Carpal Tunnel - What causes wrist pain?

Anatomy picture displaying Carpal Tunnel Syndrome

True Carpal Tunnel Syndrome is caused by structures in the wrist “pinching” the nerves which traverse to the hand (orange circle)

Does it hurt to move your wrist? Maybe your wrist even hurts at rest. You could be dealing with carpal tunnel syndrome (CTS).

When it hurts to move the wrist, we often jump to conclusion thinking, “am I getting carpal tunnel syndrome?!” Though wrist pain and dysfunction occur with CTS, it doesn’t necessarily mean you have it.

Surprisingly to many, you can have CTS-like symptoms without having carpal tunnel syndrome at all. In this article, we’ll cover what CTS is, what it isn’t, how to know if you have it, common treatments, and lastly, your options of what you can do about it.

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a condition where one of three primary nerves running down your arm, the median nerve, can become compressed by soft tissue structures, i.e. ligaments. The flexor retinaculum, also known as the transverse carpal ligament (picture of a hand/wrist to the right), creates the carpal tunnel and is the known culprit in CTS.

The compression of the median nerve through the carpal tunnel can cause numbness, tingling, weakness, or pain around the thumb and the adjacent fingers. The median nerve is the only nerve that directly traverses the carpal tunnel, which makes the symptoms consistent when true CTS occurs.

It is important to note CTS almost always occurs in one hand. If symptoms are present in both hands at the same time, diagnoses other than CTS must be considered.

Wrist pain without injury?

Not all numbness/tingling, weakness, or pain in the hand is a result of CTS.

Tingling of the hand with the absence of muscular weakness is common, but is not true CTS. There is a palmer (palm side of the hand) branch of the median nerve which passes over the top of the carpal tunnel. The palmer branch of the median nerve is often irritated when consistent pressure is applied to the palm-side of the wrist, e.g. typing on the computer.

When CTS symptoms are present in both hands and wrists, especially occurring at the same time, the symptoms may be stemming from the spine. This condition is a cervicothoracic joint derangement with pain referral. This fancy term means there are altered joint mechanics in the neck and/or upper back region irritating the nerves that send information down the arm. With a joint derangement causing nerve irritation, symptoms can occur anywhere along the path of that nerve.

As an analogy, think of a kinked hose: the issue is a lack of water flowing down the hose, but the source of the problem is the kink itself.

In the case of the neck and upper back causing wrist and hand symptoms, the source is the “kink” of a nerve(s) near the spine and the wrist/hand symptoms are due to the lack of “flow” down the “hose”.

The kinked hose analogy can also be applied to the shoulder, and the low back relative to the legs!

Shoulder Pain recovery Plymouth, MI

Highlighted in blue are the nerves that supply the arm and wrist. They are commonly affected by a neck problem.

Kinked Hose showing sciatica pain and carpal tunnel syndrome pain

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How is Carpal Tunnel diagnosed?

Does it hurt to move your hands or wrists?

Phalen's maneuver, testing carpal tunnel syndrome

Phalen’s maneuver, testing carpal tunnel syndrome

Try this: press the back of both hands into each other — like praying hands but with the back of the hands opposed to the palms — for 60 seconds (Phalen’s Maneuver). If your symptoms are produced or exacerbated, there is a chance you might be dealing with true carpal tunnel syndrome.

Common physical signs or symptoms of CTS are:

  • Numbness and Tingling (thumb, 2nd, and 3rd fingers)
  • Pain (sharp, achy, or burning)
  • Weakness (gripping or trouble trying to pick up a smaller object, such as a coin)
  • Atrophy (decreased muscle mass on the palm side of the thumb)

What are standard treatments for Carpal Tunnel?

Carpal tunnel syndrome is a condition that is rarer than how often it is diagnosed.

A clinician trained in musculoskeletal conditions can help classify whether the symptoms are sourced from the neck, the median nerve, joints of the wrist, or the carpal tunnel. Furthermore, there may be more than one source — we’ve seen the neck and wrist involved on more than a few occasions.

Knowing the cause of the symptoms ensures choosing the best treatments and strategies to correct the problem as quickly as possible.

Treatments will vary depending on the true source of the issue, but conservative, hands-on treatments with specific exercises have been proven to be most effective. In rare cases is surgery absolutely needed.

What can I do about my wrist pain and symptoms?

Carpal tunnel syndrome or symptoms resembling CTS are difficult to treat on your own because the source(s) must be identified first. We can only imagine how many CTS surgeries have been performed where conservative treatment of the wrist/hand failed, but the spine was never assessed as the possible source!

Here’s a quick test you can do on your own to potentially see if your neck is involved in your CTS symptoms: collect 1-2 baseline tests, do the move in the video below, then retest for any changes. The best baseline test is an action you know will illicit your symptoms, e.g., squeezing a water bottle.