Carpal tunnel syndrome (CTS) is one of the rising conditions I treat and perhaps the second most MIS- diagnosed case that comes to the practice.  The symptoms mimicking Carpal Tunnel Syndrome in our modern society are due to the rise in the use of computers and digital devices such as smartphones, iPads, and laptops. In this blog, I will dive into what carpal tunnel syndrome feels like, explore the relationship between carpal tunnel and elbow pain, carpal tunnel natural remedies, carpal tunnel release, and carpal tunnel relief and answer questions such as:  where does carpal tunnel hurt, can carpal tunnel come and go,  will carpal tunnel go away with rest, and what to do when carpal tunnel surgery fails.

What Carpal Tunnel Syndrome Feels Like

The wrist is a complex joint that connects the forearm to the hand and is made up of small bones called carpals. These bones are layered with many ligaments and tendons creating what is referred to as the carpal tunnel. Looking at your wrist palm up, this is where the median nerve runs through and distributes to the rest of the hand and is layered over by the transverse carpal ligament. Carpal Tunnel Syndrome rarely involves both hands and the symptoms are commonly mimicked by other issues that will be discussed in this blog.

Symptoms of Carpal Tunnel Syndrome typically include:

• Pins and needles in the affected hand(s)
• sore arm
• hand pain
• wrist pain 
• a decrease in grip strength

Not every arm pain, arm ache, pins and needles in hands, hand pain, and wrist pain is Carpal Tunnel Syndrome. In fact, it takes quite a bit of ‘insult’ before the Median nerve is impacted so you have to ask yourself if you actually have carpal tunnel syndrome or if it is something else.

The most common imposter of Carpal Tunnel Syndrome is the trigger points in the muscles close to the elbow that are active when rotating the wrist (put your right hand over the left arm close to the elbow and start turning your arm to feel the muscle) for the palm to face up and down. Another involved muscle is the one between the radius and ulna, the two long bones of the forearm. These trigger points shoot pain down the arm and in many cases weaken the grip strength which is typically seen in Carpal Tunnel cases. So if it’s not carpal tunnel, what is it, and what is the right treatment?  

Carpal Tunnel Without Surgery

Has the pain gotten so bad you’re wondering if surgery is the right choice? Carpal tunnel surgery, also referred to as carpal release surgery consists of cutting the transverse carpal ligament (a soft membrane that holds the nerve and the ligaments going to the fingers like a bracelet) with the goal of releasing pressure on the median nerve. This is performed with the hopes that symptoms will resolve.

Unfortunately, in my practice, I see so many cases of this surgery providing some relief, with the symptoms returning before long only this time with stronger and more complex related issues. If the symptoms return then it’s safe to say that what was causing the problem was not the transverse carpal ligament. If that’s why case, then what was the true cause and how do we address it?

Carpal Tunnel Natural Remedies

Even if you are okay taking medicine, chances are that you have exhausted that option and have looked into natural remedies such as diet. While Vitamin B6 is a great one to take for general nerve restoration and healing, you have to dig in (no pun intended) to find out why you are having these symptoms? Is it the actual nerve being irritated or something else. If it is the nerve, then is surgery the only option? The answer is NO, not necessarily!

If you have tried physical therapy, you might have gotten either some relief with the pain returning and you think perhaps it’s time to consider surgery or physical therapy did not help at all. You may have tried massage which may provide some relief but since the issue is deeper, the ‘good time’ is short-lived. Then it comes to Chiropractic and Acupuncture which may help but then again, it comes back after a while.

So What is the Right Treatment?

You know how you can cut a tree off but if the roots are still intact, the following year you will have new shoots coming off? When you don’t address the cause of the hand pain, you are in the same boat. The first thing to do is to avoid what contributed to the problem to begin with!!

A bad work environment plays a huge role in preventing Carpal Tunnel Syndrome or symptoms that act like it. To not make this blog about Ergonomics, check out this checklist to self evaluate your work environment to ensure it is Ergonomically sound. One thing you want to make sure you have is a large keyboard!!! The smaller the keyboard, the closer your elbows will be to your side and the more ‘contributing factors’ you have to your hand pain. Check out this blog on Ergonomics and Pain to learn how your set-up is likely causing your pain or at least contributing to it.

There are many aspects of working behind a desk that can be very damaging, the keyboard being one of them! 

Believe it or not, your wrists, elbows, shoulder, and neck are closely related and the malfunction in one interferes with the wellbeing of the others. When you sit for so many hours, you know that you are slouching, your shoulders are rolled forward (not natural), your neck is moved forward (not natural), your elbows are too close or too far from your body (not natural) especially if you have the habit of leaving your arm that operates your mouse, on the table with the best-case scenario, everything at your set up is ergonomic-friendly!!

Regardless of what digital device you use, your elbows are mostly bent and so the triceps don’t even get to do their basic foundation. Before you make the conclusion that you should run to the gym to work out those triceps and somehow at the gym improve your posture, let me tell you that your issue is not in isolation and the worst thing you can do is loading up your joints when they are not even in the right position. Your forward neck, rolled shoulders, flexed elbows and non-neutral wrists are NOT in the right position!! 

Treatment and Prevention of Carpal Tunnel Syndrome

Since my practice is full of misdiagnosed patients who have spent a lot of time going from doctors to doctors, procedure after procedure, spending money, and still with problems, I have a protocol that I go by. When it comes to the Carpal Tunnel Syndrome, after a thorough consultation, I go right to the forearm to the areas I mentioned before and try to see if tI can reproduce the main complaint. Fortunately, I have been able to be right on 100% of the time so far. This is very shocking to patients with long, ongoing wrist and hand pain but nothing new! 

If the pain can be reproduced, then we are much closer to getting relief. The next step is Functional Rehabilitation such as Active Release Technique (ART) of the JOINTS involved especially the shoulder blades. Active Release Technique for Carpal Tunnel Syndrome is no different than ART performed elsewhere in the body in that it requires pressure over certain spots while the joint goes through specific ranges of motion. 

ART allows the patient to not only gain an increase in mobility and decrease in pain but prepares you for the next step in eliminating the cause of the hand and wrist pain.

Next is starting off with Developmental Kinesiology or Functional Movement best explained in the video below which in short is following the same patterns of movement as a baby goes from infancy to walking. If you wonder what that has to do with your arm, hand, and wrist pain, I invite you to think of how during this time, the fine coordination of movement in all parts of the body takes place. This is as if we are born with a box full of tools but through the patterns of movement that we all-regardless of where we live or our gender- we learn to not only use those tools but master how to use them. ALL babies move the most functional way until the age of 3-4 years. Developmental Kinesiology such as Dynamic Neuromuscular Stabilization or DNS utilizes these patterns of movement to address the issue related to all musculoskeletal issues. is the study of how babies develop proper movement and is applied to correcting the pathological movement patterns of adults.

Soon after we initiate the Developmental Kinesiology exercises, we introduce postural neurology exercises from the Postural Neurology exam since unless the brain tells the body parts how to move, no attempt, DNS or not, will be long-lasting. Think back to when you tried to remember to sit up straight and how long that lasted? If your brain tells your body to sit up straight then it becomes automatic just as you never think about blinking and you do it perfectly!

The combination of Postural Neurology and Functional Movement addresses all causes contributing to your hand and wrist pain.

What is the best exercise for wrist and hand pain?

The best exercise for anything is the one that allows the weak muscles to get strong, the tight muscles to get stretched, the joints to work toward being in the place they were designed to be and if you are thinking there is no such exercise series, you are wrong!!

We can use infants to toddlers as our best exercise specialists. There are certain principles to abide by such as proper breathing. Proper breathing is not what you think and abdominal breathing is a PART of it. if you think of newborns to toddlers, you will see their abdomen is large; it is not because they are fat but because they breathe effectively. I won’t get into that but invite you to check out my Youtube Channel to learn about proper breathing and the principles involved.

As we develop movement and achieve fine coordination of movement, we also build nerve tracks where these movements become automatic. Look at building a neighborhood where the first thing is to develop the rough roads. Those are the neural tracks that with move movement, we asphalt over!

Through a sedentary lifestyle and living behind a desk, we slowly start to lose mobility in joints like the wrists, shoulder blades and shoulders. Muscles get tight, the shoulders roll forward, your stabilizing muscles become overstretched, and weak no longer keeping you upright so you now slouch. Meanwhile, the part of the brain that sends the upright position (PontoMedullary Reticular Formation or PMRF) does not get to work and starts shrinking. This means us having pathological vs biological patterns of movement. 

According to the guidelines of Postural Neurology, drinking out of a straw, whistling, singing, and humming are all some of the ways we can help restoring the shrunken PMRF and ‘walking’ toward the path of correction. There are quite a few exercises that help this which you may find on my Youtube Channel.

One of my favorite exercises for not only Carpal Tunnel Syndrome but all shoulder, shoulder blade, elbow, wrist and hand problems is the video below. Keep in mind that doing these exercises mechanically is NOT going to work but assuring the primary muscles involved are doing their job is the key.

Everything is connected and this is not an exception. There is no easy, quick way to get rid of the cause, and anyone saying it otherwise is not being truthful.

The best investment in life is not your stock portfolio, it is not your house and car, it is not even your children!!! The best investment is your health as without it you are not only a burden to the next best thing, your children, but all that you worked hard for and ignored your health to become of no use.

Let me know if you have any questions by contacting me via my website.

Dr. Shakib