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Home » Pain In Your Wrist, Carpal Tunnel Syndrome, and Other Hand Shenanigans

Pain In Your Wrist, Carpal Tunnel Syndrome, and Other Hand Shenanigans

Pain In Your Wrist, Carpal Tunnel Syndrome, and Other Hand Shenanigans Barefoot Rehabilitation Clinic
pain-in-the-wrist

30 Mar Pain In Your Wrist, Carpal Tunnel Syndrome, and Other Hand Shenanigans

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DisclaimerYou shouldn’t read this unless you’ve had pain wrist or hand pain for more than 3 months. The pain should be starting to frustrate and annoy you and you’re starting to wonder what, if anything, you can do about this pain. Because your pain is growing in intensity, it becomes important to make sure you’re on the right track to fixing it. For these reasons, I do offer one self-treatment fix towards the bottom. Most of what’s shown is here to give you the comfort of knowing what your problem is, then making sure your therapist or doctor is on the right track. It’s really hard to treat nerve issues with self-treatment. Too many people just need an honest answer and lose trust in doctors who have mis-diagnosed them.  

One of the most common concerns people have about pain in the wrist is:

I think I have carpal tunnel syndrome. Do I have to get surgery?

Hold your horses there Buster. The good news is that just because many people know that carpal tunnel syndrome exists doesn’t mean any pain in the wrist is carpal tunnel syndrome.

Just like anywhere else in your body, many different problems can occur at the wrist.

Before we discuss the various problems that can occur at the wrist, you need to take 30 seconds to perform one simple test.

Do This Test: Wrist and Finger Extension

The wrist and finger extension test is the #1 test you should be doing if you have pain in your wrist.

To do it, you bend your fingers and hand back like this:

wrist-goes-backwards

You need this flexibility to work at a desk, like this:

Desk-Wrist-ExtensionOr to do specific exercises like a front squat, Olympic clean, or CrossFit in general:

Front-Rack-wrist-extension

It measures the flexibility of the muscles on the front of your forearm.

Here’s how to do it:

Find a friend who can take a picture for you.

Put your forearm on a wall, straight up and down. Make sure the bottom of your elbow is against the wall.

Both of your shoulders should be square with the wall (in the picture below, Katie is not square with the wall for the purpose of showing you what to do).

Pull the edges of all fingers tips except the thumb down as low as possible. You shouldn’t have to crank your fingers all the way down. If you feel extreme stretching or pain, back off a little.wrist-and-finger-extensionHave your friend take a picture of your wrist and finger extension.

Here’s how to grade your wrist and finger extension:

Close to 9:00 is an F (or less than 50% function). If you took the picture from the opposite direction, the clock-face would now be 3:00 instead of 9:00.

failing-wrist-extension-test

Close to 8:00 is a C (or 70% function).

If you took the picture from the opposite direction, the clock-face would now be 4:00 instead of 8:00.

C-grade-wrist-extension-test

Close to 7:00 is an A (or 100% function). If you took the picture from the opposite direction, the clock-face would now be 5:00 instead of 7:00.

passing-wrist-extension-wrist

If you have wrist pain, it’s almost guaranteed that you have a C grade or worse with the wrist and finger extension test. The longer you’ve ignored the pain, the worse it probably is.

Your grade on the test will be key to permanently getting out of pain if you don’t want to stop what you’re doing, whether that’s typing, CrossFitting, or whatever else you may be doing with your hands.

Now, we can ease your worried mind and rule in or out carpal tunnel syndrome.

It’s Probably Not Carpal Tunnel Syndrome, But Let’s Check

Here’s how you know if you have carpal tunnel syndrome or not.

If you have carpal tunnel syndrome, you’d feel:

  • Tingling (you feel something that feels like a “nerve” symptom) in your hand. If the symptoms have been going on for more than a few months, the tingling may have turned into numbness (you don’t feel anything).
  • The tingling is located in the thumb, index, middle, and 1/2 of the ring finger – on the palm side and part of the fingers on the back of your hand. If you feel the tingling in any other finger pattern (only in your thumb and index finger or in your whole hand), it’s not carpal tunnel syndrome.carpal-tunnel-syndrome-front-hand

carpal-tunnel-syndrome-back-hand

If your symptom location (see the pictures above) and quality (tingling or numbness) match carpal tunnel syndrome, keep reading this section. If you don’t have carpal tunnel syndrome, skip this section.

Now, it can be helpful to determine if carpal tunnel syndrome is actual carpal tunnel syndrome or if it’s a nerve entrapment in the forearm.

Push and poke on the carpal tunnel. To find the carpal tunnel, notice the wrist crease and poke just above it, right in the middle of bottom of your hand. If the tingling gets worse, you have real “carpal tunnel syndrome.”

test-for-carpal-tunnel

If your tingling doesn’t get worse, you don’t have carpal tunnel syndrome. You have a median nerve entrapment, most commonly at pronator teres.

Save the information, median nerve at pronator teres, for your therapist or doctor.

Is the Pain on the Back of Your Wrist?

pain-in-back-of-wrist

If during the wrist and finger extension test, the pain was on the back of your wrist, you have a wrist impingement.

During the wrist and finger extension test, you are probably significantly limited. This evidence, and the fact that you feel a “pinch” during this test, points to the fact that the problem is on the front of your forearm, not the back where most people think it is.

More clearly:

  • Pain = back of wrist.
  • The Cause of Your Pain = front of wrist.

In a normal joint, the bones slide and move past one another like gears in a clock. You wouldn’t feel any symptoms except a general stretch at the end of the range of motion.

hip-flexor-pain

In a wrist impingement, the gears (or bones) are being pulled into one another to produce a pinching sensation. Even though your testing and stretching the muscles on the front of the forearm, the pinching always occurs at the back of the wrist.

Similarly, hip impingements in the front of the hip are very common with people who squat a lot.

Below, notice how the lower right gear has moved locations as evidenced by the hole in the middle of the gear, causing the gears to clunk.

hip-impingement

With the knowledge that you have a wrist impingement, save that “Google Diagnosis” for your doctor and scroll to the bottom of this post for what to do with that information.

Do you have tingling or numbness in your forearm or hand?

We already discussed one nerve problem, carpal tunnel syndrome, above.

What about other nerve problems?

Carpal tunnel syndrome is a problem with a specific nerve called the median nerve.

Ever hit your “funny bone?” If you have, you’re already acquainted with your ulnar nerve, which is another common nerve problem.

If your tingling or numbness is located below, then you have an ulnar nerve problem.

You may not want to confirm your problem this way, but hit your “funny bone” again. If you do and it’s really bad pain or nerve symptoms, you now know, with certainty, that the ulnar nerve is your culprit.

ulnar-nerve-front-hand

ulnar-nerve-back-hand

Notice that the half of the ring finger closest to the middle finger is NOT tingly or numb with an ulnar nerve problem.

With a neck problem, your fingers will be numb and tingly in these fingers:c8-nerve-problemCan you see the difference between the two nerve patterns?

I cannot stress enough how important it is for you to pay attention to that half of your ring finger.

It’s this half right here.

ring-finger-is-tingly

If that half of your ring finger:

  • is tingly/numb, you have a neck problem.
  • not tingly/numb, you have an ulnar nerve problem.

That’s a big deal and is the difference between your doctor wasting your time, money, and energy or fixing you.

Here’s a closer look at an ulnar nerve (or forearm problem) vs. a C8 nerve (or a neck problem).

ulnar-nerve-vs-neck-problem

The best way to test if you have a neck problem is by moving your neck:

  • Move your head back as if your creating a double chin.
  • Keep the double chin and bring your chin down to your chest.
  • Rotate your head as far as you can to the right and left.

If any of the neck movements above made your tingling or numbness worse, that confirms spine involvement of your nerve symptoms.

Let’s move onto other nerve problems.

If your tingling or numbness is located below, then you have a radial nerve problem.

radial-nerve-front-hand

radial-nerve-back-hand

Save your “Google Diagnosis” for your doctor and scroll to the bottom of this post for what to do now.

Is the Pain on the Front of Your Wrist?

Pain on the front of your wrist is the simplest of all.

  • Pain = front of your wrist.
  • Cause of Your Pain = front of your wrist.

pain-in-front-of-wrist

If you have it, you either have:

  1. tendonitis.
  2. a muscle strain.
  3. muscle adhesion.
  4. a muscle tear.

1. Tendonitis and muscle strains will get better with time and rest. You probably ramped up your activity a lot recently if this is your problem. The pain is usually no more than 7 out of 10 on the pain scale.

2. Adhesion will get better with time and rest, but will come back when the amount of activity creeps up again. People with adhesion have usually had pain for months to years. The pain is usually no more than 7 out of 10 on the pain scale.

3. Tears are typically intense (8-10 out of 10 on the pain scale) and won’t get much better with time and rest.

A Note for Competitive CrossFitters

During the wrist and finger extension test, you may find that you can’t get your fingers straight down behind your wrist, like Chris on the left.

Chris has restricted wrist pronation. When I asked him to pull his fingers  behind his wrist, he said:

I can’t.

Katie has healthy wrist pronation on the right, below.

Lack-of-Wrist-Pronation

The restriction is most often caused by a muscle called supinator on the back of the forearm.

The only way to get this flexibility back is by telling your ID Provider:

Look at my wrist pronation. Treat supinator please.

Feel free to put a lacrosse ball (see video below) or stretch into this position if you want. I’ll be surprised if it permanently gives you Katie’s range of motion.

Please, after a month of lacrosse balling and stretching, stop and get it fixed if you want to be a competitive CrossFitter. Your wrist might fall off if you don’t (ha).

Recommendations for Wrist Pain

You’re ready to be out of pain as soon as possible

  1. Find an ID Provider near you.

You want to try some things on your own to fix your pain:

  1. Mobilize, stretch, and lacrosse ball it (see video below).
  2. Get your joints adjusted by a chiropractor.
  3. Go to a physical therapist to get ultrasound, electronic stimulation, heat, and ice.
  4. Strengthen your muscles at physical therapy or at the gym.
  5. Go to see an orthopedic doctor and get an injection.
  6. When you’ve been messing around with #1-5 for 1 month and your pain is no better, see #7.
  7. Find an ID Provider near you.

You have carpal tunnel syndrome:

  1. Don’t mess around. Find an ID Provider near you.

You have a wrist impingement:

  1. Lacrosse ball the front of your forearm for 1 month.
  2. Find an ID Provider near you.

Your pain is mild:

  1. Feel free to mobilize, stretch, or lacrosse ball it.
  2. Ignore pain as necessary (this is me being sarcastic – 90% of pain should not be ignored because …
  3. When mild pain turns into moderate pain, repeat #1-2.
  4. When moderate pain turns into severe pain, find an ID Provider near you.

Your pain is moderate/intense:

  1. Don’t mess around. Find an ID Provider near you.

What Will An ID Provider Do?

For your ease, I’m offering the clock face to measure your wrist and finger extension test.

In the office, we use degrees to get a more precise measurement.

Normal wrist and finger range of motion is:

  • 90 degrees at the wrist and,
  • 65 degrees at the finger joints.

Our patient’s finger flexibility below went from:

  • 45 degrees with no treatment,
  • to 53 degrees after 1 treatment,
  • to 58 degrees after 2 treatments.

He didn’t have pain in his wrist. But the 6 months of elbow pain he had was 40% better in two treatments.

Wrist-Extension-ProgressIf you’re wondering what test needs to be fixed when you have tennis elbow or golfer’s elbow, you’re right. It’s the same test that you fix when you have wrist pain. The wrist and finger extension test.

speechbubblesComment below: Tell us about the pain in your wrist. What is your problem? What worked? What didn’t work?

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Dr. Chris Stepien, DC, Full-Body ID Certified, ART Certified, CSCS, and CrossFit Level 1 Certified, is a Sports Therapy & Chronic Pain Resolution Specialist with Barefoot Rehab in Parsippany, NJ.  When you're in pain that hasn't gone away and you've been to at least 3 other doctors, Dr. Chris wants to help you. And when you're sad, depressed, or not enjoying life, Dr. Chris wants to hug you. He invites you to reach out, no matter what your concern is. Barefoot Rehab is here to serve you.
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12 Comments
  • Jon Muller
    Posted at 01:38h, 03 August Reply

    Great tips, just shared on Facebook! I just want to add that your surroundings can also play an important factor when it comes to aches and pains like carpal tunnel. Make sure your keyboard and mouse fully support your arms and hands in their natural positions. For a mouse, for many people, a vertical mouse is a lot more comfortable to use over time, as it mimics a handshake that doesn’t require the user to twist his/her wrist while operating it.

    • Dr. Chris
      Posted at 23:11h, 14 July Reply

      Great points Jon.

  • Dawn G
    Posted at 08:10h, 23 April Reply

    Question my hands swell up and feel like they are on fire. It wakes me up every morning screaming in pain. This all started after I had neck surgery by a dr who caused nerve damage. Any ideas ?

    • Dr. Chris
      Posted at 15:48h, 23 April Reply

      Hi Dawn,

      Yes, this is a complication of the nerve damage, coming from the neck (not the hands). It’s possible you have adhesion around where the damage was done, around your discs, around your nerve roots at the scalenes and intertransverserii, but it’s not likely. I’d pursue the path the surgeon lays in front of you and see if there are any adhesion specialists are you. Hope this is helpful.

  • Ainars
    Posted at 08:25h, 17 May Reply

    Hi. I have tight and pressed feeling in the shoulders are where tērē minor, tere major and triceps come together. This feeling appeared when I need to make some works at home with upper arms for rather long time. And it’s hard now to make excerseses for training muscles because they become more and more tight. Seems I need to relax this places, but I can’t.. Could it be QSS syndrome? Many thanks in advance.

    • Dr. Chris
      Posted at 11:50h, 17 May Reply

      Hi Ainars, actually QSS would result with “numbness or tingling” in the area or a little down the back of your arm. So, if it’s not those symptoms, most likely, not. The most common reason for this is adhesion. Have you had your shoulder checked for adhesion?

  • Michelle Flabiano
    Posted at 18:13h, 14 July Reply

    I have numbness and tingling in all 10 of my fingertips and fingers, all the way down to the palms of my hands. It started in one hand and then both hands. It was originally just in the fingertips, and then spread to the entire finger/palm in both hands at the same time. I’ve had blood tests and have had x-rays done of my back and neck. All have come back normal. I have no pain, but the numbness and tingling in my hands (not feet) is extremely annoying. I can’t tell the difference between a dime and a nickel in my pocket. My symptoms mirror Carpal Tunnel Syndrome, but it is in both hands and occurred at the same time. Any ideas??

    • Dr. Chris
      Posted at 23:13h, 14 July Reply

      Hi Michelle, Carpal Tunnel Syndrome would only occur in the 1st 3 and 1/2 fingers like the picture above, NOT all 10 finger tips. If you have all 10 finger tips on both hands, it’s likely coming from your neck or your armpit. Get an MRI and you can see how many disc problems you have encroaching on the foramina. Then, you’ll know you need to get treatment on your neck to help the numbness and tingling. Let me know how it goes.

  • Marianne Thompson
    Posted at 23:47h, 04 August Reply

    Hello! My pain has been going on for around 5 months and I don’t feel like I could identify it on here. I think that it came from excessive typing/computer usage of that’s any help. All ten of my fingers hurt a lot but it’s not a numbness or a tingling feeling, it’s an aching that is there 24/7 and nothing really helps it. If I ever end up using stuff it feels like the insides of my hand/wrist have been all ripped and the pain becomes unbearable. I’d say it’s an 8.5/10 but what really disturbs me is how it’s ALWAYS there. Done an ultrasound test on both my wrists and they say that they didn’t find anything, I’m starting to feel hopeless. Do you know what I may have, or what I may need to do in order to treat these pains? Thank you so much in advance, this has still been the most helpful page I’ve found on the matter!!

    • Dr. Chris
      Posted at 21:58h, 05 August Reply

      Hi Marianne, if someone takes a picture of the Wrist and Finger Extension test, what does your range grade at? Any potentially “diagnosing” is relatively pointless without it.

      If the pain is ALWAYS there, I’d get checked for an inflammatory joint disorder. Go see a rheumatologist and mention this point to them.

      The closer you are in age to 50 and older, the more likely you’ll have “osteoarthritis” layered on top.

      A good pain doctor will be able to help you manage each one of these pieces in order to get better. Because this will get worse if you don’t address it now.

      Happy to help Marianne. Feel free to use me as a resource.

  • Don Henson
    Posted at 10:13h, 08 August Reply

    Cervical radiculopathy
    Cervical radiculopathy (commonly known as a “pinched nerve”) occurs when a nerve exiting your neck is irritated by compression or inflammation. Conditions that commonly cause these cervical radiculopathy include a cervical herniated disc, cervical spinal stenosis, or cervical degenerative disc disease.

    If the damaged nerve serves the hand, you may experience numbness in the same areas as they would with carpal tunnel syndrome

    index and thumb … C5 C6. degenerative disk. C 8 degeneration is uncommon.

    • Dr. Chris
      Posted at 12:14h, 08 August Reply

      Correct Don.

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