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Home > Chronic Pain > Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

What is carpal tunnel syndrome?
Carpal tunnel syndrome is a very specific medical condition with well-developed diagnostic criteria.  This article goes beyond carpal tunnel syndrome; it is about pain, numbness, or tingling in the fingers and/or wrist.  These symptoms can be the result of carpal tunnel syndrome, cubital tunnel syndrome, “tennis elbow,” “golfer’s elbow,” repetitive strain injury (“RSI”), thoracic outlet syndrome, nerve entrapment in one of numerous different carpal tunnel syndrome hand nervesplaces, or tendonitis of the some of the tendons in the forearm, wrist, or hand.  Because “carpal tunnel syndrome” is nowadays part of the layman’s vocabulary, for the purposes of this article we’ll (erroneously) use “carpal tunnel syndrome” to refer to this set of symptoms.
Wtf?  Enough diction, stay with me, the article gets more readable. 

How do you fix carpal tunnel syndrome?
Okay, so, you have pain, numbness, or tingling in the fingers and/or wrist (or carpal tunnel syndrome as we’ve just defined it).  The cause is simple: too much computer use, possibly exacerbated by golf, tennis, or some other activity that places demands on your hand, wrist, and forearm.  Maybe you’ve been to the doctor or poked around on the internet and been given the following advice: (1) take Advil, (2) ice or heat it, or (3) get surgery – and you’re frustrated with these carpal tunnel syndrome treatment options.  Well, this article is for you; this article is different.  This article is going to outline a shotgun approach to permanently fixing carpal tunnel syndrome.  Yes, I have had carpal tunnel syndrome and yes, I have successfully gotten rid of carpal tunnel syndrome permanently by doing the stuff I’m about to show you.  I am suggesting that you try every single one of the remedies below at the same time.  None of them can hurt you and some of them could be sufficient to cure you, depending on the cause of your carpal tunnel syndrome.
Perform A.R.T. on Your Own Forearm

Active Release Technique ("A.R.T.") is one flavor of soft tissue rehabilitation therapy.  The fundamental theory behind it is that musculoskeletal dysfunction, including nerve impingement, is a byproduct of the production of extraneous fascia by an injured muscle.  Fascia is connective tissue that envelopes muscles; think of it like springy plastic that encases the entire body.  This discipline postulates that a muscle responds to micro-trauma (i.e., overuse) by laying down extra fascia.  The theory is that the extra fascia produced by a traumatized muscle can, over time, shorten the muscle, bind muscle fibers together that would otherwise seamlessly glide past one another, and restrict blood flow locally.  One corollary of the theory is that stretching is physically incapable of breaking up intra-muscular and inter-muscular fascia, and thus useless for treating carpal tunnel syndrome.

The goal of A.R.T. and therapeutic modalities like it is to break up this unnecessary and unwanted fascia (whereupon, presumably, it’s carted away as waste by the bloodstream).  The treatment mechanic behind A.R.T. is simply: put a muscle in a loosened, relaxed state, apply pressure somewhere along the muscle continuously, and then gently extend the muscle to its end-range of motion while doing the same thing for other muscles in the kinetic chain, thereby stretching the fascia all along the kinetic chain (i.e., making it taut), thereby enabling the point of pressure to break up fascia underneath the point of pressure.  The process is repeated several times for each spot, and multiple spots are treated all along the muscle in question, thereby, theoretically, removing unwanted fascia throughout the entire muscle.forearms A.R.T.

So how does A.R.T. apply to carpal tunnel syndrome?  First of all, it’s important that you understand that the hand doesn’t have much muscle in it; most of the motion and strength in your wrist and hand comes from muscles in your forearm (which have tendons attached to them that run through your wrist to your fingers).  Now, the theory with A.R.T. on the forearm is that nerve entrapment in the wrist is caused by the inflammation of one or multiple tendons of the muscles in the forearm that control the fingers and wrist.  These tendons, in turn, became inflamed because the muscles to which they are attached are either shortened, literally stuck together in some places, or otherwise dysfunctional.  This means some tendons are being overused (and thus swell) while others are underused. 

You have two options: (1) you can google your local A.R.T. therapist, or (2) you can perform A.R.T. on your own forearms.  If you choose option 2, I would suggest buying a book I’ve read that shows you how to perform A.R.T. on yourself.  I own this book and have done A.R.T. on my own forearms and that of my friends and family.  There are other books on the subject but I haven’t read them.  Learning to do A.R.T. is easy.  Best of all, once you learn, it’s free, it feels fantastic, and oftentimes it provides instantaneous relief (I know, sounds too good to be true).  Note that if and when you perform A.R.T. on your forearm you don’t feel a kind of pleasurable pain or a releasing sensation, you probably don’t have soft tissue adhesions in that forearm.

Fix Your Upper Back and Shoulders

Another way you can start to have carpal tunnel syndrome is by developing excessive kyphosis (forward-arching) of your upper back (typically as a result of sitting in front of a computer or leaning over a book all day long for years on end) and/or a hunched shoulder girdle.  What happens is that the nerves exiting your spinal column, the ones that innervate your wrist and hands, are actually being squeezed in certain places, either near your thoracic spine or near your clavicle (collar bone) on their way to your hand.  That’s right, pressure on a nerve in one place can produce pain and numbness somewhere else along the nerve’s route!

To address excessive thoracic outletkyphosis of the upper back and bring your shoulder girdle back in line, you need stretches, mobilizations, and exercises designed specifically for the upper back and shoulders.  Luckily you can find some of these right here on Floota.com.  First, to get a general understanding of the problem, read Desk Jockey: What Sitting All Day is Doing to Your Body.  Then do the following:

  1. For your upper back:
    1. Regularly perform the Thoracic Stretch and Stability Ball Back Stretch.
    2. Start an exercise routine for your upper back.  This should include anaerobic exercises like the “prone cobra,” the “superman,” or reverse hyperextensions.
  2. For your slouched shoulders:
    1. Regularly perform stretches for the pectoralis major, the pectoralis minor, and the upper trapezius.
    2. Regularly perform the greatest mobilization I’ve found for the shoulders, as demonstrated in this video.  Note that a stretch-out-strap is a great tool to use to do this if you don’t have a broomstick handy.  Widen your grip as much as possible when you first start doing this if you’re having trouble getting up and over.
    3. Start an exercise routine that will facilitate retraction and depression of your shoulder girdle.  This should include anaerobic exercises for the rhomboids and middle and lower fibers of the trapezius, like “face-pulls,” non-articulating-spine seated rows (your back should be still the whole time), lean-over dumbbell rows, and supine pull-ups.

Sleep In a Different Position
If your carpal tunnel syndrome only affects one wrist/hand, try not sleeping on the side that the affected hand is on.  Sleeping on your side when you already have hunched shoulders can compress nerves in your shoulder joints.  When you sleep on your side the shoulder that is on the bed has to go somewhere, it can’t simply stay on the side of your body because your trunk would squash it.  So it shifts forward, potentially exacerbating already-compressed nerves.  Sleep on your other side, your back, or your stomach.

Ice Everything
I know, I know, you’ve tried icing and it didn’t work.  That’s probably because you did it wrong.  Here’s how you’re going to do it using the shotgun approach.  First, when icing always use a one-pound bag of frozen peas or corn packaged in plastic and DO NOT put a towel or anything around it; put it right on your bare skin.  Always apply it to the area for exactly 20 minutes.  You can repeat as frequently as every two hours if you like.  Here are the areas you’re going to ice: the bottom/inside of your elbow (seated on the couch, pillow under elbow, bag on pillow, elbow bent with hand on lap), the top/outside of your elbow (same position), the top of your shoulder (i.e., resting on your shoulder), the top of your forearm, the bottom of your forearm, the top of your wrist, the bottom of your wrist.  Why are we doing all these areas?  Because we don’t know what your diagnosis is and this covers all possible scenarios.  Keep a journal or make a mental note of how your symptoms are 2-3 hours after an icing session.  If you notice improvement, obviously keep icing that area.  cross section carpal tunnel syndromeIf you don’t notice any improvement after two session don’t repeat for that area; move on to another area.  Note that unlike the other treatments detailed in this article, icing is a temporary solution to a permanent problem.  It merely treats a symptom, swelling.

Get a Lumbar Support Pillow
If you have excessive kyphosis, chances are you’re using a computer too much or just sitting too much.  Buy a lumbar pillow to support your lower back so that it doesn’t flatten out (i.e., become more vertical or lose it’s natural lordosis) and make your kyphosis even worse.  I would highly recommend the McKenzie Rolls – that’s what I have.  They come in 2 densities, firmand standard.  I got one of each because at first the firm density one was too firm for me (because my lower back had lost so much of its inward arch!) and it irritated my lower back after an hour or two.  But after using the regular density for a few weeks my lower back had regained some of its lordosis and I was able to gradually transition to full-time use of the firm density roll, which is now the only one I use.  I know what you’re thinking: screw that, I’ve got a little couch pillow lying around that I can use because I’m frugal like that.  I did that for a while; it just doesn’t work nearly as well because it’s either not the right firmness or it’s too big and targets some of the thoracic spine as well (i.e., the support is too diffuse), not putting the support where it’s needed.  Trust me, it’s worth it to actually spend 15 bucks in this case; think about how much time you spend sitting down at a computer.

Get a Dvorak Keyboard
Only have carpal tunnel syndrome in your left hand?  Guess what?  The design of the QWERTY keyboard layout is such that when typing in English your left hand does about 70% of the typing.  This is exacerbated for MS Windows users like myself who frequently use the ALT+TAB functionality to switch windows.  This puts a lot more repetitive strain on your left hand, wrist, and forearm.  Dvorak was a psychologist who designed a keyboard layout in 1936 that ergonomically allowed for the fastest typing with the least effort and most equal distribution between hands.  The invention never caught on but nowadays you can buy Dvorak keyboard stickers to reconfigure your existing keyboard layout.  Of course, there’s also some setup that has to be done on your PC’s operating system, but both Windows and Mac support Dvorak keyboard sticker layouts.  Sure, it’s a pain in the neck to learn a new key layout, but if you’ve suffered with carpal tunnel syndrome for a decade it’s time for some serious measures.

Get a Vertical Mouse
Normal PC mice orient your hand such that your hand is pronated (i.e., palm-down, or internally rotated near its end-range-of-motion).  This makes use of certain muscles more so and certain other muscles less so.  Why not more evenly distribute the burden on your tendons?  Vertical mice put your hand in its natural, neutral position.  This could give your other tendons, the ones more utilized when your hand is palm-down, a much-needed rest. Again, probably takes some getting used to, but almost certainly worth the effort.

Further Reading: Related Floota.com Articles

  1. Chronic Pain
  2. Stability Ball Back Stretch

References

  1. William C. Whiting & Ronald F. Zernicke, Biomechanics of Musculoskeletal Injury 232-40 (2nd ed. 2008).
  2. Wikipedia’s Carpal Tunnel Syndrome, Deep Fascia, Cubital Tunnel Syndrome, Thoracic Outlet Syndrome, Repetitive Strain Injury, Tennis Elbow, Golfer’s Elbow

Last Updated: 5/31/2011
Originally Posted: 10/2/2010