This blog is for those with wrist pain, wrist tendonitis, carpal tunnel syndrome, tennis wrist, or even elbow pain, and the ‘pinched nerve in the wrist’. First off, let’s clarify that just because you have pain going down to your wrist, does not automatically mean it is a pinched nerve. Anything that irritates the nerve either as it exits the spine or along its path to the wrist can cause a pinched nerve; this may be a space-occupying lesion (cyst, tumor, herniation) or something else. In the case of a pinched nerve, the pattern of distribution is directly proportional to the level of nerve pattern. If you think that’s you, then I encourage you to read more in a blog I wrote on What is a Pinched Nerve? Otherwise, keep reading this blog to find out what is causing your symptoms!
Nerve Distribution by https://braceaccess.com
What Causes the Feeling of a Pinched Nerve in Wrist
Not every wrist pain is a pinched nerve and frankly, with our sedentary lifestyle, I am more inclined to say that it is from your posture. The number one “imposter” of a pinched nerve is trigger points. Trigger points are areas in your muscle tissue that actually refer pain to other areas.
The most common area for trigger points resulting in wrist pain is the muscles of the forearm and the triceps. This includes muscles on the anteriorly (palm side) and posteriorly (back of hand side). Rather than what specific muscle is having trigger points, you should be most concerned with what is causing these trigger points in the muscle tissue; also you cannot have trigger points in one muscle group without impacting ALL surrounding structures and joints. This is the reason why so many so-called ‘pinched nerves’ are misdiagnosed and mistreated.
You ought to remember that in order to solve any musculo-skeletal condition, we need to understand the source of the problem(s), and all that feeds the source of the problem. That means the lifestyle HAS to be reviewed and scrutinized. When the focus is all about pain vs function, the problem will always return because what was looked at was what was only on the surface!
Trigger points are caused by voluntarily or involuntarily overusing, misusing, or abusing muscles. The most common repetitive activity for this specific issue is typing! So now, if you work behind a computer but play tennis on the weekends and call your wrist pain ‘Tennis wrist”, tennis is simply the straw that broke the camel’s back!
Most people don’t have the correct desk ergonomics and this can make daily typing even more damaging. When you type, you force your hands, wrist, elbows, shoulders, and neck into an unnatural position for 8+ hours everyday. So don’t make the mistake of assuming this repetitive activity of typing only impacts that wrist, because that’s the only area you feel pain.
How is Your Wrist Connected to Your Neck Pain
By natural design, every joint and muscle group in your body works together to perform movements. Your wrist specifically works with the elbow, shoulder, shoulder blades, and neck; dysfunctional movement or restrictions in any of these areas will impact the neck because your shoulders and neck work closely together.
The correlation of movement of the wrist, elbow, shoulder, shoulder blade, and neck is established as a newborn through about 3 months of age and more so during the ‘tummy time’. This is what developmental kinesiology is all about and the core of how, at my clinic, we assess and then treat all musculo-skeletal and posture-related issues.
Typing is a known activity that over time, will restrict the range of motion in the wrist because the elbows are continuously held by the side; the side you ‘mouse with’ has a different kind of dysfunction that leads to pain down the arm and wrist while the opposite side causes similar pain and symptoms because one of the heads of the triceps is overused while another head is fully ignored!
The wrist is made up of eight tiny bones called carpals that connect to the 2 bones of the forearm called radius and ulna. It has its own range of motion through the following movements:
- Flexion
- Extension
- Ulnar deviation (little finger side bend)
- Radial deviation (thumb side bend)
If the wrist becomes restricted and cannot perform the functional range of motion, then there will be an improvisation of movement of the elbow and shoulder to get the task done. This means that the movement per design (functional movement) becomes a modified movement (dysfunctional movement). This is because we are highly resilient and adaptable and are to live a long life (hopefully); this is our way of prolonging our lives by being able to sustain life, fetching that ‘water’, ‘killing that animal to feed’ and in the new version of lifestyle, working to pay the bills!
How to Treat a Pinched Nerve in the Wrist
Rehabilitation comes when there is no pain. My treatment protocol to get rid of wrist pain naturally is as follows:
- Manipulation of the neck to stimulate your nervous system.
- Active Release Technique of the shoulder blade, shoulder, elbow, wrist, and neck muscles to address the trigger points
- Wrist Mobilization to restore proper range of motion to the wrist
- Ergonomic Evaluation and Correction
- Review of contributing lifestyle habits and patterns
- Use of Pillow when sleeping
I highly encourage you to use this Ergonomic Checklist and the Ergonomic Playlist on my Youtube Channel to see what you need to change. If these corrections are not made, and the dysfunctional movement patterns are not corrected, you can be assured that not only the wrist pain will continue showing up, but you will have more in-depth complications on the way! This is only achieved through the principles of Postural Neurology and Dynamic Neuromuscular Stabilization.The video below will give you a sneak peek of functional movement for the region and how that is performed.
Surgery for a Pinched Nerve in the Wrist
Unfortunately, when a problem is partly looked at, the treatment is only partial correction. Partial correction means the return of symptoms and when it comes to wrist pain, this means the diagnosis of Carpal Tunnel Syndrome and then surgery.
Now, if you are getting tests like NCV or EMG of the carpal nerve and see an insufficiency, you may think that your ‘Carpal Tunnel Syndrome’ is a true and correct diagnosis. What you ought to realize is that over time, every structure, including the nerves (which is soft tissue) becomes compromised. So when the transverse carpal ligament (flexor retinaculum shown in the top picture) is removed, and the dysfunction still exists, the pain will still come back. The retinaculum is like a natural bracelet holding all soft tissue at the wrist together; removing that is not going to solve your dysfunctional movement no matter what is removed. This is like you have a swelling at your ankle so the solution is to not wear tight socks or any socks so the swelling goes down!!
Not every shooting pain or tingling pain is a pinched nerve and if you’re considering surgery, I encourage you to explore all other options first.
Contact me if you still have questions and do know that you are better off looking at function vs pain when it comes to your musculo-skeletal issues.
Dr. Shakib