Lift this, move that, grab that. Our hands are essential to us—they react to whatever our eyes see that needs doing. They’re imperative to the most basic parts of our everyday lives, whether it’s brushing our teeth, typing on the computer, opening a door, so when something is wrong with the hands, it’s impossible to ignore. Persistent sensations like tingling, numbness, pain or weakness in the hand, especially the thumb and index and middle fingers, can be the warning signs of a serious condition called carpal tunnel syndrome. Although the early symptoms are intermittent and mild, if left untreated, this ailment can become incredibly uncomfortable, inconvenient, and debilitating. When caught early, carpal tunnel syndrome is easily treated. Recognizing the early signs for carpal tunnel syndrome is imperative to avoid serious nerve damage and need for surgery in the future.
Carpal tunnel syndrome is a condition in which the median nerve in the wrist gets compressed, leading to numbness, weakness, tingling, and pain in the thumb and index and middle fingers. This can affect one or both hands, though it commonly affects a person’s dominant hand first. The symptoms of carpal tunnel syndrome come on gradually, but if left untreated, it can have devastating results. The earlier that carpal tunnel syndrome is diagnosed and treated, the better your chance of a full (and non-surgical) recovery. If you notice symptoms of carpal tunnel syndrome, make an appointment with a medical professional immediately.
The symptoms of carpal tunnel syndrome develop gradually, beginning with a slight tingling and/or numbness in the thumb and index and middle finger of one or both hands; it is common for people to first experience symptoms in their dominant hand. Symptoms are often aggravated first thing in the morning because many people sleep with flexed wrists. Throughout the day, this numbness and tingling may return upon gripping a steering wheel or telephone. Over time, this numbness will become constant and may also be accompanied by weakness and a tendency to drop items (because the median nerve controls the thumb muscles). The fingers may sometimes feel or seem swollen or useless, though they usually are not actually swollen. Some people experience occasional sharp pains in the hand, which radiate up the forearm toward the shoulder.
If left untreated, the muscles in the thumb can begin to atrophy. Over time, damage to the median nerve will affect your sense of touch, rendering it impossible to recognize the difference between a hot surface and a cold one.
The carpal tunnel is a narrow passageway between the bones of the wrist (the carpals) and a thick band of connective tissue called the transverse carpal ligament. The median nerve, which passes through this passageway, starts at the neck (cervical vertebrae) and is the primary nerve serving the hand, controlling the muscles in the thumb, and providing feeling to the thumb and index and middle fingers. Also sharing this narrow passageway are the flexor tendons, which are responsible for moving the fingers.
When the carpal tunnel narrows due to inflammation or another condition, the median nerve gets compressed. Initially, this compression results in tingling or numbness in the thumb and index and middle fingers, but over time it can progress to sharp pain, and if left untreated, can lead to permanent nerve damage in the hand and wrist.
Carpal tunnel syndrome can result from one or more factors that cause the medial nerve to be compressed. Some causes and risk factors of carpal tunnel syndrome include:
Some people have a naturally smaller carpal tunnel than others due to genetics. This naturally small carpal tunnel puts them at higher risk for developing carpal tunnel syndrome, since there is less space for the median nerve and flexor tendons to pass through.
Women are 3 times more likely to develop carpal tunnel syndrome than men. Often this is because the carpal tunnel is naturally smaller in women than men.
• Trauma/injury to the hand or wrist
An acute injury like a sprain or fracture will inflame the tissues in the wrist. This inflammation can put undue pressure on the median nerve and contribute to the onset of carpal tunnel syndrome. In this case, attending to the injury and taking steps to reduce inflammation may be all that is needed to eliminate carpal tunnel syndrome.
• Neck and shoulder misalignment
Because the median nerve actually starts in the neck, any misalignment in the bones along its path to the hand (from the neck, through the shoulder, down the arm, and through the carpal tunnel) can result in carpal tunnel syndrome or similar symptoms. Misalignment in the neck and shoulders can compress the median nerve where it passes through those joints. The compression of the median nerve can cause pain and tingling in the hand. The inflammation that results from the median nerve compression in the neck or shoulder can trickle down to the wrist, creating a domino effect of misalignment, inflammation, and pain. Be particularly mindful of misalignments like forward head posture and rounded shoulders.
• Cysts and tumors
If a cyst or tumor develops in the carpal tunnel, it can trigger carpal tunnel syndrome by compressing the median nerve. If this is the case, surgery is often necessary to remove the tumor or cyst.
• Rheumatoid arthritis
Rheumatoid arthritis causes swelling in the joints. If there is excessive swelling in the wrists, it is likely that the tissues in the carpal tunnels are also swollen, and thus, the median nerves will be compressed.
• Repetitive use
A repetitive-use injury in the wrist can cause swelling. The tendons that control the fingers, which also run through the carpal tunnel, may swell, as may the synovium (fluid tissue in the carpal tunnel that cushions the joints of the wrist). If swelling occurs in either or both of these places, the median nerve may become compressed, resulting in carpal tunnel syndrome.
• Work stress
Certain professions increase your risk of repetitive-use injury and thus, carpal tunnel syndrome. People who work on an assembly line—sewing, finishing, cleaning, or packing—or those who work with vibrating tools (like a jack hammer), are often more likely to develop carpal tunnel syndrome. Additionally, spending excessive time typing with improper wrist placement (such as wrists bent and resting on the keyboard instead of straight) may put you at greater risk for developing carpal tunnel syndrome.
• Fluid retention
If the body retains an excessive amount of fluid, such as during pregnancy or menopause, the joints are usually most affected. If the excess fluid takes up too much space in the carpal tunnel, it can compress the median nerve and lead to the development of carpal tunnel syndrome.
Hypothyroidism is commonly listed as a risk factor for developing carpal tunnel syndrome; however, the link between the two is still unclear. Anecdotally, a large percentage of patients with both conditions have noticed the carpal tunnel syndrome cleared once they stabilized their thyroid levels.
• Overactive pituitary gland
Like hypothyroidism, overactive pituitary glands are linked with carpal tunnel syndrome. An overactive pituitary gland will cause decreased production of the thyroid hormone. Carpal tunnel syndrome can also, in some cases, be a symptom of a pituitary tumor. The link is still being researched.
• Other medical conditions
Conditions like diabetes, obesity, and kidney failure can all contribute to nerve damage and increase the risk of developing carpal tunnel syndrome.
- Avoid inflammatory foods. One factor that contributes to carpal tunnel syndrome is excessive inflammation of the tissues in the carpal tunnel. Because of this, eating highly processed, inflammation-inducing foods may exacerbate symptoms of carpal tunnel syndrome. Make whole foods 95 percent of your daily diet, leaving junk food for special occasions. Minimize pressure on the median nerve and expedite healing by reducing inflammation in your wrist joint. This can be accomplished by focusing your diet on anti-inflammatory foods.
- Stretch it out. Tightness in the wrist can exacerbate symptoms of carpal tunnel syndrome. Regular daily stretching of the muscles in the wrist will increase circulation between the hand and arm, reducing inflammation and enhancing overall flexibility and mobility in the wrist. When stretching, the wrist should be thoroughly warmed up; also, you never want to stretch to the point of pain or discomfort. If you overstretch, you can injure the wrist and cause more inflammation to develop. Maintaining wrist mobility is an important part of keeping the carpal tunnel passageway clear of inflammation and excess fluid.
- Attend to wrist alignment. We often think of alignment as it relates to the spine. However, paying attention to proper wrist alignment is an important part of treating and preventing carpal tunnel syndrome. Avoid spending excessive time in extreme flexion (wrist bent so palm faces toward the forearm, like when offering your hand for someone to kiss) or extreme extension (wrist bent so the palm faces away from the forearm, like when in a push up position). Instead, focus on keeping the wrist straight or in motion. Pay particular attention to your wrist alignment when typing—avoid letting the heel of the hand rest of the keyboard, and when sleeping—avoid positions that cause excessive flexion. While healing, you may find it useful to use a brace to maintain proper alignment during sleep.
1. Pressurize the Hands. Pressurizing the hands increases circulation to and from the hands to help you maintain dexterity in the fingers and thumbs. This movement helps reduce inflammation and swelling that can contribute to carpal tunnel syndrome. Additionally, when the hands are pressurized properly, the risk of injury to the hands and wrists decreases, reducing your risk of trauma-related conditions like carpal tunnel syndrome. To Pressurize the Hands, first imagine points at the base of the thumbs, pinky fingers, outer palms, and inner palms. Pull the finger stems long and push through all four points of the palms. In everyday life, you can Pressurize the Hands when you push a revolving door or hold anything in your hands. Pull finger stems long and push your palms against the door or against the object you are holding.
2. Stabilize the Arms. To ensure you are able to Pressurize the Hands proportionately, you will need to Stabilize the Arms. If the arms are not stabilized, you may notice excess pressure in the thumbs or the pinky fingers. This can exacerbate symptoms of carpal tunnel syndrome. By stabilizing the arms, the wrists and hands can maintain better alignment, reducing the amount of wear and tear on the joints. To Stabilize the Arms, first focus on the technique Align the Shoulders. Once the shoulders are aligned, make sure to micro-bend the elbows—a very small bend—to prevent excess strain on the ligaments in the elbow. Then, engage the deepest layer of abdominal muscles—the transverse abdominis—by pulling the belly in toward the back and up toward the rib cage. In everyday life, you can Stabilize the Arms when you close the trunk of your car. Simply Pressurize your Hands on the trunk door, Align the Shoulders, micro-bend your elbows, and engage your abdominals as you push it closed.
3. Mobilize the Ribs. To further avoid excessive wrist swelling and inflammation, it is important to breathe. The breath is directly related to the nervous system. When you deepen and slow down your breath, you trigger a rest and digest response in the nervous system, which actually cuts down on excessive inflammation and fluid in the body. To Mobilize the Ribs, expand the ribs in all directions on your inhale—toward the back, sides, and front. On your exhale, contract the ribs toward center. Start by noticing your natural breath and breathing tendencies. Then, actively expand and contract the ribs. You can use a mirror to see where you tend to inhale or exhale, or better yet, place your hands on your ribs and feel the movement. If you typically breathe in the front of your ribs, try to inflate the back of your ribs. It may be harder than you imagine. Since you are constantly breathing, you can Mobilize the Ribs any time of day! Practice while waiting on your morning coffee or tea, walking down the street, or warming up before you exercise. Notice the ribs expand wide as you inhale. Now, actively contract the ribs as you exhale. Challenge yourself to keep the side body—the space between the ribs and hips—long as you contract.
Sleep with a wrist brace. The symptoms of carpal tunnel syndrome are usually aggravated first thing in the morning. This is because it is hard to control the alignment of the wrist overnight while sleeping, and often the wrist ends up in a flexed position (bent so the palm faces toward the forearm). The simplest way to ensure proper wrist alignment while sleeping is to wear a wrist brace. They can be found at your local pharmacy.