HORSEBACK RIDING AND CARPAL TUNNEL SYNDROME
A few aches and pains seem like a small price to pay for a long day at the barn, and most of us simply shake off such minor discomforts. But if you often feel a tingling or burning sensation in your hands—especially the index, middle, and ring fingers—you’ll want to investigate: These are early warning signs of carpal tunnel syndrome (CTS).
Caused by swelling within the wrist that compresses a nerve, CTS received a lot of press in the 1980s and ‘90s when it became known as a hazard for those who spent hours working on computer keyboards. But not only office workers are susceptible to CTS—the condition can occur in anyone who performs repetitive tasks that also require strength and force. In fact, according to the National Ag Safety Database, many activities on the average farm can also increase a persons’ risk of CTS, such as:
- Carrying heavy buckets
- Frequent use of tools that require a strong grip, such as pitchforks and shovels
- Prolonged use of vibrating power tools
Add gripping reins for prolonged periods to that list, and it’s clear why riders need to be award of CTS. It’s not a risk to be taken lightly. It may begin as mild tingling in the fingers, but left untreated, CTS can progress to severe pain and, in the worst cases, can lead to irreversible nerve damage that can leave a portion of your hand numb or even paralyzed.
Fortunately, if you understand the causes of the condition and learn to recognize the early warning signs, you’ll be prepared to prevent it, or at least catch it early enough to avoid the worst long-term effects. Here’s what you need to know.
How it Happens
CTS results from a thickening of the transverse carpal ligament, which lies along the wrist at the base of the palm. This thickening puts pressure on the median nerve, which runs through a narrow, bony channel beneath the ligament and supplies sensation to the palm side fo the tumb, as well as the index, middle and ring fingers. A branch of the median nerve supports the motor function to the opponents muscle, located at the base of the thumb; this muscle allows the thumb to swing around to touch the tips of the other fingers.
CTS can occur in anyone, and the causes are not always identifiable.
- Women are three times more likely than men to experience CTS, probably because their wrists are generally smaller. Hormonal changes resulting from oral contraceptives or menopause can also increase susceptibility.
- Some people seem to have a congenital predisposition to the condition, perhaps because of the size and structure of their wrists. If any close relatives have had CTS, you may also be more likely to develop it.
- Middle-aged and elderly people are more susceptible than younger adults.
- Thyroid disorders, diabetes and other diseases that affect the nervous system can also cause or contribute to CTS.
CTS usually beings gradually, with a vague aching in the wrist and/or a burning, tingling or itching sensation in the palm and thumb, index and middle fingers. The sensation is usually stronger in the dominant hand. Most people experience the symptoms at night because they sleep with their wrists flexed and wake up feeling the need to “shake out” one or both hands.
As CTS progresses, people may experience any of the following:
- Shooting pains in the hand, radiating up the forearm, that may be intense enough to disturb sleep
- Numbness and tingling that persists throughout the day
- Decreased grip strength that makes it harder to make a fist or hold onto objects
If you have symptoms in one hand, compare the size of the opponens muscle to the one on the unaffected hand. You may notice that the muscles on the affected side are smaller.
Next, take a sharp object, such use a safety pin, and scratch—don’t prick—the tips of the index fingers. You may notice less sensation in the affected hand. Finally, try an exercise called Phalen’s test: Flex the writs on your affected side as fully as possible and hold the position for a full minute. A tingling/burning sensation in the middle fingers may indicate CTS.
See your physician if you suspect you have CTS. He’ll first need to rule out other injuries or disorders that can produce similar symptoms. If you do not have CTS, depending on the severity, he’ll then likely recommend any or all of the following options:
- Resting the affected hand by refraining from all activities that might have caused or aggravated the condition is usually recommended for at least two weeks.
- Anti-inflammatory medications may reduce irritation under the transverse carpal ligament in the early stages. Be sure to tell your physician that you are a rider; he may choose to prescribe anti-inflammatory drugs that do not promote bleeding following injury.
- Corticosteroid injections into the carpal tunnel may be needed to relieve pain and inflammation.
- Oral diuretics may reduce swelling if that is an issue.
- The icing of the wrist may also reduce inflammation.
- A splint to hold the wrist in a neutral position can prevent you from flexing the hand in your sleep. Some people may need to wear splints in the daytime as well.
- Exercises to stretch and strengthen the hands may be beneficial once the acute inflammation has subsided.
If symptoms do not abate after six months with other treatments, surgery may be necessary. During the procedure, which is usually done on an outpatient basis, the hand is anesthetized, an incision is made in the lifeline crease, and the ligament overlying the carpal tunnel is removed, which relieves pressure on the nerve.
Physical therapy, to help the patient regain strength in the wrist, is usually necessary afterward. Most people recover completely within weeks or months.
Tactics to avoid developing carpal tunnel syndrome while horseback riding involve finding ways to accomplish your tasks without overstressing your hands. Here are some suggestions:
- Choose tools to hold with ergonomically designed handles that are comfortable to hold and use—that is, not too big or too small for your hands.
- Take rest breaks to relax your hands when you are doing repetitive tasks. If possible, switch hands occasionally as you work.
- When riding us a thicker, braided rein. It takes less grip strength to hold a thicker object, and the braiding also helps you hold the rein with less pressure between the thumb and fingers. (The ThinLine hunter rein).
- Consider riding with gloves. You’ll avoid getting perspiration on the reins. Or just chose the ThinLine non-slip rein for both CTS and arthritic hands. ~JSW
Jim Warson, MD is a retired neurosurgeon who is a leading authority on equine-related spinal injuries. The author of The Rider’s Pain-Free Back, Warson breeds Morgan and Saddlebred Horses.
Published by Equus Magazine in September 2009