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How Can Carpal Tunnel Syndrome (CTS) Be Prevented?

Well-Connected Companies are now taking action to help prevent repetitive stress injuries.  In a major survey, 84% reported that they were modifying equipment, tasks, and process; 83% were analyzing their workstations and jobs, and 79% were buying new equipment.  No single mode of prevention exists for carpal tunnel syndrome.  It is important, however, to use common sense and ergonomic controls to help minimize risk factors predisposing to work-related CTS or other cumulative trauma disorders.  A patient can learn how to adjust the work area, handle tools, or perform tasks in ways that put less stress on the hands and wrists. Exercise programs to strengthen the fingers, hands, wrists, forearms, shoulders, and neck may help prevent CTS.  It should be stressed, however, that there has been no evidence that any of these methods can provide complete protection against carpal tunnel syndrome.  If the underlying cause is a medical condition, controlling the problem can prevent CTS.

Ergonomic Controls
Ergonomics is the study and control of posture, stresses, motions, and other physical forces on the human body engaged in work. Altering the way a person performs repetitive activities may help prevent inflammation in the hand & wrist from progressing into full-blown CTS. For example, replace old tools with ergonomically designed new ones.
Repetition and Rest
Anyone who does repetitive tasks should begin with a short warm-up period, take frequent breaks, and avoid overexertion of the hand and finger muscles whenever possible. Employers should be urged to vary tasks and work content.
Good posture is extremely important in preventing carpal tunnel syndrome, particularly for typists and computer users. A keyboard operator should sit with the spine against the back of the chair with the shoulders relaxed, the elbows along the sides of the body, and wrists straight. The feet should be firmly on the floor or on a footrest. Typing materials should be at eye level so that the neck does not bend over the work. Keeping the neck flexible and head upright maintains circulation and nerve function to the arms and hands. Poorly designed office furniture is a major contributor to bad posture. Chairs should be adjustable for height, with a supportive backrest. Employers should be advised that the higher cost of a custom designed chair for a worker whose body does not fit a standard chair is still far less than the medical or absentee costs.

The force placed on the fingers, hands, and wrists by a repetitive task contributes importantly to CTS. To alleviate the effect of force on the wrist, tools and tasks should be designed so that the wrist position is the same as it would be if the arms dangled in a relaxed manner at the sides. No task should require the wrist to deviate from side to side or to remain flexed or highly extended for long periods.

Keyboard operators should adjust the tension of the keys so that depressing the keyboard does not cause fatigue. The hands and wrists should remain in a relaxed position to avoid excessive force on the keyboard. For computer users, replacing the mouse with a trackball device and the standard keyboard with a jointed-type are helpful substitutions. Wrist rests, which fit under most keyboards, can help keep the wrists and fingers in a comfortable position.

The handles of such tools as screwdrivers, scrapers, paintbrushes, and buffers should be designed so that the force of the worker’s grip is distributed across the muscle between the base of the thumb and the little finger — not just in the center of the palm. People who need to hold any objects — such as a pencil, steering wheel, or tools — for long periods of time should grip them as loosely as possible. In order to apply force appropriately, the ability to feel an object is extremely important. Tools with textured handles are helpful. Working at low temperatures, which reduces sensation in hands and fingers, should be avoided if possible.

Tools and machines should be designed to minimize vibrations. Protective equipment, such as shock absorbers, can reduce vibrations. Bicyclists who ride frequently on rough roads should wear thick cycling gloves to lessen the shock transmitted to the hands and wrists.
Hand and wrist exercises may help reduce the risk of developing CTS. Isometric and stretching exercises can strengthen the muscles in the wrists and hands, as well as the neck and shoulders, improving blood flow to these areas. Performing the following simple exercises for four to five minutes every hour may be helpful.
Make a loose right fist, palm up, and use the left hand to press gently down against the clenched hand. Resist the force with the closed right hand for five seconds, but be sure to keep the wrist straight. Next, turn the right fist palm down and press against the knuckles with the left hand for five seconds. Finally, turn the right palm so the thumb-side of the fist is up and press down again for five seconds. Repeat with the left hand. Another easy wrist exercise requires first holding one hand straight up next to the shoulder with fingers together and palm facing outward. (The position looks like a shoulder-high salute); next, with the other hand, bend the hand being exercised backward with the fingers still held together and hold for five seconds; and third, spread the fingers and thumb open while the hand is still bent back and hold for five seconds. Repeat five times for each hand. A third simple exercise is called wrist circles. First hold the second and third fingers up and close the others. Draw five clockwise circles in the air with the two fingertips. Draw five more counterclockwise circles. Repeat with the other hand.
Fingers and Hand
The first exercise is the finger bend and stretch. Clench the fingers of one hand into a fist tightly, and then release, fanning out the fingers. Do this five times. Repeat with the other hand. To exercise the thumb, bend it against the palm beneath the little finger and hold for five seconds. Spread the fingers apart, palm up, and hold for five seconds. This should be repeated five to 10 times with each hand. Then, gently pull the thumb out and back and holding for five seconds, repeating five to 10 times with each hand.
Excessive use of the hands can cause the forearm muscles to tighten, increasing pressure on tendons as they pass through the wrist.   Stretching these muscles will reduce this tension.  Place the hands together in front of the chest, fingers pointed upward in a prayer-like position.  Keeping the palms flat together, raise the elbows to stretch the forearm muscles.  Stretch for 10 seconds.  Then gently shake the hands limp for a few seconds to loosen them.  Repeat frequently when the hands or arms tire from activity.
Neck and Shoulders
Sit upright and place the right hand on top of the left shoulder.  Hold that shoulder down and slowly tip the head down toward the right.  Keep the face pointed forward, or even turned slightly toward the right.  Hold this stretch gently for five seconds.  Repeat on the other side.  A second exercise requires standing in a relaxed position with the arms at the side. Shrug the shoulders up, then squeeze the shoulders back, then stretch the shoulders down, and then press them forward. The entire exercise should take about seven seconds.
General Exercise
A regular exercise regimen using a combination of aerobic and resistance training techniques strengthens the muscles in the shoulders, arms, and back, helps reduce weight, and improves overall health and well-being. Some experts have reported that people, who are physically fit, including athletes, joggers, and swimmers, have a lower risk for cumulative trauma disorders.  People with any chronic medical condition or with risk factors for heart disease should check with their physicians about an appropriate regimen.

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