One of the more common problems that I see in my office on a day to day basis is a patient with pain and numbness into an arm and hand. With ready access to the internet, patients will narrow down what the problem could be and will often end up under my care. Upon taking a patient’s history I more frequently encounter a self-diagnosis of a “pinched nerve” and/or carpal tunnel syndrome (CTS). This is a popular default diagnosis for hand numbness and with the amount of repetitive work that occurs in society on in both office and industrial settings; it is easy to arrive at the explanation that this numb hand must be CTS.
Fortunately this is usually not the case. True carpal tunnel syndrome often requires surgery and may not always be successful due to the fact that the source of the pain is coming from somewhere further up the arm or structures around the neck. Fortunately, CTS is relatively easy to rule out in a clinical setting through careful review of the symptoms along with orthopaedic and neurological testing. Carpal tunnel syndrome occurs specifically when there is an impingement of the median nerve at (you guessed it) the carpal tunnel which is located on the palm side of your wrist. True CTS (as pictured in blue) will primarily affect the thumb, index, middle and half of the ring finger. Some specific testing and observation helps to determine whether or not CTS is the likely culprit.
The vast majority of the time, I find that a person is not dealing with CTS but rather is getting a more broad based nerve irritation from somewhere further up. This is good news because generally with a more accurate diagnosis, some specific Active Release Technique treatment and following some common sense at work advice, patients recover quite quickly most of the time. Complicating factors to this are: how long the problem has been present, previous history of surgery, osteoarthritis and underlying diseases such as diabetes which can also greatly affect the nervous system. In previous columns, I have addressed workstation ergonomics and the problems of working at a computer station. These can be found here and here and are worth a read if this is happening with you.
An important aspect of treatment for this problem is to modify whatever activities are contributing to the pain. Whether it is work or recreation; if changes are not made a patient will often find that getting better is a slow process and the frequency of reoccurrence high. The internet can be a valuable source of information for health, however self-diagnosing can often lead to a delay in proper treatment. With any health concern, it is always best to consult your health care practitioner.
Dr. Marc Nimchuk