DEAR READER: The carpal tunnel is literally a passageway on each palm side of the wrist that protects the main nerve to the hand and accompanying tendons responsible for allowing the fingers to bend. The syndrome occurs when pressure is placed on the median nerve, causing pain, tingling, numbness and eventual weakness of the affected hand. Repetitive motion for extended periods of time, such as swinging a hammer, and diabetes, rheumatoid arthritis, some thyroid problems and amyloid deposits are a few of the possible causes. Amyloid is an abnormal protein manufactured in bone marrow. Symptoms of the syndrome typically begin slowly but can progress to the stage at which a physician should be consulted.

Confirmation might be made by an electromyography or through a nerve-conduction study.

Initial nonsurgical control for mild nerve impairment might include a wrist splint, over-the-counter nonsteroidal anti-inflammatory drugs, supplemental vitamin B6 or a cortisone injection. Chiropractic therapy, acupuncture, yoga and a number of similar techniques for relaxation might also be appropriate. When conservative measures fail to produce positive results, surgery might follow. That decision is best left to you and your primary-care physician or specialist.

Chiropractic therapy is therapeutic manipulation of the spinal column and deep muscle massage that does not involve the use of drugs or surgery. It is performed by a qualified chiropractic doctor and based on the theory that a person’s health is determined by the condition of the musculoskeletal and nervous systems.

Acupuncture involves the ancient practice of inserting thin needles into the skin at strategic points throughout the body for relief from pain. Treatment plans commonly involve from six to 12 sessions over a period of a few months. Up to 20 needles will be used in a single treatment and will remain in place for up to 30 minutes.

Yoga is yet another ancient practice that combines relaxation and exercise to provide pain relief. Simply put, a person controls his or her breathing while going through a series of specific movements.

Tai chi has developed over the years into a gentle form of exercise aimed at reducing stress and anxiety. This Chinese art is known to help with a variety of health disorders.

If you are experiencing a return of symptoms, return to your acupuncturist for periodic maintenance, which is often found to be beneficial.

It goes without saying that if you perform repetitive motion in your line of work or at home, modify the practice as much as possible. Be sure to take frequent five- to 10-minute breaks to allow your hands to rest while performing these actions.

To provide related information, I am sending you a copy of my Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I do have numbness in my hand during the day, but it is not as intense. It occurs when I apply my makeup, style my hair, write, drive and a few times it has happened while playing tennis. Is there anything short of surgery that can be done?

DEAR READER: Carpal tunnel syndrome (CTS) is a common condition of the hands and wrist. It is commonly thought to be caused by using a computer keyboard for extended periods of time, repeatedly; however, it actually has many causes.

The condition involves the median nerve that runs though the carpal tunnel. This tunnel protects the nerve and the nine tendons that allow us to move our fingers. Problems arise when the nerve becomes compressed, causing tingling or numbness of the fingers (excluding the little finger) or hand, a sense of weakness causing a tendency to drop objects, and pain extending from the wrist up the arm into the shoulder — typically on the palm side of the forearm, or from the wrist down into the fingers.

The nerve itself is known as a mixed nerve because it provides both sensory and motor functions. The sensory portion of the nerve is responsible for providing sensation to the thumb, index and middle fingers and the middle-finger side of the ring finger.

Causes of pressure on the medial nerve include specific health conditions such as rheumatoid arthritis, diabetes, pregnancy-related fluid retention, thyroid disorders and menopause, repetitive flexing and extending of the hand and wrist tendons, wrist injuries that cause swelling, and having a narrower-than-average carpal tunnel. Risk factors include overuse or strain from certain tasks such as from the use of power tools or heavy assembly-line work, having a family history of CTS, having certain health conditions and being female, because women are three times more likely to develop the condition. While computer work is commonly considered a cause and risk factor, scientific evidence is not definitive on this point.

Those with mild symptoms may need only to take frequent breaks to rest their hands and/or apply cold packs to reduce occasional swelling. As symptoms increase or if these techniques fail to provide relief, wrist splinting such as you have used is an appropriate next step. Nonsteroidal anti-inflammatory drugs (NSAIDs) may offer relief by reducing swelling and pain. A final option is corticosteroid injections directly into the wrist to decrease inflammation. If the CTS is caused by an underlying health condition, treating that condition may result in lessened CTS symptoms.

The last resort is surgery, which does not work for everyone; however, about 70 percent of those who have undergone the carpal-tunnel-release procedure say they are completely or very satisfied with their results. Some may experience residual pain, numbness or weakness.

Speak with your physician regarding further treatment options, or request a referral to a specialist who can better help you.