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Repetitive Overuse Injury
& Carpal Tunnel Syndrome


Few problems are more controversial and more misunderstood than the group of problems called repetitive overuse injuries. The view presented here will be as objective as possible for a subject that is almost impossible to study properly.

Repetitive Overuse Injury vs. Carpal Tunnel Syndrome

The vs. in the title of this section is for emphasis. Repetitive Overuse and Carpal Tunnel are two different problems; but the same person can have both problems from the same cause. Sometimes one of the two problems is the more important than the other; it can be either carpal tunnel or repetitive overuse causing the bigger problem.

The following table is written to clarify the distinction:

Comparison: Repetitive Overuse Vs. Carpal Tunnel
+ Problem Repetitive Overuse Carpal Tunnel
* Pain in wrists Usually, if the wrist is involved Variable, usually mild
* Tingling Minor problem Always, and almost always includes the fingers
* Pain in the forearm (below the elbow) Usually Often
* Pain in neck and shoulders Often No

What is a Repetitive Overuse Injury?

A repetitive overuse injury involves repeated strain on a tendon in a particular area, used beyond its ability to cope. The most common place for this problem is in the wrist, where a condition called tenosynovitis occurs.

To explain how this works, first a definition: A tendons is a structure that connects a muscle to a bone. To make our bodies move, the bones have to be moved. The power to move them comes from the muscles. For the movement power to get to the bones, connectors are needed, which are the tendons. In most injuries, the tendons are the most easily hurt among bone, muscle, and tendon.

In the wrist, there is a special situation. The tendons from the powerful forearm muscles need to move the fingers, while the wrist can be in any position. (Try this: bend your wrist part of the way in each direction; You can still close your fingers!) To make this work, the tendons pass through some sheaths that act like pulleys. The system, like most things in the body, works well when it is working normally.

The problems happen when the area is used over and over, rapidly, all day and without rest. Then instead of gliding smoothly, the pulley area gets irritated and inflamed. This is called tenosynovitis.

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a pressure on one of the main arm nerves in the wrist area. The nerve is called the median nerve. At and just below the wrist, the median nerve goes through a narrow place called the carpal tunnel. There is no extra room in the tunnel, so that any swelling or pressure in the tunnel irritates the nerve, and if it is strong enough, causes damage to the nerve. This nerve irritation or damage produces the problem called carpal tunnel syndrome. For many years this common problem was missed, a sad situation because true carpal tunnel syndrome is usually treatable. Now, we have tended to go too far the other way, and people think any hand or wrist pain is carpal tunnel syndrome.

Why it matters which one you have

Because the treatment is different. The two problems should be treated differently. If you have repetitive overuse syndrome, and are treated for carpal tunnel syndrome, the treatment won't help you.

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Last modified: 1 Sep 2002

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