Many of us experience periods of episodic numbness or tingling in our hands or arms, which is often the result of temporary nerve impingement that is neuromuscular in origin. This impingement is usually caused by repetitive use injuries: chronically contracted muscles squeeze the nerves in between surrounding structures and/or cut off blood flow to the nerve through the contraction. The most common of these peripheral nerve compression syndromes is Carpal Tunnel Syndrome, which can affect anyone who performs repetitive movements for several hours per day with their hands, wrists and forearms. Isn’t that almost everyone in modern society?! It’s not hopeless, however; we can understand this condition, and there is help for Carpal Tunnel!*
The median nerve supplies sensation to the thumb, forefinger, middle finger and half of the ring finger. It branches off from the brachial plexus, the nerve bundle which originates in the cervical spine and runs down the arm. It passes through the “carpal tunnel”, or the passageway in your wrist to your hand (essentially the tunnel in between the carpal bones). In Carpal Tunnel Syndrome, the compression normally happens due to increased pressure on the median nerve as it passes through this space, in between the carpal bones of the wrist and the ligament that holds down the flexor tendons.
This compression could happen due to swelling in that area or subluxation of one of the wrist bones, but the most common reason is the fibrotic buildup of connective tissues in the wrist due to repetitive use (like in keyboard typing). It is often worse at night, even causing some sufferers to wake up from the pain. This is attributed to increased pressure on the nerve from an increase of fluid in the area, due to a combination of decreased lymphatic activity and blood circulation.
There is no specific method of prevention that is guaranteed, but the following tips will help avoid Carpal Tunnel onset:
- Avoid bending the wrist all the way up or down. Typing on a laptop while reclining, for example, will keep the wrist in constant extension or flexion, depending on how you rest the laptop. Either way is not ideal for the wrist.
- Relax your grip or force. When typing, for example, it’s better to type softly. When taking notes with a pen, try not to have a death-grip on the pen (although if you write like I do, this is difficult advice to incorporate). A larger soft grip pen is advised.
- Take frequent breaks from repetitive use of the wrist if possible, and stretch the forearm muscles.
- If you use a mouse for your computer, use an ergonomically friendly one for correct wrist posture.
- Use proper posture when sitting at a desk typing, in order to avoid nerve impingement in the neck or shoulders. Proper upright position should keep your wrists neutral, as well.
If you suspect you already have this condition, there are two easy initial tests commonly used to test for Carpal Tunnel. Although they are not conclusive, they are simple and quick to perform at home as a place to start.
- Phalen’s test: Hold your hands in front of you at chest level, with the backs of your hands together. Press the backs of your hands gently together for 60 seconds. If you feel tingling, numbness or pain in your thumb or first three fingers, you may have Carpal Tunnel.
- Tinel’s test: Rest your arm on a table, palm facing up. Tap lightly on the inside of your wrist, over the area where the medial nerve is (not quite the middle, but closer to the thumb). If you feel tingling, numbness or pain, you may have Carpal Tunnel.
A wrist splint is normally the first step in treatment, the goal being to keep the tissues at rest in order to reduce inflammation. Ceasing the repetitive movement is recommended, but not always practical if the movement is a part of professional life. Doctors often prescribe anti-inflammatories or surgery, but studies have not shown either to be effective long-term. In fact, although it is the second most common musculoskeletal surgery performed in the U.S. (back surgery being the first) with over 500,000 performed each year, the surgery has a 60% failure rate. Many patients experience recurrence of symptoms or permanent nerve damage. Fewer than 23% of people who undergo carpal tunnel surgery are able to return to their previous professions.
Massage, manual lymphatic drainage and acupuncture can work wonders for this condition, however. You can even perform easy self-massage techniques at home on the hands and forearms. With a very light application of lotion, you can gently massage and stretch the muscles of the palm. Use your thumb to slowly elongate the tissues on the pads of your palm, back and forth between wrist and fingers and also across the pad area. You can also use a closed fist. The forearm muscles can be addressed by lying the arm, palm up, on a table and slowly gliding the other forearm gently up from wrist to elbow, applying more pressure as the muscles warm up. You can alternate with a closed fist for deeper pressures. Stretches and exercises for the surrounding muscles are helpful, as well. Here are some simple ones. Finally, analyzing your diet for foods that might be causing an inflammatory response can be extremely impactful.
Carpal Tunnel Syndrome is a very common condition, affecting over eight million people each year. However, there are preventive measures that can be done to avoid it, as well as self-care tips that can help manage the condition after onset. Massage therapy has proven to be very effective in treatment. Next week we will explore Thoracic Outlet Syndrome, a related nerve compression syndrome further up the arm, which can also cause tingling and numbness in the hand.
*(NOTE: if symptoms are severe or chronic and accompanied by pain, they could be a sign of a more serious problem. This type of peripheral neuropathy could be caused by diabetes, kidney failure, tumors, bacterial or viral infections, neurological pathologies, chronic inflammatory disorders or nutritional deficiencies. If you think that might be the case, it’s best to partner with your health care practitioner to determine the root cause.)
“A Massage Therapists’ Guide to Pathology”, 6th edition, Ruth Werner, LMP, NCTMB, 2016.
I do not agree with the findings of this article, but if you want the opposite take on the surgery: