Here’s the story:

The Cincinnati Reds right-hander has carpal tunnel syndrome in his pitching hand. It got so bad during spring training last year that he had to wear a brace when he wasn’t pitching. He wasn’t allowed to write or play the guitar.

The weakness he felt in his hand started affecting his pitches, giving the Reds a huge scare heading into the season. The problem eased with cortisone shots and Arroyo got better as the season went along, finishing with a 2.07 ERA in his last 16 starts.

Then, he had to make a decision. He could have had surgery to try to fix the problem. Instead, he decided to stay with the same regimen. He limited his guitar playing in the offseason and will give it up again while he’s playing baseball, hoping that gets him through another season without an operation.

“The last 16 games of the season were just too good to take a chance,” Arroyo said Tuesday. “I didn’t want to come into camp being two-thirds ready because my hand got cut on and I wasn’t up to par.”

Read more from USA Today: Reds RHP Arroyo’s carpal tunnel has subsided

Currently, employers have a legal duty to prevent the occurrence of risks of injury or illness, which are reasonably foreseeable in relation to their employees. However, the latest statistics suggest preventative action to reduce the risk of RSI is still lacking, causing many thousands of workers to develop this debilitating condition.

Despite the well-proven business case of providing occupational health services, it seems to be a low priority with many employers. Only 12.5% of employers provide rehabilitation services and as few as 6.5% of small businesses provide any access to occupational health services for their employees. But it is a big worry to workers -– a recent TUC survey found that 40 per cent of workers felt RSI was a safety concern.

RSI costs employers around £300 million per year in lost working time, sick pay and administration. An estimated 2.8 million working days were lost in 2007-08 due to RSI, with on average each person affected taking 13.3 days off sick. However, RSI is usually preventable or treatable with help from a physiotherapist.

The CSP said that “There is a clear opportunity for employers to do more to provide occupational health services both with regard to prevention of RSI and rehabilitation”, and they are “calling on the Government to both encourage and enforce measures to address this with legislation, combined with incentives and best practice guidance. We may then, after the frustration of many years of no progress, begin to see some reduction in the rates of this almost completely preventable condition.”

In addition to calling for legislation, the CSP is providing a fact sheet on how to avoid repetitive strain injuries.

Refer to the CSP web site for comprehensive statistics on RSI in the UK, with particularly interesting data on the occupations with the highest rates of musculoskeletal disorders.

No guitar strumming for Bronson Arroyo these days. No autograph signing, either. Pitching? He’s still doing that, but the results weren’t good the past couple times.

The Cincinnati Reds’ musically inclined pitcher is having a recurrence of the carpal-tunnel syndrome that has bothered him from time to time over the past few years.

This bout is especially nasty, along with the timing: The season starts in less than one week.

The problem has forced him to make changes in his lifestyle. Arroyo said it’s so difficult to squeeze a pen that he’s having teammates pay his bills for him. He has to turn down all autograph requests from fans at games — writing his name on a baseball or a piece of paper is too bothersome.

“I’ve been having guys write stuff for me,” he said. “They’re paying my bills. I can’t write.”

The biggest change involves his second love. Arroyo rarely goes a day without playing his guitar. He does numerous concerts in the offseason, playing lead guitar and singing in a band. On road trips, there’s usually a melody coming from his room.

Not lately. Holding a pick between his thumb and index finger aggravates the problem. For now, the music is on hold, something that is starting to exasperate him.

“I can’t play at all,” he said, dropping his head and his tone of voice. “That’s it. It drives me crazy.”

Besides putting the guitar away and letting someone else pay his bills, Arroyo has been wearing a brace when he’s away from the field as a reminder to take it easy with the hand. He’s taking anti-inflammatory drugs as well, hoping that makes the problem subside.

Read more

But the Arizona State University News reports that thanks to a new five-year, $1 million grant from the National Institutes of Health, there may soon be hope,According to Marco Santello, an associate professor of kinesiology at Arizona State University:

The goal of the project is to fill in the knowledge gaps that exist concerning CTS and its effect on hand dexterity. CTS currently affects the quality of life for 6 to 14 million people in the U.S.

“Our main goal is to quantify the effect of CTS on hand control and grasping,” Santello said. “If you have CTS, even in its mild severity, you have problems learning how to control digit (finger) forces as a function of object properties such as weight and texture.”

Santello said that current clinical methods of determining the severity of CTS focus on the state of a person’s median nerve, which conveys sensation from the thumb, index, middle and part of the ring fingers, as well as motor commands to some of the hand muscles. One of the electro-diagnostics tests of the median nerve, where an electrical stimulus is administered to measure how fast the nerve can transmit the stimulus, tells doctors if the nerve is healthy or, alternatively, the extent of its degeneration. But it doesn’t provide information on the person’s ability to control the hand.

“It is difficult to correlate that measurement with a person’s dexterity,” Santello said. “It might say, yes I have mild CTS, but how much does that impact my dexterity, my ability to manipulate?”

This information is important because it could be used to measure the effectiveness of surgical intervention and physical rehabilitation to improve hand function.

Santello explained that a person with CTS might have intact sensory feedback from one and a half of the five fingers on that person’s right hand, for example. But when that person manipulates objects, the brain receives and integrates sensory inputs from all digits engaged in the task, so that movement and forces of the digits can be properly coordinated.

With the majority of the sensory inputs now not properly working, the brain has to compensate for the insufficient data coming to it. Often that means over grasping an object to secure it before picking it up. Over grasping can result in an even greater compression of the median nerve, resulting in greater severity of CTS.

“If you are exerting more force than you need on a daily basis and you are not fully aware of it, it is likely to make CTS worse because you keep adding compression to the nerve,” he said. [Read more]

The project hopes to improve understanding of how tactile feedback is utilized by the central nervous system.

If you suffer from CTS, how has it affected your hand dexterity?

According to Dr. Elliot L. Ames, carpal tunnel syndrome can result from acute injury, as indicated by a retrospective study. Symptoms of carpal tunnel syndrome developed in 96 patients within 2 months after an automobile accident in a study conducted by Dr. Ames. Forty-four (44) of these ninety-six (96) patients underwent carpal tunnel release. It is postulated that the mechanism of injury is blunt trauma from the steering wheel or dashboard.

The carpal tunnel joint on the wrist are in close proximity as the hand grasps the steering wheel, and as a result, are vulnerable during impact. The injury can occur when the hand is braced on the steering wheel at the time of a front or rear-end collision. Because the base of the thumb can be injured by the steering wheel and the carpal tunnel is in close proximity, it is reasonable to calculate the carpal tunnel takes blunt trauma during impact. [Read more]

This is an interesting finding. It’s not something I’d considered before, but it certainly makes sense that your hands can be severely injured in car accidents, and that the symptoms may not show up immediately, but may take awhile to present themselves.

Have your hands been injured in automobile accidents? If so, please share your story.

There are many industries where employees notice body pains and back injuries because of the type of work they endure. Whether you work in an industrial warehouse, or are a magazine editor of a national publication, today’s work responsibilities and deadlines are becoming more strenuous and fast-paced. At the same time, there are repetitive strain injuries (RSI) that affect a bounty of people in the labor and office work environments.

Repetitive strain injuries are mostly caused by making the same movements over and over again as part of the responsibilities and duties of a particular job. It is unbelievable how the overuse of a simple motion can put a toll on particular parts of your body. Here is a compilation of various repetitive strain injuries that can affect your body’s health.

The article goes on to discuss four specific conditions: Carpal Tunnel Syndrome, Tendonitis, Tenosynovitis, and DeQuervain’s Syndrome. It’s a good, quick overview.

Read the complete article.

The research, based on a survey of corporate computer users and managers, found that 68 percent of office workers suffered from RSI-related aches and pains, with the most common symptoms including back ache, shoulder pain, and wrist/hand pain.

The report finds a worrying lack of knowledge about the risks of RSI, and in a rather startling finding, that 76 percent of managers were not aware of the high risk of RSI themselves, and 68 percent did nothing when employees reported problems.

John Allen, Managing Consultant at The Royal Society for the Prevention of Accidents (RoSPA), believes there is much more employers can do to minimize the risk: “We are shocked that this research indicates that the number of office injuries is on the increase due to companies not taking the right actions in investing in their staff’s well being. This issue needs to be addressed and companies should start assessing the risks and investing in ergonomic solutions where they are needed.”

Read more: Repetive Strain Injury (RSI) Cases Soar To All-Time High As Working Trends Go Mobile

With the personal computing boom of the 1990s came thousands of “repetitive stress injuries” or “repetitive strain injuries.” RSI became the hip medical acronym of the keyboard era, with subset carpal tunnel syndrome the diagnosis of the day.

“At its height of diagnosis, anybody showing up at a doctor’s office with wrist pain or hand pain was being diagnosed with carpal tunnel,” said Carol Harnett, vice president of insurer Hartford Financial Services Group Inc.’s group benefits division.

Since then, carpal tunnel cases have plummeted, declining 21 percent in 2006 alone, according to the Bureau of Labor Statistics. Among workers in professional and business services, the number of carpal tunnel syndrome cases fell by half between 2005 and 2006.

The article goes on to discuss why this might be, ascribing the decline to early over-diagnosis of CTS, as well as companies taking steps to improve on-the-job ergonomics. It also suggests that “While it’s possible that improvements in factories and offices may be behind the decrease in cases, another possibility is that existing cases aren’t always reported.”

The PointOfLaw blog expands on this point, discussing the lawsuit history related to CTS and RSI, noting that due to a court decision, “RSI-carpal tunnel litigation has subsided and is no longer seen as a threat to the financial health of computer makers, and most lawyers have given up on it.”

In other words, carpal tunnel syndrome may be “just as real and frequent an ailment as ever but is now being seriously underdiagnosed because workers are ever more discouraged from even so much as reporting it, knowing there will be no remedy.”

So, back to the original question: Is Carpal Tunnel Syndrome really in decline?

One year ago, Blalock underwent surgery for thoracic outlet syndrome, and missed most the season. He said it is medically impossible to have a recurrence of that condition after the operation he had to correct it.

The Disabled List Informer (a fantasy baseball blog written by a Physical Therapist) offers this analysis:

Hank Blalock has been diagnosed with Carpal Tunnel Syndrome (CTS) in his right wrist. This is a peculiar diagnosis, in my opinion – especially after having surgery for Thoracic Outlet Syndrome (TOS) in the same arm in the recent past, as well as being involved in a car accident in which he sustained whiplash to the Cervical spine.

Is it possible that he does, in fact, have CTS? Sure it is. Given his history, he might also be suffering from some proximal nerve compression issues (either at the neck or in the Brachial Plexus) stemming from the aforementioned injury and surgery.

Double Crush Syndrome occurs when a more proximal nerve compression or irritation lessens the threshold for pain and irritation of the distal aspects of the nerve (in this case, wrist at the Carpal Tunnel).

CTS is commonly misdiagnosed. In a large percentage of cases of people with CTS, a more proximal Cervical pathology is also present (some sources say over 70%). What we need to know is the location of his symptoms, i.e. is the pain/numbness in certain fingers or one side of the hand or the other. CTS affects mainly the palmar aspect of the thumb, index finger, middle finger, and sometimes the medial half of the ring finger (and dorsal tips of fingers 1-4). If the symptoms are not in these areas, then it is not CTS.

In any event, regardless of diagnosis, a nerve problem is not something that goes away in a couple of days, as they are suggesting.

Blalock, for his part, just sounds frustrated: “I feel like I lead the league in syndromes,” he said.