Is it Carpal Tunnel Syndrome, or Something Else?

Carpal Tunnel Syndrome: A Guide for Desk Workers

As a chiropractor, I frequently see desk workers struggling with wrist, hand, or arm discomfort. One common condition is carpal tunnel syndrome (CTS), which can significantly affect your daily work and quality of life. This post outlines the three most common symptoms and causes of CTS, explains why pinpointing its origin can be challenging, and provides two practical at-home tests to help determine whether your symptoms stem from the wrist, elbow, or neck. My goal is to equip you with clear, reliable information to better understand your condition and seek appropriate care.

What Is Carpal Tunnel Syndrome?

Carpal tunnel syndrome occurs when the median nerve, which runs through a narrow passage in your wrist called the carpal tunnel, becomes compressed. This nerve controls sensation and movement in parts of your hand, so compression can lead to discomfort and functional limitations. Desk workers, who often spend hours typing or using a mouse, are particularly at risk due to repetitive hand and wrist motions.

Three Most Common Symptoms of Carpal Tunnel Syndrome

Based on clinical observations and research, the following are the most prevalent symptoms of CTS:

1. Numbness or Tingling in the Hand: You may feel a "pins and needles" sensation in your thumb, index, middle, and part of your ring finger. This often worsens at night or during activities like typing.

2. Wrist or Hand Pain: A burning or aching pain in the wrist or hand is common, sometimes extending up the forearm. The pain may intensify with prolonged wrist use.

3. Weakness in the Hand: You might notice difficulty gripping objects, such as dropping a pen or struggling to open a jar, due to weakened thumb muscles.

These symptoms can disrupt work and daily tasks, making early identification critical.

Three Most Common Causes of Carpal Tunnel Syndrome

Understanding the causes of CTS helps in prevention and management. The primary causes include:

1. Repetitive Wrist Movements: Prolonged typing, mouse use, or other repetitive tasks can irritate the tendons in the carpal tunnel, leading to swelling and nerve compression.

2. Poor Wrist Posture: Holding your wrist in a bent position for extended periods (e.g., while typing without proper ergonomic support) increases pressure on the median nerve.

3. Underlying Health Conditions: Conditions like diabetes, arthritis, or pregnancy can cause swelling or inflammation, narrowing the carpal tunnel and compressing the nerve.

Desk workers are especially prone to the first two causes due to long hours at a computer.

Why Pinpointing the Source Can Be Tricky

Symptoms like numbness, tingling, or pain in the hand can originate not only from the wrist (true CTS) but also from the elbow, chest, or neck. This overlap occurs because the median nerve, along with other nerves, travels from the neck through the arm to the hand. Compression or irritation at any point along this path can mimic CTS. For example:

• Neck (Cervical Spine): A pinched nerve in the neck (e.g., due to a herniated disc or poor posture) can cause radiating symptoms into the arm and hand, resembling CTS.

• Elbow: Conditions like cubital tunnel syndrome (affecting the ulnar nerve) or radial nerve irritation can cause similar tingling or weakness in the hand.

• Chest: The neurovascular structures that run into the arm pass under your chest muscles, and chronic or excessive tightness hear, can also cause similar symptoms.

• Wrist: True CTS involves compression specifically at the carpal tunnel, but distinguishing this requires careful evaluation.

Because these areas are interconnected, misdiagnosis is possible without professional assessment. However, you can perform simple at-home tests to narrow down the source before consulting a chiropractor or doctor.

Two At-Home Tests to Identify the Source of Symptoms

These practical tests can help you determine whether your symptoms likely stem from the wrist, elbow, or neck. Perform them carefully and note your results to discuss with a healthcare provider.

1. Phalen’s Test (Wrist):

   • Purpose: To check for median nerve compression in the carpal tunnel.

   • How to Do It: Press the backs of your hands together, fingers pointing down, so your wrists are flexed at a 90-degree angle. Hold for 60 seconds.

   • What to Look For: If numbness, tingling, or pain in the thumb, index, or middle fingers increases within a minute, it suggests CTS originating in the wrist.

   • Note: If symptoms don’t worsen, the issue may not be CTS or may involve another area.

2. Cervical Spine Rotation Test (Neck):

   • Purpose: To assess if symptoms originate from the neck.

   • How to Do It: Sit upright and slowly rotate your head to the left and right, then tilt it side to side. Hold each position for 10 seconds while monitoring your hand symptoms.

   • What to Look For: If turning or tilting your head (especially toward the affected side) increases numbness or tingling in your hand, the issue may stem from the cervical spine rather than the wrist or elbow.

   • Note: Avoid forcing movements that cause pain.

If these tests are inconclusive or symptoms persist, a chiropractor can perform a thorough examination, including orthopedic tests and possibly imaging, to confirm the source.

Next Steps for Desk Workers

If you suspect CTS or related symptoms, take these practical steps:

• Adjust Your Workstation: Use an ergonomic keyboard and mouse, keep wrists neutral, and take breaks every 30 minutes to stretch.

• Consult a Chiropractor: A professional can assess whether your symptoms stem from the wrist, elbow, or neck and provide targeted adjustments or therapies.

• Monitor Symptoms: Keep a log of when symptoms occur and what worsens or relieves them to aid diagnosis.

Treatment Options

Treatment for carpal tunnel syndrome can range from conservative treatment (chiropractic care, physical therapy, massage therapy etc.) all the way to surgery. If you can manage it conservatively, that is typically going to be the favored choice here. If you start to notice that you are losing grip strength, or the meaty part of your palm at the base of your thumb on one hand looks smaller, that is when we should at least consider a surgical consultation, as the nerve compression has likely started to cause muscle weakness/atrophy. Once atrophy begins, it is very hard to regain that muscle mass.

When considering surgery, there are not many studies on long-term outcomes of carpal tunnel surgery. Some studies show a success rate of 75%-90%, however there are reports of carpal tunnel syndrome reoccurrence being as high as 57% post surgery.

Carpal tunnel syndrome is manageable with early intervention. By understanding its symptoms, causes, and potential origins, you can take control of your health and maintain productivity. If you’re experiencing these issues, schedule a consultation with a chiropractor to develop a tailored plan.

Disclaimer: This information is for educational purposes only. Always consult a healthcare professional for a proper diagnosis and treatment plan.