I came across a tweet the other day saying “the wrist pain, it’s either a trapped nerve or carpal tunnel”. This got me thinking:
- Do most people with wrist pain think a trapped nerve is different from carpal tunnel syndrome?
- Do they know that in a way these two situations are different, but also not?
Does that sounds confusing to read? Sorry, let me explain my thinking to you.
Today I want to look at wrist pain from the angle of a trapped nerve being the source of pain. Below I will discuss the difference between a trapped nerve in wrist pain and carpal tunnel syndrome. I will then show you how ultimately they are related and how to treat your wrist pain.
Pain In Your Wrist?
Have you got a pain in your wrist area at the moment? Are you wondering if you have a pinched nerve causing the pain?
Some types of painful wrists can be coming from a specific nerve in your body. So we could be talking about a compressed nerve at the wrist, like the median nerve. Or a referred pain shooting down to the wrist area from an area higher up in the neck where the nerve is stuck.
Carpal Tunnel Syndrome
Let me start with this common type of wrist injury. Carpal tunnel is when there is a problem localised in the wrist.
The carpal tunnel contains the median nerve. The pain and dysfunction you get with carpal tunnel syndrome is due to excess pressure on this median nerve.
The contents of the carpal tunnel include:
- Median nerve,
- Three Tendons:
a. Flexor digitorum superficialis
b. Flexor digitorum profundus
c. Flexor pollicis longus.
Causes of Carpal Tunnel
The major cause of Carpal tunnel is typically a repetitive strain injury of the wrist. This could be from holding different prolonged wrist postures when working on the computer or a daily repetitive movement like a when a carpenter is turning a screwdriver.
There are times when other medical conditions that cause carpal tunnel, like:
- Thyroid disease (hypothyroidism)
This means that wrist pain of yours could be a sign of other health changes happening your body.
Stop, Now Here is a Difference
So far I have been telling you about the median nerve being trapped causing wrist pain. That is very different from someone with a trapped nerve in neck problem shooting pain into the wrist. The cause of a compressed nerve in the neck is likely to be from an arthritis in the neck joints or herniated disc in the neck.
Have you ever heard of trigger points? A trigger point is basically a muscle knot. Having one of these types of muscle knots can send pain into your wrist. This is called a referred pain along a nerve supplying the wrist. Then there is another common cause of wrist pain. This is called de Quervains Tenosynovitis.
What I’m trying to show you here is a trapped cervical nerve root and a trapped median nerve are both nerves. However, each cause of wrist pain needs to be dealt differently.
Carpal Tunnel Symptoms
Common symptoms of carpal tunnel include:
- Pins and needles in the first three fingers (thumb, index & middle fingers)
- Weakness in your hand grip
- Pain around your wrist, possibly going up the forearm (not above the elbow)
- Feeling of swollen fingers or swelling in the palm
- Change in hot/cold temperature feeling of the hand
Ok so now you are probably wondering:
“How do I know if the wrist pain is from a pinched nerve in my neck or pinched nerve in my wrist?”
Let me start with the how the symptoms of carpal tunnel syndrome occur.
Median Nerve vs Cervical Spine Nerves
The median nerve is quite distinctive in supplying the first three fingers of your hand. So that means your thumb, index and middle fingers.
That nerve controls the sensation and motor control to those fingers.
You can see the area of sensation that the median nerve supplies in the picture of the hand to the right.
The median nerve cutaneous nerve supply area of the skin is very different from the skin areas that are affected with one cervical spine or brachial plexus nerves from a nerve entrapment problem in your neck.
When a nerve is pinched in your neck you are more likely to experience neck pain, restricted head movement, pain going from the shoulder blade into the arm down to the wrist not just at the wrist, with weakness in the upper arm and maybe your grip strength.
You don’t get those problems when just the median nerve is trapped in the wrist.
I hope this makes it a little bit clearer where the problem is and the difference depending what area of skin you feel affected.
How To Test for Carpal Tunnel Syndrome?
This is a very important part in your quest in order to get rid of the wrist pain. If you start treating the wrong area then the pain in your wrist will not get better.
Positive Test Signs
Orthopaedic and neurological tests that help indicate carpal tunnel syndrome include:
- Tinels Sign
When your doctor compresses or taps over the median nerve in the wrist to reproduce your symptoms.
- Nerve Conduction Studies
This is when electricity is put into the median nerve to see how it reacts. It can test to see if the conduction is slow cos it is trapped. I have written about nerve conduction studies before.
- Phalens Test
An orthopaedic test where you hold you the back of your hands together and make your wrist bend forward. Holding the wrists in this position compresses the median nerve in the carpal tunnel reproducing the symptoms. See how to do a phalens test in the video below.
Negative Test Signs
It is very unlikely you have it is NOT carpal tunnel syndrome when:
- You have changes in the deep tendon reflexes of the bicep or triceps,
- Weakness in your forearm, bicep, tricep or deltoid shoulder muscles,
- Pain in when moving your neck or shoulder joints,
- Positive pain with orthopaedic tests like Spurlings, L’Hermittes, or Neers and Hawkins.
Carpal Tunnel Treatment Options
The treatment options are different because the nerves affected are different between carpal tunnel syndrome and a pinched nerve in your neck.
Here are some simple carpal tunnel treatment options:
- Cardiovascular Exercise: Some carpal tunnels can be from lack of general movement,
- Stretches: Stretching your forearm muscles while at the desk,
- Ergonomics: Changing your work station could help reduce the repetitive strain,
- Splinting: Using a wrist splint when you sleep and work.
If you need more specific carpal tunnel exercises I found this ebook and videos for wrist pain.
Usually if conservative care does not work for you then your doctor will prescribe anti-inflammatories, perform a cortisone steroid injection or recommend wrist surgery. The goal is not to get to this point at all.
I hope I have answered the original question “the wrist pain, it’s either a trapped nerve or carpal tunnel.” for you. You can let me know what worked best for you with curing your carpal tunnel and did you start with the problem of treating the wrong area? Let me know in a comment below.Image Credit: Some rights reserved by Chika