Okay! I apologize. Forgive me. Im sorry. I messed up. I made a boo-boo. I goofed. I forgot. My dog ate it. There was a fire. I lost it. Someone stole it. My computer crashed. I got the Love Bug virus. My nine-pin dot matrix printer ribbon broke.
Now that Ive used every excuse in the world for not submitting my monthly column to the editors of sCORPSboard, I give you this months column. Actually, the editors of sCORPSboard have been both very patient and very nice to me about my not submitting my columns for the board. Its just that I kept getting this weird feeling that I forgot something whenever they were around. Caryn would occasionally look over the top of her glasses and give me a cold glare and remind me that as a guard member, she had access to a sword. Cathy would gently pick up her soprano, turn in my direction, place the bell of the horn close to my ear, and screech out a note that would rattle my little brain inside the big empty skull. I figured that Id better write something before things escalated.
When I last wrote, I spoke about an injury I had to my wrist as a beginning drummer, and how I overcame the injury to develop my range of motion and lost chops. I mentioned how my instructor at the time advised me to use a pillow so I could develop more speed and bounce using my muscle versus the bounce of a practice pad or drum. It worked for me. Several readers sent me e-mail also recommending pillows for practicing their diddles, as well as the use of hand exercises to develop their finger muscles. Of course, I dont recommend anything for rehabilitation of an injury unless you speak with your physician first. Your doctor will know the particulars of your injury and can recommend a regimen of therapy to help regain your strength.
From some of the input I received from members of my own corps, and from reading the newsgroup rec.arts.marching.drumcorps, injuries to drummers are quite common. One particular topic that keeps rearing its ugly head is (insert drum roll here) carpal tunnel injuries from playing on kevlar. The familiar sentences, "I got carpal tunnel from playing on kevlar." Or "Matched grip gave me carpal tunnel in the left hand." Make me want to cringe. Carpal tunnel has another name. That name being repetitive stress syndrome or cumulative trauma disorder. This is what Ive found from the Multimedia Web Groups Web page.
Carpal tunnel syndrome is a common problem that affects the hand and wrist. This condition, or syndrome, has become the focus of much attention in the last few years due to suggestions that it may be linked to occupations that require repetitive use of the hands - such as typing. In reality, there are many people who develop this condition - regardless of the type of work that they do.
Anatomy: The Median Nerve
The carpal tunnel is an opening into the hand that is made up of the bones of the wrist on the bottom and the transverse carpal ligament on the top. If you were to look at a cross section of the wrist, it would allow you to visualize the anatomy of the carpal tunnel. Through this opening called the carpal tunnel, the median nerve and the flexor tendons run into the hand. The median nerve lies just under the transverse carpal ligament.
The flexor tendons are important because they allow us to move the fingers and the hand, such as when we grasp objects. The tendons are covered by a material called tenosynovium. The tenosynovium is very slippery, and allows the tendons to glide against each other as the hand is used to grasp objects. Any condition that causes irritation or inflammation of the tendons can result in swelling and thickening of the tenosynovium. As the tenosynovium covering all of the tendons begin to swell and thicken, the pressure begins to increase in the carpal tunnel - because the bones and ligaments that make up the tunnel are not able to stretch in response to the swelling. Increased pressure in the carpal tunnel begins to squeeze the median nerve against the transverse carpal ligament - because the nerve is the softest structure in the carpal tunnel. Eventually, the pressure reaches a point when the nerve can no longer function normally. Pain and numbness in the hand begins.
One of the first symptoms of carpal tunnel syndrome is numbness in the distribution of the median nerve. This is quickly followed by pain in the same distribution. The pain may also radiate up the arm to the shoulder, and, sometimes the neck. If the condition is allowed to progress, weakness of the thenar muscles can occur. This results in an inability to bring the thumb into opposition with the other fingers and hinders one's grasp.
There are many conditions that can result in irritation and inflammation of the tenosynovium, and eventually cause carpal tunnel syndrome. Different types of arthritis can cause inflammation of the tenosynovium directly. A fracture of the wrist bones may later cause carpal tunnel syndrome if the healed fragments result in abnormal irritation on the flexor tendons. The Key Concept to remember is that anything which causes abnormal pressure on the median nerve will result in the symptoms of pain, numbness and weakness of carpal tunnel syndrome. Recently, physicians have begun to recognize that activities that involve highly repetitive use of the hands can result in carpal tunnel syndrome. This is thought to be caused by inflammation and swelling of the tenosynovium due to overuse.
If more information is needed to make the diagnosis, your doctor may request electrical studies of the nerves in the wrist. Several tests are available to see how well the median nerve is functioning, including the nerve conduction velocity (NCV). This test measures how fast nerve impulses are conducted through the nerve.
Treatment: Non-Operative Treatment
Anti-inflammatory medications may also help control the swelling of the tenosynovium and reduce the symptoms of carpal tunnel syndrome. These medications include the common over the counter medications such as ibuprofen and aspirin. In some studies, high doses of Vitamin B-6 have also shown some efficacy in decreasing the symptoms of carpal tunnel syndrome.
There is some evidence that exercises may prevent or control the symptoms of carpal tunnel syndrome. Another good discussion of the technical aspects of the reducing the risks of carpal tunnel syndrome suggests that wrist position may contribute to the problem. Workplace ergonomics have long been thought to be a contributing factor and alteration of the worksite is a must for patients doing any type of repetitive work.
If these simple measures fail to control your symptoms an injection of cortisone into the carpal tunnel may be suggested. This medication will decrease the swelling of the tenosynovium and may give temporary relief of symptoms. It is used not only to treat the problem, but serves to aid in diagnosis. If you don't get even temporary relief from the injection, it may be a sign that other problems exist that are causing the carpal tunnel symptoms. There is also a newer way to get cortisone medications down into the carpal tunnel. Iontophresis is a technique where an electrical current is used to move the molecules of the medication through the skin down into the carpal tunnel. It is less painful than an injection, but is probably not as effective.
Treatment: Surgical Treatment
Basic Steps in Open Carpal Tunnel
Step 2: After the incision is made through the skin, a structure called the palmar fascia is visible. An incision is made through this material as well, so that the constricting element, the transverse carpal ligament, can be seen.
Step 3: Once the transverse carpal ligament is visible, it is cut with either a scalpel or scissors, while making sure that the median nerve is out of the way and protected.
Step 4: Once the transverse carpal ligament is cut, the pressure is relieved on the median nerve.
Step 5: Finally, the skin incision is sutured. At the end of the procedure, only the skin incision is repaired. The transverse carpal ligament remains open and the gap is slowly filled by scar tissue.
A bulky dressing is applied to the hand following surgery. You should leave this in place until your first office visit after the surgery. Your sutures will be removed 10 - 14 days after surgery. You should avoid any heavy use of the hand for 4 weeks after your surgery. You should not get the stitches wet. Expect the pain and numbness to begin to improve after surgery, but you may have tenderness in the area of the incision for several months.
See you next time Frank