Complications of diabetes are nothing that anyone likes to think about, but here at the 'Mine, we believe knowledge is power. So we've been running a "411 info series" on a variety of complications, from heart disease to neuropathy to depression.
Back in December we talked about frozen shoulder (which has nothing to do with cold weather), and now we're moving down your arm to talk about carpal tunnel syndrome — an incredibly common ailment in our keyboard-laden, button-pushing society.
As you may know, carpal tunnel syndrome is a progressively painful hand and arm condition caused by a pinched nerve in your wrist. Specifically, it affects the median nerve, which runs through the "carpal tunnel" from your hand into your forearm. The median nerve provides feeling to the palm side of your fingers and is the muscle power that powers your thumb. When the median nerve is pinched from swelling of nerves or tendons in the carpal tunnel, numbness, tingling and pain can affect the hand and fingers. It can also lead to other symptoms, like poor circulation and loss of grip strength.
The root cause of the condition is unknown, but with diabetes, researchers believe that high blood glucose levels cause the tendons of the carpal tunnel become glycosylated, which means the tendons become inflamed and excess sugars form a "biological superglue" that makes the tendons less able to slide freely. This is similar to what happens in frozen shoulder. Research has shown that women are three times more likely to have carpal tunnel syndrome, and approximately 15 percent of people with diabetes will get it. (Lucky us!)
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Not only that, but researchers have found that carpal tunnel syndrome might actually predict diabetes: A study in Diabetes Care found that people who had been diagnosed with carpal tunnel syndrome were 36% more likely to be diagnosed with type 2 diabetes later in life, regardless of other diabetes risk factors.
Other studies have shown a "lifetime risk of symptomatic carpal tunnel syndrome in type 1 diabetes." Oy!
If you think it's just a case of sore wrists, think again. The pain can be awful! Amy has suffered with carpal tunnel, and wrote in a 2008 post: "I never imagined how painful or disabilitating it can be. At its worst, I could literally not make toast for my kids in the morning, let alone help them button their sweaters. I could barely hold my blow drier up straight, and was wiped out from being up all night with the pain."
Scott King, former editor of Diabetes Health, also suffered with carpal tunnel, and his was so severe he underwent arthroscopic surgery. After his surgery, he wrote to us, verbatim: "I have only one little hole in both wrists, almost healed now but scars are still sensitive and i can TYPE again with no pain! that was the worst part after the surgery hands hurt horrible for the 1st 2 days (they should have given me better pain drugs, as I was in so much pain, i had to chew up 3 vicadins just to get some relief) but by 1 week i was flying out on a business trip, everything was great! I DO WISH I had the surgery earlier as i still have tingling in my left hand, damage to the nerve."
Keep in mind that symptoms for carpal tunnel start gradually, so it's important to see your doctor early. How do you know if you have it? Do you often feel "pins and needles"or a burning feeling or a loss of sensation in your hands? Do you wake up at night with your hands or thumbs feeling numb, like they've "gone to sleep"?
When you do get examined, your doctor will run some tests, most importantly to make sure that you aren't suffering from peripheral neuropathy. The two conditions can feel similar, but are not the same thing, and require different treatments.
Two clinical tests used to diagnose carpal tunnel syndrome are the Tinel and Phalen maneuvers, which sound really scary but are actually just flexing exercises to check if you experience a tingling sensation in your hands or wrists. In the Tinel test, the doctors taps the inside of your wrist over the median nerve. If you feel tingling, numbness, or a mild "shock" sensation in your hand when tapped on the wrist, you may have carpal tunnel.
The Phalen test has you resting your elbows on a table, and then letting your wrists dangle so your hands are pointing down with your palms pressed together in the prayer position. (This dorky video sums it up nicely.) A positive result is when your fingers tingle or feel numb within a minute.
For most folks, avoiding activities that aggravate the wrist (which, sadly, includes working on the computer), using a wrist splint and taking ibuprofen can help with the pain and keep the pressure off the median nerve until things heal. Sometimes ice packs, physical therapy exercises or corticosteriod injections may also be administered.
If your condition doesn't improve within a few weeks, your doctor may recommended that you see an orthopedic surgeon or a neurologist. Severe cases, such as Scott's case, may require surgery, which involves cutting the ligament that forms the top of the carpal tunnel. Cutting this ligament relieves pressure on the median nerve. Any other tissue (such as a tumor) that may be putting pressure on the median nerve can also be removed during surgery.
There are two methods of carpal tunnel surgery, called open and endoscopic. But be aware: neither is fool-proof. Each has advantages and disadvantages, mostly related to ongoing discomfort after the surgery. According to WebMD, "when done by an experienced surgeon, endoscopic carpal tunnel release heals more quickly and does not leave the larger and potentially painful scar that open surgery produces."
Naturally, diabetes also complicates things; many medical sources still state the disclaimer: "Surgery may only provide partial relief when another medical condition, such as rheumatoid arthritis, obesity, or diabetes, is contributing to carpal tunnel syndrome."
Hmm... so choosing whether or not to undergo surgery can be a big decision. WebMD has this guide to help you make a decision.
So what else can you do? In addition to managing blood sugars, a good way to help prevent carpal tunnel syndrome is keeping your wrists straight as much as possible and avoid flexing them unnecessarily (which often happens when using our old friend Mr. Computer!). To help with this, Amy even had an ergonomics specialist visit her office to check the set-up of her chair height and keyboard. Sounds pretentious, but it actually really helped, she says.
So, any PWDs out there suffering with carpal tunnel syndrome? We really feel for you!