Talk:Carpal tunnel syndrome

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This page has been cited as a source by a media organization. See the 2004 press source article for details. The citation is in: "Hotlist: Repetitive stress injury", Houston Chronicle, February 25, 2004.

	To-do list for Carpal tunnel syndrome:	edit  · history  · watch  · refresh
Improve opening definition/intro section. As muddled as the CTS definition can be, the opening must be clear, concise, and correct. SPAM patrol (continuing). Causes section "...a 2083 study..." Typo or spam. Causes section needs organization, sub-sections, and more references. Treatment and Prevention sectionneeds better organization, references, and VooDoo treatment cleansing. Make a section to clarify the relationship of CTS to office/computer work & clear up any misconceptions. Integrate in-line, non-standard references and port to new Cite.php format. Done - 1/25/2007 Anatomical images are needed—throughout the entry. References. References. References. (Eventually we should get to the point that ~90% of all sentences have refs—with the remainder falling in the "connecting sentences" category.)

Contents 1 Editing Non-traumatic part of the Causes section 2 AID appeal 3 Opening comments 4 Treatment 5 Diagnosis 6 Some questions 7 Treatment 8 Need to discuss Double Crush Syndrome 9 My Teenage Daughter Just Diagnosed 10 Dr. Brown, Dr. Brown... Paging Dr. Brown 11 Soft Tissue Therapy? 12 writer's cramp 13 Editing 14 SPAM 15 Vocabulary 16 Policarpal SPAM? 17 Merge 18 Ergonomic computer pointing devices 19 Uncited statements 20 Diagram 21 Plastic and Reconstructive Surgery article (November 2006) 22 "medication and diet" section (what diet?)

[edit] Editing Non-traumatic part of the Causes section

Icarus3 wanted to delete the following bullet points from the Non-traumatic part of the Causes section, because "the controversy over whether or not such things cause CTS is covered in more depth in earlier section or article":

• Common activities that have been identified as contributing to repetitive stress induced carpal tunnel syndrome include:
  • Use of power tools
  • Construction work such as handling many bricks, stone and/or lumber
  • Computer keyboarding or typing
  • Playing video games or computer games
  • Playing a musical instrument
  • Cycling, due to pressure and vibration on hands
  • Any activity where hand use is vigorous and routine could contribute (surgeons, dentists). Still, these activities are often merely associated with, but do not actually cause, carpal tunnel syndrome.

I disagree, because the following words do not have any other instances in the entire article: 'power', 'construction', 'bricks', 'typing', 'games' or 'cycling'.

I have reversed Icarus3's change, but would welcome discussion on how to integrate these points in a better way. From my own point of view, the above points were enlightening when I was first investigating Carpal tunnel syndrome, and I think there's a great benefit in having them listed together. Perhaps it's worthwhile putting some disclaimer againt them to indicate that there is some disagreement between experts, with a reference to the relevant section. --Matthew 1130 02:50, 24 December 2006 (UTC)

[edit] AID appeal

Let's shine some light down the dark hole this article has been hiding in. Please go to the AID page and vote to have this article spotlighted for a thourough cleaning-up! --DanielCD 00:40, 17 February 2006 (UTC)

[edit] Opening comments

Hi, I was trying to get the RSI article a little bit better, but I found out, that it is probably the same as Carpal tunnel syndrome. Thanks for comments, Fantasy 13:29 16 May 2003 (UTC)

AFAIK, CTS and RSI are not the same. But CTS can be considered a type of RSI - Tarquin 15:24 16 May 2003 (UTC)

Carpal tunnel syndrome, (though it usually is), doesn't have to be caused by repetition. I'll rearrange the article to fit in the other causes a bit better tomorrow Tristanb 12:00 27 May 2003 (UTC)

Great, thanks! I look forward to it! Fantasy 14:07 27 May 2003 (UTC)

Hopefully you weren't looking too forward to it! :-) i've added more info, but destroyed the structure, i'm too tired at the moment. i'll (or someone else will) add headings, and more information. plus a general sorting out. Tristanb 10:45 28 May 2003 (UTC)

Don´t worry, I look forward to every single contribution ;-) Fantasy 11:28 28 May 2003 (UTC)

Has someone vandalised the current page? I ask this because I am wondering where the author got the correlation between breasts and CTS.

[edit] Treatment

Does anyone know anything about prevention? (Without commercial products)

There are many ways to prevent CTS. They are very simple yet effective and remain as the crucial part in CTS recovery. Believe me, they are general common sense:

1. Maintain a good body posture, especially in the work place. In most of the cases, while sitting in front of a computer desk you want to make sure your shoulders are approaching a 90 degree angle and that your wrists are not resting on the edge of your desk.
2. A break from work from time to time is definitely beneficial, lots of shorterm breaks have proven more effective that a few long breaks. A good pattern would be a 30sec break every 3-5mins.
3. A person with a healthier lifestyle can be more immune to contracting CTS, longtime exposure to a repetitive task WILL EVENTUALLY lead to CTS, even if it takes 20yrs. Improved health can prevent and treat CTS being a combination of: if using a computer use a CTS prevention app, consuming B complex, wearing wrist braces at night and taking hypercium (an extract of St John's Wart).

[edit] Diagnosis

An update regarding the Diagnosis of CTS. An article published by Kuschner SH, Ebramzadeh E, Johnson D, Brien WW, Sherman R. at Entrez PubMed, Nov, 1992, suggested that Tinel's sign is not useful in CTS diagnosis. While Phalen's test, remains as a accurate method. Shall this to be revised? OR anyone has any comments? See this: Tinel's sign and Phalen's test in carpal tunnel syndrome. --Garlics82 16:23, Nov 1, 2004 (UTC)

Another thing on the current diagnosis part; on the Phalen's test paragraph is merely state that if you feel pain/burning/tingling, it would be a sign, but it did not tell you that you're supposed to be looking for these sensations at the fingers, such as stated at the link to the Phalen's test. Pretty much anyone who bent to the extremes of their flexibility would experience discomfort at the wrist.--24.85.147.171 19:00, 31 August 2005 (UTC)

Physical examination is not a reliable way to diagnose cts. Manouevers above are 20-70% sensitive or specific at best. History with confirmator nerve studies are the gold standard. Roger, MD

[edit] Some questions

Is carpal tunnel syndrome some type of compartmental syndrome? If so, can it be treated using mannitol? --Eleassar777 17:19, 10 Feb 2005 (UTC)

After much reading on this, I was wondering if lack of D3 is a common cause. --Seb-Gibbs 00:13, 24 Feb 2005 (GMT)

While mannitol might possibly help, I think it's too aggressive of a drug to be used for this purpose. About D3, I fail to see how Vitamin D3 relates to the swelling and nerve damage in the wrist. But as this article states, B Complex has been shown to be very helpful. --TravisOwens 11:13, 30 Nov 2005 (EST)

[edit] Treatment

In the UK at least, nearly all carpal tunnel syndromes are treated with surgery, so much so that most NHS plastic surgeons spend their time doing operations to correct the problem. Think this needs editing... -- Unknown

Rebuttal - Surgery is a horrible option for carpal tunny treatment imho. Many studies (Google for yourself) have shown it's not very effective, and obviously if the patient continues the stressfull task, carpal tunnel will only come back, and the surgery cannot be performed multiple times. I have known 2 people to have gotten the surgery here in the US and both said it wasn't worth it. The WikiPedia's health articles should not encourage treatments that are viciously unneccesary just because one country still performs such actions. (I will admit the US is riddled with inferior treatments ala the whole medicine industry). Considering mulitiple studies have shown surgery to be a poor option and not a single study has shown otherwise, the only proper editing would be along the lines of "While studies have shown surgery to be a poor option because of X, Y and Z, it is still a popular choice for treatment in the UK." To show it in any other light would be biased. -- TravisOwens 9/7/05

Re-rebuttal Travis, whats up with you? have you read any of the current medical literature? Carpal tunnel release enjoys excellent success and minmal complications and recurrence. If symptoms recurr, they are unlikely carpal tunnel. Instead of googling for your friendly merchant selling snake oil, why not look for reliable sources in the juried medical literature like in PUBMED.COM (the index of the national library of medicine) Roger Blauvelt, MD

[edit] Need to discuss Double Crush Syndrome

Not quite sure how to weave this into the article, but the double-crush syndrome needs to be mentioned.

See http://www.icpa4kids.org/research/chiropractic/carpal.htm and http://www.erinelster.com/carpal_tunnel.html for some references.

The key message is that the primary cause of carpal tunnel syndrome may actually be in the upper back or lower neck.

Excercises that relax and strengthen the back muscles can relieve the wrist symptoms in some cases.

I speak from experience -- a regular regimen of exercises approved by my osteopath prevents my carpal tunnel symptoms from flaring up. I was able to avoid any surgery.

Rick Rutt 22:18, 14 December 2005 (UTC)

We have an article for Crush syndrome -- are they related? --Arcadian 00:01, 15 December 2005 (UTC)

No, double crush refers to the median or ulnar nerve being compressed in the back as well as in the wrist. The compression in the back inflames the nerve so it is more sensitive to compression at the wrist. A problem with the median nerve causes numbness in the forefinger, 2nd finger, and one side of the 3rd (ring) finger. A problem with the ulnar nerve causes numbness in the 4th (pinky) finger and the side of the 3rd finger. If either nerve is inflamed, there can be a burning sensation at the wrist where the actual carpal tunnel resides. Note that I am not a doctor, just a person who has had carpal tunnel syndrome that was luckily treatable with exercise: pushups, situps, touch toes, etc. Rick Rutt 16:47, 16 December 2005 (UTC)

Rick Rutt 17:08, 18 December 2005 (UTC) I added double crush as one of the non-traumatic causes, and added these 2 URL links as external references.

While double crush is a sound clinical entity, it rarely has a true meaningful contribution to CTS. CTS by definition is a problem originating in the hand/wrist area. Anyone that sugessts "the primary cause of carpal tunnel syndrome may actually be in the upper back or lower neck" is by definition redefining the problem! We have enough confusion/conflict without that happening. A fair statement is that neck disorders may mimick CTS. This is easily determined however by history, physical exam and nerve studies. Another fair statement is that nomatter where on your body your complaint, you will not likely leave a chiropractor's office without treatment/manipulation to your neck or back.

[edit] My Teenage Daughter Just Diagnosed

I am looking for information on CTS that I can share with my teenage daughter and her coaches. She is 15 years old plays volleyball, is a cheerleader, and throws shot put and discus for her track team. Everything I have found so far discusses adults and things such as surgery and ergonomics. Unfortunately, we are a military family and do not get consistant treatment - you get whatever doctor is available and they don't put a lot of emphasis on dependents. Is there information for young athletes and their coaches? She has said that she will give up cheerleading, shot put and discus, but refuses to give up her volleyball. What can I do to help her.

First, get here an accurate diagnosis. While possible, CTS is very uncommon in teens. Other sources of hand pain is more common. Read the AAOS web site for info on cts and other disorders. Good luck, Roger, MD http://orthoinfo.aaos.org/brochure/thr_report.cfm?Thread_ID=5&topcategory=Hand

[edit] Dr. Brown, Dr. Brown... Paging Dr. Brown

It is unfortunate that Dr. Michael Brown has used the Wikipedia as an advertising page and in the process produced disinformation reguarding CTS surgical treatement and results. His results are not unlike most surgical treatments, and there are more widely used endoscopic methods out there with similar results. Attempts at correcting his entry are reversed. This lack of integrity of contributors is a weakness of this community forum, when greed and commercialism predominates. So sad. Shame on Dr. Brown.

[edit] Soft Tissue Therapy?

I removed the soft tissue therapy section entirely, since it is part of a group of edits across multiple articles by individuals seeking to push their own commercial products. If anyone has verifiable evidence that soft tissue therapy is actually a real medically approved therapy to treat CTS, feel free to remake the section. But include sources. --Xyzzyplugh 00:00, 14 February 2006 (UTC)

[edit] writer's cramp

Why does this topic link to writer's cramp (and vice versa)? Apart from being disorders that affect the hand, the two have nothing in common. Ikkyu2 01:11, 14 February 2006 (UTC)

The link may serve to help people realize this difference if the two are often confused. In fact, it might not hurt to mention in the article that there is a difference and what it is. This information could likely prove helpful to people not familiar with the terminology. --DanielCD 19:55, 16 February 2006 (UTC)

[edit] Editing

I think the article could benefit from a vigorous copyedit. This is really good information. Perhaps the AID?

Notations such as these are not really correct: (Arch Internal Med 158:1506 1998 & Hospital Practice, March 1999). The standard format is to give the last names of the author(s) of the relevant articles and a year, leaving the reader to refer to the refence section for more details. Without the article names and authors, these references may be more difficult to find or confused with other articles in the same magazines/magazine volumes/issues etc. This should likely be remedied. Does the researcher have the full references? I would not mind adding them in proper format if they could be provided. --DanielCD 20:21, 16 February 2006 (UTC)

My grounds for the citation/source tag are that there's a lot of information here, and little of it is cited/referenced. As I said above, these aren't going to count as references as they are not complete. As there is some information that seems to be giving advice, please do not remove the tag without consulting here on the talk page. This is a subject that can be solidly referenced, so it shouldn't be a problem. I'm going to look for some sources as well. --DanielCD 21:04, 16 February 2006 (UTC)

Per the comment at the top of the page here: Could someone give voice to the concerns surrounding "Dr. Michael Brown"? Is there an issue or not? --DanielCD 21:09, 16 February 2006 (UTC)

...computer use did not increase a person's risk of developing carpal tunnel syndrome.

There is a citation here, but key information like this, along with needing complete citations to actual medical studies, could use more discussion. Computer use and its relation to CTS perhaps even calls for its own section.

One hundred and nine separate atraumatic conditions can cause CTS-like symptoms.

Can we say that the number is exactly 109? Some rewording might be in order here. --DanielCD 21:18, 16 February 2006 (UTC)

...recent studies and peer review articles have found no relationship between carpal tunnel syndrome and office-type work.

sigh --DanielCD 21:20, 16 February 2006 (UTC)

I'm not disputing these facts, but people need to leave the article not wondering whether it's a crock of s**t. We need to give readers more of a feeling of certainty regarding some of these things. I'm assuming many people would, off hand, associate CTS purely with office work. This may be a blatant misconception, but I'd like to see the reader leave thinking their misconceptions have been corrected, rather than wondering if the people who wrote the article know what they are talking about. The facts are not the issue: it's the writing, citing, and presentation. --DanielCD 21:39, 16 February 2006 (UTC)

I added a cleanup tag on the following grounds: this article is a mess. It needs some re-thinking, and perhaps even a re-write. --DanielCD 00:22, 17 February 2006 (UTC)

I have been working on cleaning this up now that the admin has come in and cleaned up the spam that was so poisoning. I am a MD and dont want to step on the alternatives toes, but I am trying to clean it up a bit. Thanks for the interest and contact me with questions.Rogerdoger 04:14, 20 February 2006 (UTC)

[edit] SPAM

I removed the following segment:

In 1991, the Brown Procedure Endoscopic Carpal Tunnel Release was patented by Michael G. Brown, M.D. of Houston, Texas. The procedure is performed on an outpatient basis. No hospital stay is required and the recovery period is approximately 2 days. An endoscope is used in two small cuts in the hand, which require no stitching afterwards, compared to the old technique of cutting through the palm to reach the tight ligament.

Thousands of patients have found relief from Carpal Tunnel Syndrome via the endoscopic procedure and it is now performed worldwide.

The Brown Procedure Endoscopic Carpal Tunnel Release is a patented procedure performed by surgeons all over the world. It has been the most successful advance in the treatment of Carpal Tunnel Syndrome since 1947. It is not an "alternative" therapy. Arthroscopic surgery is an extremely valuable tool for all orthopaedic patients and is generally

[edit] Vocabulary

Ok, is it just me or is this article a little confusing if your not a doctor? I"m trying to write a report on CTS and I'm reading this too help as a first chice and I'm having to find places I can understand easier. What is a lateral 3.5 finger? I suggest we make the article more understandable to readers not in the medical field, like those of us in high school. H-BOMB 13:51, 20 October 2006 (UTC)

It appears that someone (Lilymuriel) botched the article. If you go back a couple dozen edits, then you can see the orignal text. The current text is crap. Can someone revert this? Rogerdoger

[edit] Policarpal SPAM?

In the Immobilizing Braces section of the article, the article states that there is a new type of brace (policarpal) that is very successful. When following the 'policarpal' link, you come to a wiki page that says there is no article by that name. When I googled 'policarpal', the first couple links are the manufacturers page, and then the exact same blurb as the one in the wiki article has been posted on a numer of different sites. Policarpal appears to be a proprietary name, and does not appear to be reviewed anywhere, nor is does it appear to be available from any other site.

I think it's SPAM. What do you think?

Meira Voirdire 04:19, 11 December 2006 (UTC)

[edit] Merge

The discussion regarding a merge between Carpal tunnel syndrome and Carpal tunnel is at Talk:Carpal_tunnel#Merge. Please post any relevant comments there.

[edit] Ergonomic computer pointing devices

Hi MarcoTolo,

Great work with your recent edits, your marathon effort has improved the article noticeably. I agree with your deletions except for this one, so while I have reinstated the Ergonomic computer pointing devices section you deleted, I am also posting here to invite comment on this from you and the other editors of this article.

I don't believe this section violates WP:EL#Advertising and conflicts of interest or Wikipedia:Conflict of interest because:

1. I am a database software developer, not a manufacturer or seller of pointing devices, so there is no commercial conflict of interest.

2. I am not employed or associated with any of those companies.

3. I do not maintain or contribute to the listed websites.

4. There are multiple links in this section to companies that compete head to head in the same market space.

I added the Ergonomic computer pointing devices section back on 18 January 2007 for the following reasons:

• I could not find any ready resource on the web for locating these products.
• These products are certainly relevant, possibly very important, for computer users suffering from Carpal tunnel syndrome.
• I found multiple independent recommendations and endorsements for these products on other websites, while researching to work out which product to buy for myself. Please note that I left other products off this list, because I could not find such enthusiastic independent recommendations for them.

I want to do the right thing here, so I have reviewed Wikipedia:Spam#How not to be a spammer to which item 6 seems to indicate that adding a link to a product is ok, provided that others agree that the product is relevant.

I also reviewed WP:EL#Links normally to be avoided on which items 4 & 5 may be a concern in this case. I think that this particular case is an exception to the "normal" rule, because this list is very useful to readers, and for the same reason that products are identified on Entity relationship#ER diagramming tools and at Database management system#External references, because it makes Wikipedia more informative. I have striven to provide links to the most informative page of each website.

Is there a better way to handle this? There is not enough independent information on these products to create a separate Wikipedia page for each of them. Another possibility is to place a disclaimer at the top of the section, so I made a stab at doing that just now ... you're welcome to revise or delete that disclaimer as seems best.

Would it help if I attempted to list my sources for these independent recommendations here on the talk page?

Regards,
Matthew 1130 14:32, 25 January 2007 (UTC)

• Matthew 1130 -- Kudos for taking the time and effort to write such a complete commentary for a revert; much appreciated. And, before I forget, my apologies for the unwarranted implication that you spammed the page -- I was too quick on the draw. Mea culpa.

You do make reasonable arguments about why the Ergonomic computer pointing devices (ECPD) section may be an exception to the general WP:EL guidelines. I must admit, however, that sites with SHOP NOW! and Buy Now! links make me very nervous. Yes, an ECPD list is useful to some Wikipedians, I'm just concerned about the impression such a list sets (not to mention the on-going difficulty in managing such a list). In the past, its been suggested in other articles to provide a base link to an ODP site like dmoz -- the ergonomic mouse section there is a little thin, though the Zero Tension Mouse appears in another category. (As an aside, opening the Perific site ends in a blank page (as in zero content after the http header response) for me under both Firefox and IE, and from both home and work).

I guess that, if I had my druthers, the CTS articles would stick with a link to an ODP site. I guess I'd need to think about how other options might work and do a little more research on current WP community consensus in situations like this. In any case, thanks again for your thoughtful input. -- MarcoTolo 01:31, 26 January 2007 (UTC)

• After more thought and looking around at the Open Directory Project, I think it would be more appropriate to replace the three links in the Carpal tunnel syndrome#Ergonomic computer pointing devices section with this link: Carpal tunnel syndrome at the Open Directory Project (suggest site) . This lets us point Wikipedia readers to a more complete list, and one which we don't have to maintain. Thoughts? -- MarcoTolo 03:14, 24 February 2007 (UTC)

• Sans additional comments, I'm going to be bold.... (but consensus can change, too). -- MarcoTolo 21:56, 22 March 2007 (UTC)

[edit] Uncited statements

• I've removed the follow sentence from the article, "B vitamins, specifically Vitamin B6, can have an anti-inflammatory effect on the nerves decreasing symptoms. A B-50 or B-100 complex daily provides relief for many people. It should be noted that dosages of B6 should not exceed 300mg per day." A statement this broad must be cited per WP:ATTRIB. -- MarcoTolo 02:25, 2 March 2007 (UTC)

[edit] Diagram

The diagram is kind of creepy, can we get one that doesn't look like a severed hand? --Candy-Panda 08:35, 8 March 2007 (UTC)

I've spent a fair amount of time looking for a freely-available alternative image (i.e. meets Wikipedia image policies); any suggestions? -- MarcoTolo 08:01, 13 March 2007 (UTC)

[edit] Plastic and Reconstructive Surgery article (November 2006)

"The most recent data, from Mayo Clinic microscopic studies (published in a November 2006 issue of Plastic and Reconstructive Surgery): indicates that it is in fact a shearing injury caused from the acute trauma of repeated motions. The scar tissue from during healing impedes the sliding motion at the tendon. Clearing any doubt that it is in fact work related."

I've pulled this paragraph from the article because it appears to exaggerate the study outcome based on the abstract (i.e. it does not appear to "clear any doubt".) I haven't had a chance to dig up the full article; will do so as soon as possible. -- MarcoTolo 07:58, 13 March 2007 (UTC)

[edit] "medication and diet" section (what diet?)

Good day. Perhaps I've msised something but the "medication and diet" section does not seem to have any info on diet. Is this an oversight or should the word "diet" be removed from the section (or perhaps dietary content added). Thanks, Hu Gadarn 22:41, 22 March 2007 (UTC)

This is left over from a unreferenced dietary segment that was removed; I've corrected the subheading. Thanks for catching the error. -- MarcoTolo 22:50, 22 March 2007 (UTC)