Uncomfortably Numb

Jul 19th, 2018

Nail techs are particularly prone to developing carpal tunnel syndrome. Here’s how to stop it in its tracks.

A cover shoot with Heidi Klum for Cosmopolitan Germany should’ve been an exciting experience for celebrity nail artist Destinee Handly, but instead she found herself crying in her car at the day’s end, overcome by pain in her hand. “It hurt so bad,” she recalls. “My thumb wouldn’t move. It was just burning and felt numb.”The cause of Handly’s pain that day was carpal tunnel syndrome (CTS), a condition where the median nerve in the hand becomes compressed. It caused her so much pain that it took a half-hour of hand massage to relieve the discomfort enough to allow her to drive home. Doing nails had triggered pain in Handly’s hands before, but never to such a severe degree. Only 23 at the time, Handly took a nearly two-year break from doing nails after that shoot to recharge. Although CTS only affects around 5 percent of the population, women are three times more likely than men to develop the condition, and the physical demands of certain occupations, including nail technician, can exacerbate it. Here’s why doing nails might be putting you at risk for developing CTS, and what you can do to prevent and treat it.

Understanding Carpal Tunnel Syndrome
At the root of CTS is the median nerve, one of the three major nerves that supplies sensation and motor activity to the hand, explains Mark Elzik, MD, a hand and upper-extremity surgeon at South Orange County Orthopaedics in Mission Viejo, California. When it’s compressed, it can cause numbness and tingling in the thumb, index finger, middle finger and half of the ring finger. The median nerve also helps power the muscle that enables the movement of the thumb, and can become weakened with severe carpal tunnel syndrome.Many people are aware of CTS, particularly people who work on computers all day, but nevertheless, the condition is often misunderstood, Dr. Elzik says. “Frequently in my office, I have patients come in thinking they have carpal tunnel syndrome simply because they have wrist pain,” he says. “But that’s not a typical symptom of carpal tunnel syndrome. It’s a nerve condition.” What causes the compression of the nerve is a ligament that lies on top of the nerve in the wrist and can thicken with time and age, Dr. Elzik explains. “We think what’s really happening is that the nerve is losing its blood supply,” says Rachel S. Rohde, MD, associate professor of orthopaedic surgery at the Oakland University William Beaumont School of Medicine and spokesperson for the American Academy of Orthopaedic Surgeons. A ligament and several bones form a “tunnel” through which the median nerve and all of the tendons that flex our fingers travel, Dr. Rohde explains. Any swelling of the tendon, thickening of the ligament or position that reduces the space in the tunnel can press on the blood supply to that nerve and cause numbness, tingling and pain.

Who Is at Risk?
People who are obese or pregnant or have diabetes, arthritis or thyroid disease are at higher risk for developing CTS, and some people seem to be genetically prone to it. It’s also more commonly experienced by individuals with certain jobs. Quarry and rock drillers, forestry workers using saws, jackhammer operators, dentists and jewelry makers using vibrating tools, factory and assembly workers, and nail techs all have a higher incidence of CTS, Dr. Elzik says. The thing they all have in common? People in these professions perform specific physical tasks over and over again. Anyone who spends a lot of time forcefully gripping, pinching or pounding with their hands, for example, is at greater risk of experiencing CTS.
“It’s the repetitive and prolonged time spent with the wrist in [certain] positions that can really serve as a risk factor,” Dr. Elzik says. “Some studies have shown that you need to have your wrist in extreme positions for at least 20 hours a week in order to have a significant increase in the risk of carpal tunnel syndrome.” “Poor wrist position and extremes of motion certainly can contribute,” Dr. Rohde agrees. “I’ve seen nail techs grip the instruments and polish bottles pretty forcefully, so it’s very much like working on jewelry or other objects with instruments.” Handly has found this to be true in her own situation. “It’s not the hand that I paint with [causing the pain], but the one I hold people’s hands with—holding each finger individually and pinching the polish bottle for two hours,” she says. Sitting in one position for a long time, which restricts circulation, doesn’t help either.Gripping a polish bottle, using an e-file and pushing back cuticles require using the thumbs and many of the same muscles repeatedly. Ruth Kallens, owner of Van Court Studio in New York City, says her CTS pain is so bad that she can’t do nails nearly as often as she used to, adding that writing and typing on a computer hurt as well.

Signs and Symptoms
At first, CTS symptoms might be mild and come and go. Usually, the first symptoms of carpal tunnel are numbness, tingling or a “pins-and-needles” sensation in those fingers, Dr. Rohde says. “Often, people experience this at night because we tend to sleep with our wrists bent, which presses on the nerve more,” she says. A telltale sign that CTS is progressing occurs when people start feeling pain or numbness during the day as well. CTS sufferers might also experience a burning sensation or pain particularly in the thumb and index, middle and ring fingers, and hose sensations sometimes travel up the forearms to the shoulders. “If that continues, over time permanent nerve damage can occur,” Dr. Rohde says. “That might be numbness, weakness and loss of dexterity, which nail techs need. And it can lead to dropping objects, having trouble with buttons and zippers, and having difficulty with other minor tasks we take for granted.” Dr. Elzik concurs, “If left untreated, carpal tunnel syndrome can cause permanent loss of sensation in the thumb and index, middle and ring fingers, and can also cause permanent atrophy of one of the thumb muscles.”

Prevention and Treatment
Because CTS is often hereditary, there isn’t a lot you can do to completely prevent it, other than address controllable risk factors such as diabetes and obesity. But being proactive can help you reduce its impact, should you start to see signs of it developing. If you experience symptoms of numbness and tingling in the hands on a regular basis, it’s important to see a doctor as soon as possible, Dr. Elzik says. Doctors can evaluate how well your median nerve is working, as well as the strength of the muscles around your thumb. “The earlier we catch carpal tunnel syndrome, the easier it is to treat and the better the outcome,” he says. A common treatment for early-stage carpal tunnel syndrome is a wrist brace that keeps the median nerve in a “comfortable” position. A brace can keep the wrist straight, maximizing the space for the nerve inside the wrist, Dr. Elzik explains. To temporarily reduce the inflammation that exacerbates CTS, doctors may prescribe ibuprofen or cortisone shots as well, or refer patients to a therapist who can demonstrate “nerve gliding” exercises that might help.
If none of that helps, surgery is an option, Dr. Elzik says. “In general, people recover very well,” he says. “I’ve had patients who are nail techs undergo carpal tunnel surgery and return to work within a week or two, but it very much depends on the patient.” Although Drs. Elzik and Rohde say they haven’t yet seen scientific evidence that alternative therapies are effective at alleviating CTS pain, Handly and Kallens have found some relief using natural remedies. Handly also credits her recovery in large part to the “yoga for surfers” classes she discovered. She stays off her wrists, doing some poses on her forearms or standing instead. The National Institutes of Health notes on its website, in fact, that yoga has been shown to help relieve pain and increase grip strength in people with CTS. Likewise, Kallens has found stretching, acupuncture and massage helpful. “All the muscles in the forearm that techs use are all connected to the elbow and then the shoulder blade, and a really good masseuse can help alleviate that pressure and pain,” she says.