Dr. Peter Borten, LAc, DAOM

Articles and Resources on All Facets of Health and Healing

Are You Sure That’s Carpal Tunnel Syndrome? Getting to The Source of Wrist and Hand Pain

(Originally published as a two part article for Imbue Pain Relief Patch)

Part One

Many people who have pain or numbness in the wrist, hand, or fingers are told they have Carpal Tunnel Syndrome (CTS) and may believe surgery is their only option. But CTS is often misdiagnosed and there are numerous natural remedies and treatments that are worth trying before undertaking anything invasive.

The carpal tunnel is a space in the wrist through which nine tendons and a nerve pass into the hand. There are eight small bones in the wrist, called carpal bones. Four of these form a bowl-shaped depression on the palm side of the wrist that these tendons and nerve pass over. This could be thought of as the floor and sides of the carpal tunnel. The “ceiling” of the tunnel is a rather tight band of tissue (called the flexor retinaculum of the hand, or the transverse carpal ligament) right under the skin, which connects the bones to either side of the wrist and lies on top of the tendons and nerve.

In CTS, the carpal tunnel becomes too tight, causing compression and irritation of the nerve. This nerve – the median nerve – transmits sensation and initiates movement in the hand.  The main symptom of irritation of this nerve is a particular kind of sensitive, tingly, zingy pain and/or numbness of the palm and fingers. In particular, the thumb side of the hand is affected, including the thumb, index finger, middle finger, and maybe a bit of the ring finger (on the side toward the thumb). Also, the hand can become weak, and in a case of true CTS, if the nerve is compressed for a very long time, it can be permanently damaged, leading to shrinking of the muscles of the hand.

Conventional medicine doesn’t have a complete explanation as to why swelling within the carpal tunnel and entrapment of the median nerve occurs. Certain behaviors and medical conditions (such as fibromyalgia) may contribute to it. Most doctors and those who suffer from CTS believe that repetitive motions involving the wrist and hand, and prolonged gripping with the hand or bending of the wrist exacerbate the condition, though others dispute this claim. Typing is an especially common culprit, as are using hand tools, driving, playing sports involving a racquet, painting, writing, and working on an assembly line. Sleeping with the wrist bent also tends to be problematic. Some researchers have hypothesized that there is a genetic factor that predisposes some to develop CTS. The condition is more common in women than in men.

Doctors diagnose CTS in a number of different ways, and I have seen many patients who have been diagnosed with this condition who I don’t believe actually had it. If the muscle of the palm at the base of the wrist is weak and atrophied, this is a pretty good indicator that it is a median nerve problem. If there is mostly pain but not much numbness, it is less likely to be CTS. If tapping on the inside of the wrist, near the center of the wrist crease, causes tingling in the hand and fingers (called Tinel’s sign) it is more likely to be CTS. If pressing the hand toward the inside of the wrist and holding it there for one minute (called Phalen’s test) causes numbness in the hand and fingers, it is also more likely to be CTS, especially if numbness occurs quickly. If there is reduced sensation in the first three fingers but not in the palm, this, too, indicates a greater likelihood of true CTS. Electrodiagnostic studies (electromyography and nerve conduction tests) are considered by many to be the most reliable tests for diagnosing CTS. These tests compare how fast signals travel along the median nerve as compared to other nearby nerves. If CTS is present, the median nerve will conduct signals more slowly than normal nerves.

If you suspect you have CTS or a doctor has made this diagnosis, it’s important to determine if there are active trigger points in relevant muscles of the arm, neck, and upper back, as these can produce pain and numbness in the hand that is frequently misdiagnosed as CTS. I always hope to discover that trigger points (localized regions of strain, shortening, inflammation, and tightness in muscles) are the actual culprit in “CTS” cases, since this means the problem is muscular, not neurological, in nature. And muscles are usually very responsive to treatment.

There are several muscles that are capable of causing referred pain, numbness, or tingling in the hand. The most common are the forearm flexors. These are the muscles which originate near the elbow and narrow into the tendons that pass through the carpal tunnel. Trigger points in the fleshy parts of these muscles (the upper third of the inside aspect of the forearm) can produce discomfort in the forearm, wrist, hand, and fingers. Brachialis, a muscle of the upper arm that is partly covered by the biceps, can cause pain and numbness in the thumb and the fleshy mound of the palm adjacent to it. The scalenes muscles at the front of the neck can cause a similar sensation in the same area.

Some local trigger points – shown as X’s – and the pain patterns they produce. Each X is the (approximate) site of origin of the pain pattern indicated by shading of the same color. Therefore, a trigger point near the red X is one of the most common causes of CTS-like pain.

Trigger points in the infraspinatus muscle, one of the rotators of the shoulder which lies mostly over the back of the shoulder blade, can produce pain in the wrist, hand, middle fingers and thumb. The serratus posterior superior muscle of the upper back can also refer pain into the hand, although this pain tends to occur in the ring finger and pinky, while true CTS will affect mainly the other three fingers. Trigger points in the subscapularis muscle, between the shoulder blade and the back of the rib cage, can produce pain in the wrist. The subclavius muscle under the collar bone can produce pain and/or numbness in the wrist, hand, and fingers that is almost indistinguishable from that of CTS. The pectoral muscles of the chest and the latissimus dorsi muscle of the back can also cause hand and finger discomfort when aggravated by trigger points. In addition to these direct referral patterns from trigger points of muscles that are “upstream” of the symptoms, other disorders of the neck and shoulder region can cause numbness of the hand, such as a condition known as Thoracic Outlet Syndrome, in which nerves and/or blood vessels passing through this region are compressed. You can check out some pictures and more detailed explanations of these trigger points and their pain referral patterns in the wrist/hand pain section of my Pain Expert tool.

Unless a healthcare practitioner has thoroughly investigated each of these areas, it’s difficult to make a conclusive diagnosis of Carpal Tunnel Syndrome. Yet, most of the patients who have come to me with this diagnosis were never examined above the forearm. Next week I will discuss some of the treatment options for CTS. In the meantime, hold off on surgery.

Part Two

In part one of this article, I discussed the symptoms, mechanisms, and diagnosis of Carpal Tunnel Syndrome (CTS). This time, let’s look at treatment.

Treatments for CTS include the following:

• Acupuncture. I have seen acupuncture produce dramatic results in as little as one treatment (though I recommend a series of five to ten, with possible ongoing maintenance). The fine acupuncture needles can alleviate inflammation in the carpal tunnel, and can release shortened areas (myofascial trigger points) in the “bellies” (the fleshy upper part) of the flexor muscles that lead to the tendons that run through the carpal tunnel. They can also neutralize trigger points in muscles of the upper arm, shoulder, upper back, neck, and chest which may be implicated in the problem. Corresponding points – such as the opposite ankle – may also be used.

• Massage. Good, thorough, deep massage can often work wonders for CTS. A seasoned therapist will be sure to work on the entire upper limb, torso, and neck. A nice side benefit of both massage and acupuncture is that they are excellent at alleviating stress, which definitely plays a role in CTS. Which leads us to…

• Relaxation techniques. Meditation, biofeedback, taiji quan (tai chi), yoga, slow deep breathing, and other stress-reduction techniques all seem to be helpful for CTS. My patients with CTS often report that the condition is worse when they are under more stress.

Rest. Taking a break from activities that intensively use the hands is important. Set an alarm on your phone or computer to take a short break every 30 minutes. During this time, do some stretching, apply some heat to your forearms, wrists, and hands (or, briefly, cold).

Work Station Optimization. Whatever your work station is – a chair at a computer, standing at a table saw, driving a truck – it’s worth doing whatever you can to ensure good ergonomics. Get elbow and wrist support, use a split keyboard, grip less tightly, try a trackball, etc. If there is an OT or someone else who helps optimize workstations at your job, take advantage of their services.

• Splinting. Bending the wrist in either direction tends to flatten the carpal tunnel, which can exacerbate compression of the nerve.  Bending the hand downward (flexion) tends to be a bigger issue. A splint immobilizes the wrist to keep it from bending, giving the tendons and nerve more room.

In my opinion, splints are something of a band-aid. They aren’t a miracle treatment. But if you bend your wrists or clench your fists while sleeping, and wake up with lots of numbness/pain, a splint may be worthwhile. Whether you go with a splint or not, try to stop sleeping with your hands under your body or with your arm raised (don’t put your arm under your head/pillow).

Physical therapy. A good physical therapist can advise you on a stretching/exercise routine to practice daily. If you intend to do the same kinds of activities with your hands, you will likely need to have some sort of physical therapy routine that you do on a regular basis. Luckily, it doesn’t need to take long. Here are two examples: (1) Wrap a wide rubber band around the fingers of the hand that is affected (get all five finger tips in there). Then spread your fingers, hold them apart for a few seconds, and release. Doing this whenever you take a work break sometimes makes a big difference. (2) Flexing and extending the wrist against resistance. Either hold a light dumbbell in your hand – palm up – or hold one end of a light exercise band with the other end under your foot. Slowly flex your wrist and release ten times. Then turn your palm down and extend your wrist up and release ten times.

B Vitamins. Nearly all of the B vitamins are helpful at mitigating the impact of stress on us, and vitamin B6 is of particular value in CTS. Take a whole B complex once or twice a day, plus extra vitamin B6 (pyridoxine or P-5’-P), so that your total daily dose of B6 is 200 to 300mg a day. You should not exceed 300mg of B6 a day. It is best to break this amount up into two or three doses over the course of the day. B6 is healing to nerves and also helps remove excess fluid buildup in the body. In the case of CTS, fluid stagnation in the carpal tunnel may account for the compression that is occurring and B6 can relieve this.

Imbue Pain Relief Patch. Although the patch cannot create extra space in the carpal tunnel, it is an effective external pain reliever that many, many clients with wrist pain have reported works excellently to alleviate their discomfort.

Magnesium. Magnesium is a safe, mildly tranquilizing mineral, and a useful muscle relaxant. I usually have my patients take Natural Calm (a powdered form that dissolves in hot or cold water and tastes pretty good) or a similar product, one to two teaspoons, morning and night. If you have a laxative effect from it, reduce the dose.

Methyl Sulfonyl Methane. While usually thought of for muscle and joint pain, some users find that MSM, a natural form of sulfur, can alleviate the discomfort of CTS. A usual dose is 1000mg for every 50 pounds of your body weight, twice a day.

Surgery. Since the transverse carpal ligament is a relatively soft structure that forms the ceiling of the carpal tunnel (if your palm is facing up), it seems natural that someone should suggest simply cutting this ligament to make more space – and that’s exactly what surgeons do. The ligament is like a watch band that runs across the inside wrist. After it’s severed, the expectation is that it will scar back together, but with more slack than before, making the carpal tunnel more spacious. About 70% of people who get the surgery do experience some improvement, though it may be partial. Recovery usually takes six to twelve weeks – sometimes up to a year. Post-surgical scarring may be quite thick, resulting in a tighter carpal tunnel than before. Frequently, there is some permanent loss of grip strength, lifting strength, and reduced range of motion in the wrist.

Before undertaking any invasive treatment, I again urge you to get thoroughly examined by someone who is intimately familiar with structural disorders. Pain in this part of the hand can be produced by a problem with the fourth and fifth vertebrae of the neck; a loose ligament (annular) at the outside of the elbow; trigger points in the forearm (flexors), the upper arm (brachialis), the front of the neck (scalenes), under the collar bone (subclavius), the chest (pectorals), the upper back and shoulder (infraspinatus, subscapularis, serratus posterior superior, latissimus dorsi); and other problems of the bones, ligaments and cartilage of the upper trunk where a bundle of nerves called the brachial plexus exits from the torso.

Wishing you rapid relief from your pain.

 

Copyright 2012 by Peter Borten. No unauthorized reproduction in any form without permission.

26 Comments

  1. Wow! Very enlightening, but also just read “Quackwatch” which says most people are not deficient in sulfur, since they eat a lot of meat which is abundant with MSM? I’ve been dosing on MSM at various levels for at least 1 month and was dx’d w/severe cts in my right wrist in 2011; had a cortisone shot which did nothing but probably exacerbated my osteoporosis, since I also have corticosteroid in my asthma inhaler and nasal (allergies) prescription. Somewhere (here?) I read MSM can also cure allergies, asthma, etc.? I have also had a right neck pain for several years initially helped by PT and subsequent exercises I was given, but it flares up overnight, probably related to sleep positions, but also maybe my CTS is actually related to that muscle(s) you mentioned! I’m thinking acupuncture is my next treatment option if covered by my insurance.

    • Peter Borten

      March 25, 2013 at 6:06 PM

      Hi. Well, what the short-sighted writers at Quackwatch may not understand is that there is a difference between taking a nutrient to treat symptoms of deficiency versus the additional therapeutic or nutritive functions that higher doses of the nutrient may serve. For instance, small doses of vitamin C can treat scurvy (vitamin C deficiency), but the alleviation of symptoms of deficiency is not the only thing vitamin C does. Imagine if we thought vitamin C was only worth consuming if we had scurvy… In the case of this vitamin, there are the antioxidant, anti-inflammatory, wound repair, and immune bolstering properties that larger doses of vitamin C provide – which have nothing to do with the user being deficient in the nutrient. Similarly, while sulfur deficiency is basically unheard of, this doesn’t mean that sulfur is only beneficial to people who are deficient in it. The implication by this Quackwatch writer is that the many people who have experienced a firsthand benefit from taking sulfur in the form of MSM must be fooling themselves. But what about the horses and dogs who stop limping after taking it? Is it just the placebo effect? In any case, as I said, MSM isn’t a cure all (I don’t think I wrote that it “cures” anything – such as asthma or allergies) but it can often be of great benefit in these conditions. Happily, it’s pretty cheap and very safe, so if you give it a good try and nothing changes, you’re not out a bunch of money. Based on what you say, it sounds like it’s worth a try. Also, working on keeping yourself sleeping on your back, possibly with a support under your neck, may make a big difference. Be well.

  2. I’m a medical transcriptionist, so I know about the split keyboards and have used them for years to avoid CTS. I have severe pain at times in my left wrist directly under the thumb and soreness in the fleshy pad under my thumb. I was diagnosed with arthritis in my neck years ago by x-ray. My dad (RIP) was a chiropractor so I know about tightness and problems in neck can make it’s way into the hands. I once gripped a phone so tightly for so long on the line with Microsoft Support years ago, and I couldn’t type for 2 days due to numbness and tingling in my last 3 fingers. I was thinking maybe since it’s my nondominant hand I may have injured it putting all my weight on my left hand when getting out of my rocking recliner. That’s the only thing I could think of. I know I’m under loads of stress and tend to sleep with scrunched up arms and hands too. Sometimes just the most slightest movement the wrong way causes it to hurt a lot. Ice seems to help, Motrin too but I’m trying to limit how much I take. I don’t think it’s CTS so glad I found this site.
    Thanks,
    Leslie

    • Peter Borten

      February 19, 2015 at 7:52 PM

      Hi Leslie,
      I agree, it’s unlikely that it’s CTS. You really need to examine the whole region “upstream” from the area that hurts. Especially the upper half of the forearm directly in line with where you feel the pain and an inch or two to each side. Methodically press firmly over every inch of this area and see if there’s anything tender. If so, massage this place firmly. While pressing on a tender spot, you can also try rotating the hand back and forth or opening and closing the fingers. If this is helpful, you can make it a regular practice (but better would be to have it worked on more thoroughly by an acupuncturist or massage therapist). If not, the next place to look would be around the neck and shoulder. I know you have neck arthritis, but I’m guessing that it isn’t actually a symptom of that (spinal nerve impingement at this level of the neck) unless you’re really getting neck pain, too. The brachialis muscle in the upper arm, and the subclavius muscle under the collar bone, as well as the scalenes muscles on the front/side aspect of the neck are all capable of referring pain to the thumb also. You could also have a look at this article I wrote on hand pain: http://imbuebody.com/wrist-hand-and-finger-pain/ I’d also highly recommend seeing an acupuncturist.
      I hope you find a solution to this.
      Best,
      Peter

  3. I am struggling finding the right diagnoses. I have been told by my OBGYN that I developed CT after having my 4th child in 2004, but I think it is more than that. After the delivery of my 4th child I would wake up in the night with my thumbs out of place and in terrible pain. My husband would pull on my thumbs to get them back in place. Prior to the birth I did not have pain or any problems with my hands, wrist etc….. within 48 hrs of her birth these symptoms started. I wore wrist splints, took motrin and put ice on my wrists, none of which relieved the pain. I have slowly lost the grip strength that I once had. I can no longer open jars or do anything that requires that type of motion. My thumbs no longer come out but I have pain in my arms (elbow area) and wrists and a feeling of a cramp in the center of the palm of my right hand. When I exercise my hands swell. Any suggestion to help my find out what is going on or where I can go to find out would be helpful. I am currently taking meloxicam which helps some what. I had some dental work done and was on pain medication for about 5 days recently. I didn’t realize how much this has affected my daily routine until I was pain free for those few days. I feel exhausted most days, I will try to get my daily chores done but to go beyond that is hard. I have 4 children at home that need me and I can’t be on pain medication to feel better. I don’t want to take any meds if avoidable. It is hard for me because I have always had something to get done and enjoyed doing so many DIY crafts. I will not take on anything because I do not have the stamina to get it done anymore.

    • Peter Borten

      November 20, 2015 at 6:42 PM

      Hi Kim,
      Sorry to hear of this collection of issues. Of course it’s not CTS – or not JUST CTS anyway. There seems to be something going on systemically for you. You may have thoracic outlet syndrome, or some other “upstream” issue in the forearms, neck, or shoulders affecting the nerve and vascular function in your hands. A neurovascular compression issue such as TOS could account for some of what you’re experiencing. But beyond that, I’d recommend getting your thyroid and adrenal function tested. And it may be that a ligament support formula, such as Standard Process Ligaplex or specific nutritional interventions would be useful to support better structural integrity. Unfortunately, I’m only really able to make guesses over the internet. I’d recommend getting the help of both a naturopathic physician and an acupuncturist. Meanwhile, start making and drinking BONE BROTH. With some skilled holistic practitioners, you’ll get this figured out.
      Be well,
      Peter

  4. Hello I’m Lisa. I’m 23 and a stay at home mom of 3. I’ve noticed a tingly sensation in both hands and a little bit in my forearms. This has been going on for a couple of months. Not everyday but maybe a few to several times a month. When I do feel the numbess it’ll last for hours. Recently I discovered I clench my fingers in my sleep and when I wake up to release my fingers it feels uncomfortable. I know I have been gripping my phone alot more than usual and I also do sleep with my wrists bent but I’m m still unsure if it could be CTS.. Im a little worried.

    • Peter Borten

      November 20, 2015 at 6:34 PM

      Hi Lisa,
      I think it’s worth getting checked out by a skilled acupuncturist and possibly also a neurologist. It’s probably a good idea just to have the neurologist rule out any sorts of more serious neurological or autoimmune-neurological conditions, which are pretty unlikely, but would be treated in a very different way than if it were something structural. Actual CTS and also pseudo-CTS due to other structural issues in the arm and shoulder are all more common in new moms. Lots of picking up of kids and sitting in weird positions as you try to get them to sleep. CTS is also more common with hypothyroidism (low thyroid function), which is sometimes worse after the strain of pregnancy, sleep deprivation, etc. I can’t examine you thru the computer, and I think that’s really what you need. Meanwhile, if it’s possible to sleep on your back and to become more conscious of habitual clenching, this may help – and would also tend to support a structural diagnosis, which is what we’re hoping for. I wish you the best,
      Peter

  5. I started a new job 2 weeks ago amd a few days later I started suffering from tingling arms and hands and pains in my wrists and unable to make a fist in my right hand . It’s a lot of lifting heavy large panel work f which I’ve come from a much less physical work environment any idea what I can do to improve this

    • Peter Borten

      April 9, 2016 at 3:54 AM

      If you can get acupuncture or a deep tissue massage from someone with experience treating this kind of thing, that will probably get you the best results the quickest. But clearly, something you’re doing at your job is making this happen – probably muscle strain leading to trigger point formation. Could be your scalenes, the muscles of your upper back, or your forearms (these are the most likely culprits) – and there’s no good reason to think that if you keep working there it’s not going to persist, or even get worse. Sorry. If you must keep the job, the key is going to be warming up beforehand, having excellent form, stretching and taking breaks throughout the day, staying well hydrated, and doing a lot of self-maintenance – in the form of massage, acupuncture, self-massage, stretching, etc. You might check out The Trigger Point Workbook by Clare Davies for ideas of self-treatment.
      -Peter

  6. Hi.
    I was told 8 years ago that I had carpal tunnel in both hands. I had the surgery on my left which resulted in a broken wrist bone and r.s.d.
    I still suffer from pain/ brurnjn/tingling/numbness in my hand. I now have pain and swelling in my left elbow and torn tendons in my shoulder. I have chronic neck pain and severe headaches
    I went for tests today and my left side shows no nerve problems. Ultrasounds showed a strange thingg- my nerve splits into 2 in my wrist!
    It joins back into one but none of the 4 doctors have seen it before me.
    Can this be causing the problem?

    • Peter Borten

      April 20, 2016 at 3:26 PM

      Hi Yvonne, I doubt that the nerve split is the cause of the pain in itself, unless the split results in part of the nerve being pinched in some way. Even then, it’s unlikely to explain any of the “upstream” pain you’re having. I’d recommend seeing an acupuncturist who specializes in pain, and have someone (acupuncturist or other) thoroughly examine your neck and shoulder area for trigger points. Get some deep tissue massage or myofascial release work in that area. Make sure they look around your shoulder blades, too. Good luck, Peter

  7. I’m writing this in hopes of gaining some knowledge and insight. In a week and a half I will be having a nerve conduction. Background: two years ago Jan. I fell hard and fractured my humorous. Five days after I saw my Ortho I faxed him that I thought I had nerve damage or pinched nerves. My chief complaints were that “my shoulder blade muscle was in constant pain (beyond excruciating at times) and it goes all the way down to my elbow.” , “My elbow bone also hurts a lot and pops”, and “my hand and fingers are always swollen and tight” . My next appointment he blew it off and said it was from the impact of the fall and it would get better. I faxed him again the next month with my continuing concerns, and again he told me at my appointment that it would get better to give it time, 8 months to a year. Due to the ongoing shoulder blade/scapula pain, a YEAR later I saw the PA my PMC’s office and she ordered an x-ray. All it showed was arthritis and again the ball was dropped. Nine months later I saw my primary care and he ordered an MRI. Pinched nerves in my neck. This past February I have my 5-6 and 6-7 fused. The shoulder blade and scapula pain is way way down , but my bicep, elbow and hand issue is still a daily issue and more noticeable since I have alleviated the other pains. My Nuerosurgeon referred me for the nerve conduction test . Could you supply me with the little input of knowledge so that I do not allow this to be swept into the CTS category. Will the nerve test be able to show what nerve is causing this ( like the one that is under my shoulder blade lol). Thank you in advance.

    • Peter Borten

      April 20, 2016 at 3:23 PM

      It would be absurd for anyone to diagnose this as CTS. There’s absolutely no reason to believe this is caused by median nerve compression in the carpal tunnel, which wouldn’t explain the “upsteam” pain. Why not go with the simplest explanation, which is that this is all due to the fall, which affected the arm, shoulder, and neck? It sounds like nerve pain (which might be alleviated by alpha lipoic acid – you can look into studies on neuropathic pain), but could be myofascial. The nerve conduction test could help in determining the nerve(s) involved. There are a handful of muscles in the arm/shoulder/neck area that can produce the pattern you mentioned. Look at trigger point charts. See an acupuncturist who specializes in pain. Good luck, Peter

      • Thank you for your reply. I am a bit leery of the “simplest explanation” as the orthopedic doctor basically gave that explanation. If I would have settled with his explanation, I would not have verified the deeply pinched nerves in my neck, and been in a whole lot more pain than I am now. I do agree however, that the simplest explanation is probably what’s left now – pain/discomfort management. Thanks for your time. DeeAnn

  8. Great article! I was curious if you knew of any topical creams or botanical solutions that promote circulation or nerve healing?

    • Peter Borten

      August 9, 2016 at 8:39 PM

      Well, St. John’s Wort and the essential oil Helichrysum both have a reputation for promoting nerve healing and alleviating nerve pain. Usually St. John’s Wort is main into an oil for this purpose, by soaking the dried herb in some oil (like olive oil) for a couple weeks and then straining the oil. I think you could probably get at least as good of an effect, without the wait, from buying St. John’s Wort as a tincture (though it’s not all that hard to find St. John’s Wort infused oil in natural stores). Then you could add some helichrysum essential oil to that (it’s quite expensive). I can’t vouch for the effectiveness, but I hope it’s useful.
      – Peter

  9. Hello there. 43yr old male here. 6’3″ 200 lbs.

    I’ve been experiencing pain in my left wrist for the last three weeks. I’m unable to make fist with that hand. Bending my thumb at the uppermost joint causes pain — again, primarily in my wrist, not the thumb itself. Grip strength is extremely poor.

    This all came upon me quite suddenly. I went to bed fine and woke up in pain.

    I suspect the problem was triggered by a ill-fitting watch I wore the day prior. It was quite tight and may have caused nerve damage.

    I’m not sure where to turn. Doctor had me get an MRI to check for stroke. That came back all clear. Spinal and chest x-rays are fine. Blood tests all look good. But I’m not improving. All symptoms persist. Carpal tunnel is a now suspected but I’m dubious of this diagnosis given that I live a very low impact life-style with no repetitive strains placed on that hand.

    I’m at a loss as to what to do. Any advice appreciated. Thanks!

    • Peter Borten

      December 1, 2016 at 10:23 PM

      Hi David,
      Yes, it doesn’t sound like CTS. Maaaaybe nerve damage from the watch, but this doesn’t sound like that either. It sounds more like a sprain than anything else, but could possibly be a strain of one of the muscles that serves the thumb (there are several and they run from the forearm to the thumb). I encourage you to look at a trigger point chart for the muscle opponens pollicis and also adductor pollicis. These muscles can refer pain to the wrist. Here’s one of many sites that discusses these muscles: http://www.painotopia.com/adductor-pollicis.html

      Be well,
      Peter

  10. What is it if the pain is on the opposite side of the hand/wrist from carpal tunnel. My right wrist on the right side between hand and wrist?

    • Peter Borten

      December 1, 2016 at 10:09 PM

      This is not CTS. I’d guess you have a sprain of your wrist or, more likely, referred pain from your forearm. Press methodically up your forearm, more or less in line with where the pain is and see if there’s a sore area, probably in the upper 1/3rd of your forearm where the muscles are thicker. If no luck, try an acupuncturist or skilled massage therapist.
      Be well,
      Peter

  11. Hi Peter,

    I just had Carpal Tunnel Surgery last Friday. It has taken away the numbness but not the tingling sensation. I have shooting pain from my right side of my right hand shooting to my neck since Surgery. I also cannot unscrew anything either. My concern is my doctor told me I would be 100% better within days after surgery. This is not true; He says that Physical Therapy does not work. I am concerned as I am on worker’s comp and want to return to work but at this point it does look like it. I believe the surgery relieved some of my symptoms but I got symptoms now that I never had prior to surgery. Any suggestions would be beneficial.

    • Peter Borten

      December 1, 2016 at 10:00 PM

      I’m sorry to hear it. Perhaps there was some significant nerve damage or the surgery wasn’t successful. OR it wasn’t actually CTS. I’d recommend seeing an acupuncturist or a massage therapist who does trigger point work and have them examine your whole arm, shoulder, and neck. Meanwhile, a B-vitamin complex wouldn’t hurt.
      Be well,
      Peter

  12. hey hi I’m Myan i’m 28. I’m just wondering if i really got CTS, my left thumb is normal i just feel a little numbmbess but i suffer from pain in my left middle finger and index finger. I went to see ortho few weeks ago and he said i need injection. I’m gonna see him on monday, will steroids really help? thank you

    • Peter Borten

      December 1, 2016 at 9:59 PM

      Hi Myan, I can’t really say without examining you. I assume by now you’ve had the steroid injection and can say for yourself whether it worked. Usually there’s some short to medium term relief. I wouldn’t do it more than a couple times on that wrist. I highly recommend seeing an acupuncturist!
      Be well,
      Peter

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