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

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.

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.

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.

If you’d like to learn more about how to find and clear your trigger points, as well as many more techniques you can use to get out of pain, check out my online course, Live Pain Free.

Be well,