Dr. Nathan confirmed: “In fact, the job studied requiring the most intense repetitive motions, keyboard data entry, actually had a significantly reduced risk for CTS in over 2600 subjects studied. Ongoing studies conducted at the Mayo Clinic in Rochester, MN continue to provide the proof Ms. Dumal seeks. Many of these published findings can be accessed online through university and public library systems, often at no charge. These and other epidemiological studies have demonstrated that so called” repetitive stress injury” has no relationship to compression neuropathies. There are other well-known researchers whose studies have shown that people with repetitive motion jobs don’t experience any more aches or pains in their hands than the population at large. Despite published scientific data that repetitive activity is not the cause of CTS, this mythical link seems impossible to correct. The media, and even members of the medical community, choose to ignore the evidence refuting this fallacy. If in fact, repetitive activities “caused CTS” then every computer user, video game player and typist would develop CTS. Much of the world’s professional work force would be disabled due to such widespread computer use. Not only is this obviously not the case, but many CTS sufferers I have treated have never used a computer or keyboard of any kind, or performed any repetitive activities whatsoever. Ms. Dumal asks why “recurrence is so high (for CTS) when one returns to the same job that involves what many researchers believe contributes to this syndrome, such as repetitive motion…” This is simply not true. Resuming prolonged repetitive activities can aggravate the symptoms of CTS once a patient experiences the onset of those symptoms—this is not a “recurrence of CTS.” Logically, how could you expect to do the same thing and have different results? An important component of conservative treatment advises the patient to change his work habits if the job requires such activities; take breaks from those activities frequently, rest, and stretch. With proper evaluation by a hand specialist and early treatment, the majority of patients experience relief from CTS symptoms. If a patient fails to respond to conservative treatment, then a simple surgical procedure called endoscopic carpal tunnel release, discussed at length in the series, has proved extremely effective in relieving CTS symptoms and those symptoms have a very, very low recurrence rate. I hope that if Ms. Dumall herself is suffering from CTS symptoms she will overcome her suspicion and fear and be evaluated by a hand specialist. I welcome any readers with concerns or questions to contact me through my website, https://www.drbadia.com/. It’s important to understand the medical facts about CTS and know that treatment is not only available to you, but also quite simple. Dr. Alejandro Badia Miami, FL
