Every year, over three million cases of carpal tunnel syndrome (CTS) are reported in the United States (Mayo Clinic). True CTS results from irritation or inflammation of the median nerve as it passes through the tunnel in your wrist. This tunnel is a narrow passageway of ligaments and bones at the base of your hand. Pressure can build up in this tunnel, resulting in numbness or tingling in the hand. Continued strain can lead to severe pain in your wrist, making work and daily activities uncomfortable to accomplish.
However, symptoms such as numbness, tingling, and wrist pain are oftentimes resulting from musculoskeletal dysfunction (meaning: tight muscles), and not true CTS.
Sometimes, thickening from the lining of irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be numbness, weakness, or sometimes pain in the hand and wrist, or occasionally in the forearm and arm. CTS is the most common and widely known of the entrapment neuropathies, in which one of the body’s peripheral nerves is pressed upon.
Many cases of Carpal Tunnel Syndrome are misdiagnosed for several reasons. One, we still don't truly understand the causes of Carpal Tunnel. It does however seem to be very related to overuse and correcting our daily movement has shown significant improvement. Another common reason is due to the median nerve itself. The median nerve starts in your spinal cord, comes out through your neck, and roots out from nearby vertebrae, before running down to your fingers. And because it crosses numerous muscles on the way, there are multiple factors that can cause CTS-like symptoms e.g. a tight muscle in your shoulder or neck can cause "tingling" in the fingers, but it isn't necessarily CTS. Lastly, it is commonly misdiagnosed because most doctors don't understand soft tissue related dysfunction and will often diagnose Tendonitis, which is code for "I don't know what it is, so just rest and I'm sure it'll feel better". Or they lean on reactive health care like injections and surgery as it's easier to diagnose and make a quick buck.
Fortunately, carpal tunnel-like symptoms can often be easily managed with soft tissue work performed on the scalenes, pec minor, coracobrachialis, and several other upper extremity adhesion sites at the cervical spine.
Two very common suggestions to relieve CTS are cortisone injections in your wrist, or surgery to cut the transverse carpal ligament to release pressure. While it may seem like a quick fix, I am strongly against cortisone injections as they have been shown to speed up degeneration of damaged ligaments and cartilage. When having the choice between soft tissue work or injections/surgery, I don't know about you, but I'd try out the former first.
Do I Have Carpal Tunnel Syndrome?
Many cases of CTS are often misdiagnosed but can be resolved with soft tissue work and improving every day movement. The following tests will help gauge if you should seek help from a medical professional:
1. Phalen's Test
- You can perform this seated or standing.
- Passively let your wrist flop into a flexed position as shown in the diagram above.
- Hold this position for 60 seconds or until symptoms are reproduced.
Positive response: numbness and tingling occurs on the palmar aspect.
Negative response: 3 minutes passing without symptoms reproduced.
(The two hand version above is an alternative way to test, though I prefer the one hand version.)
2. Tinel's Test
- Lightly tap over the median nerve as it passes through the carpal tunnel in the wrist.
- Follow your index finger from the tip, then down the palm and up the forearm looking for any sensation.
Positive response: A sensation of tingling in the distribution of the median nerve over the hand or in the thumb or first 3 digits.
Negative response: no sensations.
If either test returns positive, I recommend seeing a doctor. If both tests return negative, great! You most likely do not have CTS and can relieve symptoms without surgery.
What to do if both tests return negative:
1. Correct Your Posture
- Focus on sitting up straight, shoulders neutral, and keep the chin in and head straight. By making sure you're sitting and standing upright, it will take the tension of the muscles that might be causing your CTS-like symptoms in the first place.
Releated: Thoracic Spine and Breathing to help unlock better posture
- Keep your wrists in a neutral position, not bent backwards. This can help prevent a lot of the tightening of the muscles which can possibly entrap a nerve.
As stated above, something as simple as poor posture can give you CTS-like symptoms. Here are three main areas of the body and their stretches to relieve poor posture:
- Upper shoulders and neck (upper trapezius, levators, SCM, scalenes)
- Upper chest/shoulders (pectoralis major and minor, serratus anterior)
- Forearm (numerous muscles, including pronator teres.)
Upper Shoulders and Neck (Trap) Stretch:
- Reaching your right hand down at your side towards the floor, let your head tip to the left.
- Slightly vary the angle of your head to feel different versions of the stretch.
- Hold this to each side for 15-30 seconds and repeat 2-3 times per side.
Chest and Shoulder Stretch:
- Standing up straight with a tightened belly, reach your arms straight out to your sides at shoulder height (as seen above).
- Move your arms straight back as far as they’ll go without arching your back. You can do this with assistance from a doorway or wall to help your hands move back.
- Hold for 10-30 seconds, without pain. Repeat 2-3 times.
- With your right arm held out in front of you, use your left hand to stretch the wrist stretching the hand up (shown above).
- Hold each for 15-30 seconds, 2-3 times. Repeat on other side.
3. Manual Therapy & Corrective Exercise
In conjunction with the improving your posture, wrist position, and stretching, manual therapy from a Licensed Massage Therapist can greatly relieve CTS-like pain. After finding and relaxing the contracted muscles in the above mentioned areas, corrective exercises are performed to offset any problems associated with poor posture and poor breathing patterns.
Has a doctor suggested wearing a wrist brace for extended periods of time (all day and all night, even when you're sleeping)? Restricting wrist movement isn't a solution and doesn't even address the real problem. If this sounds like you and the tests above show you don't have true carpal tunnel syndrome, schedule a consultation and get rid of your tingling, numbing, debilitating wrist pain for good.