BY LUGA PODESTA, M.D.
(Originally published in DRUM! Magazine’s February 2006 Issue)
Carpal tunnel syndrome (CTS) is a common painful disorder involving the wrist and hand. The carpal tunnel is formed on three sides by the wrist carpal bones and covered by a thick band of tissue called the flexor retinaculum. Within the carpal tunnel lies the median nerve surrounded by the flexor tendons of the hand.
Carpal tunnel syndrome develops when the median nerve is compressed within the wrist. Individuals such as drummers who repetitively use their wrists are at risk for developing CTS. Carpal tunnel syndrome may also develop from pressure on the median nerve from a wrist fracture, inflammation, or swelling around the nerve as it passes within the carpal tunnel or pregnancy. Vibration may also predispose you to CTS. This occurs when the drumstick or hand hits a drumhead, cymbal, or pad. Inflammatory diseases such as arthritis, diabetes, and hypothyroidism may cause CTS.
CTS symptoms include the following:
1. Pain, numbness, and/or tingling in the wrist, thumb, index, and middle fingers. Pain may radiate into forearm, arm, and shoulder.
2. Pain increases with increased use of the wrist or hand.
3. Pain worsens at night and awakens you from sleep.
4. Grip strength decreases, and you can begin to drop objects.
5. Muscle wasting in the thumb occurs in severe cases.
CTS is diagnosed by finding the following:
1. A positive Tinel’s sign, which is characterized by an electrical shock in the wrist and fingers when tapping on the palm side of the wrist.
2. A positive Phalen’s test, which occurs when numbness and tingling is felt in the thumb, index, and ring finger during wrist flexion.
3. A positive nerve conduction/electromyography test (NCV/EMG), which uses an electrical test to evaluate nerve and muscle function.
Treatment includes anti-inflammatory medication, wrist splinting at night and during periods of repetitive wrist motion, treating of underlying disease process, therapy, avoiding aggravating activities, and oral steroid medications. Surgical treatment of severe cases includes open or arthroscopic carpal tunnel release.
Make sure your hands and wrists are comfortable while playing, take regular breaks from repetitive motion, avoid resting your hands and wrists on hard or ridged surfaces for prolonged periods, make sure your positioning is ergonomically correct, maintain adequate control of any disease process, and practice daily wrist and hand stretches and exercises.