Last month I kicked off a series of articles on common hand and wrist injuries in drummers. The nerves crossing the wrist and into the hand are very vulnerable to injury either from direct trauma or due to repetitive injury. The most common nerve injury occurring in the wrist is carpal tunnel syndrome or median nerve entrapment neuropathy.
Carpal tunnel syndrome (CTS) is a common painful disorder involving the wrist and hand. The carpal tunnel of the wrist is formed on three sides by the wrist carpal bones and covered by the flexor retinaculum a thick band of tissue. 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 repetitively using their wrists are at risk for developing CTS. Carpal tunnel syndrome may also develop from pressure on the median nerve due to a wrist fracture, inflammation or swelling around the nerve as it passes within the carpal tunnel. Vibration may also predispose us to CTS. This can occur in drummers when the drumstick or hand hits a drumhead, cymbal or pad. Inflammatory diseases such as arthritis, diabetes and hypothyroidism may cause CTS.
Symptoms of carpal tunnel can present with pain, numbness and/or tingling in the wrist, thumb, index and middle fingers. It is not uncommon for the pain to radiate into forearm, arm and shoulder. Pain can increases with increased use of the wrist or hand. Pain typically worsens at night and awakens you from sleep. Grip strength can eventually decrease and you can begin to drop objects. Muscle wasting in the thumb eventually occurs in severe cases.
The diagnosis of CTS is suspected when a number of clinical findings are found by your physician such as a positive Tinel’s sign, an electrical shock sensation in the hand and fingers with tapping over the nerve or a positive Phalen’s test causing numbness and tingling in the thumb, index and ring finger with wrist flexion. However, the definitive diagnosis for CTS is made by performing a nerve conduction/electromyography test (NCV/EMG), which is an electrical test to evaluate, nerve and muscle function.
Treatment of CTS can include anti-inflammatory medication, wrist splinting at night and during periods of repetitive wrist motion, treating of an underlying disease process, therapy, avoiding aggravating activities, oral steroid medications. Severe cases may require surgical treatment including open or arthroscopic carpal tunnel release.
An ounce of prevention is worth a pound of cure. 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 drum set up and positioning is ergonomically correct, maintain your health and practice daily wrist and hand stretches and exercises.