Carpal Tunnel
Syndrome and Golf
By Larry
Foster, M.D., F.A.A.O.S. (Dr. Divot)
One of
the most common clinical problems I see in my orthopedic practice is carpal
tunnel syndrome (CTS). I’m sure you or
someone you know has suffered from CTS.
In the
We do know
that carpal tunnel syndrome is associated with certain medical conditions, such
as diabetes, thyroid disease, and gout.
Furthermore, it is widely believed that repetitive use of the hands and
wrists causes CTS. However, no
scientific study has ever proven a direct link between any specific job
activity and carpal tunnel syndrome.
The truth
is that the causes of CTS are what we doctors call multifactorial. That is,
multiple factors, including occupational and recreational overuse, underlying
medical conditions, genetics, and who knows what else, all contribute to this very common syndrome.
Although
playing golf has not been identified as a direct cause of carpal tunnel
syndrome, the repetitive use of the hands and wrists seen in golf could
certainly contribute. But to say that
playing a few rounds of golf a month is a major factor in the development of
your CTS is probably stretching the point.
The same may not be true for the serious amateur or pro, for whom the
countless hours of practice and play could take its toll. For one, Ken Venturi has noted that he
developed such severe carpal tunnel syndrome in both hands that his touring
career was ended.
Carpal
tunnel syndrome occurs as a result of injury to the median nerve. As this nerve
travels from the forearm to the wrist, it passes through a structure called the
carpal tunnel. The wrist (carpal) bones form the floor of
the carpal tunnel, and a thick ligament forms the roof. Packed into the tunnel, along with the median
nerve, are most of the flexor tendons en route to the fingers. When inflammation and swelling of the tendons
cause crowding and increased pressure on the median nerve, CTS is the
result. The increased pressure on the
nerve causes it to malfunction, resulting in the symptoms of carpal tunnel
syndrome.
Patients
with carpal tunnel syndrome describe several classic symptoms. Numbness
and tingling involving the thumb and the index and middle fingers (and
sometimes the whole hand) are the hallmark of CTS. Annoying numbness can occur both during the day
(while doing things such as driving, holding a telephone, or using hand tools)
and at night (patients are frequently awakened from sleep by numbness in the
hands). Clumsiness and weakness when
trying to grip things are also common complaints. There may be pain as well.
A course
of rest, wrist splinting (especially at night), and anti-inflammatory
medication are frequently the initial treatments for carpal tunnel
syndrome. Identifying work-related or
recreational activities that may be aggravating the situation is also
helpful. Looking for ways to get the job
done using less force, less repetition, and /or less wrist motion may help. For the golfer, simple measures—such as
easing up on grip pressure during the address phase of the golf swing and
making sure that worn golf grips are replaced regularly—may reduce the stress
on the wrists/hands and help minimize the severity of CTS. Also, wearing a glove on each hand may provide extra cushioning. Finally, simply cutting back on the rounds of
golf played or the number of balls hit at the range each week may help an
injured nerve to recover.
The
nonoperative measures listed above are most successful for early and mild cases
of CTS. Studies show that only about
one-third of patients will respond to these simple measures. For the rest, surgery may be the only
answer—or, as one of my former co-residents used to say, the only cure left is
hot lights and cold steel!
The
concept behind CTS surgery is quite simple—the tunnel is “unroofed” by cutting
the ligament overlying the nerve. This
gives the nerve extra breathing space that is usually sufficient to allow the
injured nerve to recover and for symptoms to resolve. In the early 1900s, surgeons mistakenly
believed that CTS was caused by pressure on the nerves at the base of the neck and that the treatment was rib resection. Ouch!
For those of you who constantly long for the “good old days”, I
recommend that you stick to reminiscing about five-cent Hershey bars and leave
out the early days of medicine.
Surgery
can be performed either through an open incision or through tiny incisions with
the aid of a camera (endoscopic
technique). Either way, the success rate
of CTS surgery is very high.
Postoperatively, patients can return to golf once the incision has
healed and wrist strength and range of motion have returned to normal.
If you or
someone you know is experiencing the symptoms of carpal tunnel syndrome, make
sure to see an orthopedic doctor. Delaying
treatment not only results in unnecessary suffering, it can lead to
irreversible nerve damage with permanent
numbness and weakness. One the other
hand (bad pun intended), prompt treatment can get you back on the golf course
in no time.
Larry Foster, M.D.,
F.A.A.O.S., is a board-certified orthopedic surgeon and self-described golf
nut.
Trained at
Visit Dr. Divot’s website at: www.doctordivotmd.com.
Or call:
1-800-247-6553 ($19.95).
The articles at GolfFitnessProducts.net are for informational purposes only and are not intended to substitute for direct examination and exercise prescription by the appropriate health professional. It is strongly recommended that you do not perform any exercise program without the consent of your personal physician.
