Arius-Eickert Technical Papers Carpal Tunnel Syndrome and Tool Ergonomics Say Carpal Tunnel Syndrome and many of our readers cringe. Either because of the pain they endure or because they are afraid of developing it. Carpal Tunnel Syndrome is one of several cumulative trauma disorders that can occur from repeated body motions. It can cripple the body, causing great pain and ending the careers of many beauticians and barbers. It is also the most common occupational illness in our industry. Do you have Carpal Tunnel Syndrome? Do you have or think you may be developing carpal tunnel syndrome? How can you tell? Try some of these simple tests. Slowly press the backs of your hands together to bend your wrists as much as possible, until you feel slight resistance (do not force them). Point your fingers toward the floor. Keep your hands in this position for a minute. Does this produce tingling or numbness in your hands? It will in a high percentage of people who have carpal tunnel and in about 20% of people who do not have it. Try another test. Tap your fingers along the inside of the opposite wrist. Is there a pins and needle sensations? 50% of people with carpal tunnel will experience this sensation and about 6% of people who do not have it will feel the prickling sensation. How do I get Carpal Tunnel Syndrome? Cumulative Trauma Disorders (CTD) to the body are caused by improper posture or an inability to use correct posture in long-term repetitive tasks. Carpal Tunnel Syndrome, which is in the wrist area, is the most common CTD. You can also develop problems in the elbow, shoulder area, neck, lower back and ankles, just by holding your wrist incorrectly while cutting! Carpal Tunnel Syndrome is caused by improper extension of your wrist. The first diagnosis of a problem in your wrist is usually tendonitis. One symptom is pain in the wrist, elbow and/or shoulder. Another symptom is one or more tendons catching instead of moving in a smooth motion. The carpal tunnel is a small passageway in the wrist through which nine flexor tendons and the median nerve travel. A problem develops when one or more of these tendons abrade against a bone or ligament bordering the area. Turn your wrist, so that the palm of your hand is facing you. Where your wrist bends, there is a shallow indent in the bone, kind of like a semi-circle.  In this indent run nerves, arteries a nd tendons from your arm to your hand. Holding these nerves and tendons in place is a ligament It is like a rubber band holding the ligaments down, creating a tunnel for the tendons to run through. This area where the nerves run between the bone and the ligament is called the Carpal Tunnel Area. The tendons running through the carpal tunnel make your fingers close, by connecting the first three fingers and the thumb to the muscles in your arm. Much like strings make a puppet move. As the tendons are contracted and relaxed, they move back and forth through the carpal tunnel. If the line of travel through the Carpal Tunnel is straight, there is very little friction or impedance, but if you bend the wrist in any direction, the tendons rub against the bone and the ligament. Surrounding each tendon is a sheath, much like an electrical wire has a plastic coating to protect it. As the tendons rub, the sheath surrounding each tendon inflames. This covering contains synovial fluid, which acts like a lubricant to promote smooth movement as muscles contract and relax. Inflammation and pain result when the fluid wears out from long-term repetitive movements, causing increased friction between the tendon and the sheath. As the tendon inflames, it expands and begins to compress the median nerve, causing pain. It also begins to constrict the blood flow of the artery, which reduces the flow of oxygen and nutrients into the hand. If the tendons continue to inflame, the nerve can be damaged. Lack of blood to the hand can cause a person to lose their sense of touch in the fingertips. In the later stages of carpal tunnel syndrome, it is common to lose hand strength. As a person loses the feeling and strength in their hand, they try to squeeze harder and compensate by using the forearm and thumb muscles more. This can lead to more problems to the point where the forearm muscles can atrophy and weaken. Other disorders caused by cumulative trauma in the tendon sheaths are: 1. Ganglion cysts whose symptoms include bumps on the wrist and forearm containing synovial fluid. 2. DeQuervain's Stenosing Tendinitis caused by the continual motion of the thumb while cutting. The thumb motion can cause the tendon sheaths of the long and short abductor muscles of the thumb to inflame, which again causes great pain. 3. We don't know if you want to call age a disorder, but carpal tunnel syndrome increases in people over the age of 30, resulting in faster scarring of the tendon sheath, which restricts thumb movement. Enough of all this doom and gloom! How can you keep from getting Carpal Tunnel Syndrome? What do you do if you already have it? What can I do to prevent Carpal Tunnel Syndrome? There are several factors that create carpal tunnel syndrome and hand pains for hair stylists. Lets start at tip of the hand and work our way to the shoulder, since everything is connected. The classic way to hold a scissor, as taught in the United States, is to place the ring finger and thumb into the holes of the scissor (also known as the finger rings). The logic here is that you can use your index finger to place on your customer as a guide when detailing and the middle finger acts to stabilize the scissor while opening and closing it. As you open and close your hand, you are forcing your thumb to your ring finger. This is a VERY unnatural motion and causes much of the thumb damage and pain associated with cutting. The thumb should move towards the index finger as much as possible. For example, when you pick up a penny, what do you pick it up with? Your thumb and ring finger? No, usually you use your thumb and index or middle fingers. This is the way a hand naturally opens and closes. This also explains why stylists who cut using their index or middle finger and thumb to hold their scissors have less carpal tunnel problems. It is interesting to note that Europeans and barbers use their index or middle fingers more. Only in the past 25 years have many schools taught their students to use their ring fingers. To alleviate this problem, scissor manufacturers started to develop ergonomic scissors. (Ergonomics is a fancy word to describe the study of the relationship between man and his working environment.) On a traditional scissor the handles are even, meaning that both handles look the same and are the same length. One of the first and most popular ergonomic scissors developed was the offset scissor, where the thumb ring has been brought forward. This allows the thumb to have a more natural movement and not force it opposite the ring finger when closing. Now when your cutting hand is in the closed position, the thumb is opposite the index or middle finger. Examples of our offset scissors are the Geisha 8315 or the Eickert 1140 Offset. Even better are the swivel thumb scissors.   These scissors allow total freedom of movement for the thumb, putting very little stress on the thumb.  An example of these scissors is the Arius 8360 Swivel Thumb. The next most common cutting mistake is to bend the wrist. Again, bending the wrist causes the tendons to rub over the bone or ligament in the carpal tunnel. Somewhat like a rope being dragged over the corner of a table. As you open and close your hand, the tendons are rubbing over the bone edge. Remember, it is best to cut with your wrist straight. Another habit many stylists have is to cut with their elbow sticking out or up. The bent arm is held parallel to the ground, instead of closer to the body. The elbow works best close in to the body and when raised is subject to a higher stress distribution. To counter both the bent wrist and raised elbow, scissor manufacturers made the crane necked scissors. With these scissors not only is the thumb ring brought forward like on the offset scissors, but the whole handle is bent downwards to fit the hand better, allowing you to drop your elbow while cutting. The handle of one blade is directly straight in line with the blade. In other words, if you put a ruler over the center of the scissor tip and run it through the center of the screw hole, the other end of the ruler will go directly through the center of the ring finger hole. Having this very straight blade and handle forces the thumb ring foreword and down. This gives the scissor a birdlike "crane" look. Examples of these scissors are the Arius-Eickert Cobra 8340 or Scorpion 8350 scissors. These scissors allow a more relaxed elbow and straight wrist. Holding your wrist and elbow wrong also makes many people slouch while cutting. This translates into lower back and ankle pain. Your hands or wrist hurts If your hand starts to hurt or feel cramped, many doctors recommend flexing and strengthening exercises to build up the muscles in the hand, wrist and forearm. The stretching also helps the blood flow. Here are some commonly recommended exercises. 1. Open your fingers all of the way. Stretch them out, then relax them. Do this several times. 2. Do some shoulder and neck exercises. Start by standing with your feet apart, hands on your hips. Turn your head left and right slowly 10 times. Lightly stretch the neck muscles. Now move your head shoulder to shoulder, bringing your right ear to your right shoulder, then the left ear to the left shoulder 10 times. Do not try to touch both shoulders at the same time...... (That was a feeble joke by the way!) . You should be loosening up slowly. Now roll your head clockwise a few times, then counter clockwise. You may not have much flexibility at first, but do this every day and you will soon feel better. Next stretch your arms out straight like an airplane, then let them down and relax. Purse your lips and blow out deep. Make sure that you make a brrrrrrrrr sound. (This helps you complete your airplane effect). Do this stretch a few times. You may think, what do these stretches have to do with my hand and wrist? Remember, everything is connected, from your hand to your shoulder and tension in your shoulders can translate to your hands. The first wrist problem signs many people have can show up in their shoulders or neck. A pinched nerve in the wrist can show in strange places. Until more serious symptoms appear, many people may not even know they have a wrist problem. Initial symptoms may appear hours after the person has stopped cutting. For instance, an early warning , the prickling sensation in the wrist, is sometimes experienced when the person goes to sleep at night. Please do not confuse this symptom with the prickling sensation you feel at night when your cat has it's claws buried deep into you hand. If your carpal tunnel symptoms get worse, the doctor may tell you to take an anti-inflammatory medicine such as Aspirin or Ibuprofen. You may also be told to wear a brace to keep your wrist straight. If things get worse, the doctor may inject an anti-inflamant such as Hydrocortisone directly into the wrist. They will usually only do this once since it either works or does not work. The hope is that the massive dose will bring the inflammation in your wrist down. This shot must be coupled with a change in your work habits. Such as the ones discussed above - keeping your wrist straight, doing stretching exercises and purchasing an ergonomic scissor. Multiple shots are usually not given, because of the side effect of the hydrocortisone. Your Carpal Tunnel Syndrome just will not go away! You have tried everything else and nothing works. You are in pain and work just is not fun any more. Two of the most popular solutions are to marry a rich person and move to the Bahamas where you can bask your hand in the sun, or OPERATE!!!! Argh! Yes I said it, you may have to get the cutters "badge of courage"! I know, you are saying that you already have all this pain so a little operation can't be much worse. Well.......you are right. Carpal tunnel operations are very advanced, fast, relatively painless and quite successful. The operation consists of cutting into the ligament holding all those tendons down (remember that Rubber band thing we talked about?). The ligament is to relieve the pressure on the tendons and median nerve running beneath it. The procedure is usually an out patient one. You go to the hospital in the morning and go home in the afternoon. You are put to sleep so that you do not move (hmmm... maybe the wrong term for you dog groomers). Today, the operations are usually done using an endoscopic procedure (that's another fancy word for really small instruments). Many doctors now even use lasers. In the old days, to cut the ligament, an incision was made from your palm all the way down your wrist. That way the doctor could get at the carpal tunnel ligament to cut it. But today, with the advancements in endoscopic equipment only a small incision is made in the palm of your hand, about the point where the middle finger and the thumb intersect if you drew a line down them. Another incision is made on the wrist on the other side of the carpal tunnel. The doctors instruments travel under your skin. Snip, snip and your done. A few stitches, some recovery time and they send you home that same day. You can use your hand in a limited capability after a week. Most people have full use of their hand after 4-6 weeks. If you think that you have carpal tunnel syndrome, we recommend that you see your doctor. The earlier you treat the problem, the better.