30 Mar Pain In Your Wrist, Carpal Tunnel Syndrome, and Other Hand Shenanigans
Disclaimer: You 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:
You need this flexibility to work at a desk, like this:
Or to do specific exercises like a front squat, Olympic clean, or CrossFit in general:
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.Have 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.
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.
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.
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.
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.”
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?
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.
- 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.
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.
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.
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:Can 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.
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).
We recently talked to a person on instagram who has been getting physical therapy for 6 weeks with NO RELIEF.
She had numbness and tingling ONLY in her thumb and half of her index finger. This is not the neck pattern for a C8 Nerve problem above.
Notice, this also does NOT match the “carpal tunnel pattern” above.
But it does match a C6 Nerve Root problem.
Dr. Joe discusses the diagnostic process in this video.
The point is that neck problems and forearm/wrist problems occur with different patterns.
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.
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.
If you have it, you either have:
- a muscle strain.
- muscle adhesion.
- 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:
Katie has healthy wrist pronation on the right, below.
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
You want to try some things on your own to fix your pain:
- Mobilize, stretch, and lacrosse ball it (see video below).
- Get your joints adjusted by a chiropractor.
- Go to a physical therapist to get ultrasound, electronic stimulation, heat, and ice.
- Strengthen your muscles at physical therapy or at the gym.
- Go to see an orthopedic doctor and get an injection.
- When you’ve been messing around with #1-5 for 1 month and your pain is no better, see #7.
- Find an ID Provider near you.
You have carpal tunnel syndrome:
- Don’t mess around. Find an ID Provider near you.
You have a wrist impingement:
- Lacrosse ball the front of your forearm for 1 month.
- Find an ID Provider near you.
Your pain is mild:
- Feel free to mobilize, stretch, or lacrosse ball it.
- Ignore pain as necessary (this is me being sarcastic – 90% of pain should not be ignored because …
- When mild pain turns into moderate pain, repeat #1-2.
- When moderate pain turns into severe pain, find an ID Provider near you.
Your pain is moderate/intense:
- 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.
If 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.