A quick Google search for hand and wrist pain is guaranteed to return with carpal tunnel syndrome at the top of the list. While carpal tunnel issues are prevalent in many situations, it is often used as a catchall term for any generalized hand and wrist pain. Read on and you may be surprised to learn that the root of the discomfort often stems from other areas of your body.
*Note: This article should not be used to form a diagnosis and if you suffer from any of these symptoms you should consult with a healthcare professional.
To begin, let us walk you through a basic breakdown of inflammation.
Have you noticed any redness or swelling? Have you felt heat, numbness, or tingling? Have you experienced weakness, decreased function? If so then the pain and discomfort you feel in your hand or wrist is likely the result of inflammation. Inflammation is your body’s natural defence against injury and is the mechanism for healing; however, when this inflammatory response gets carried away, additional problems begin to show up. How so you might ask?
When Inflammation inside joints and along tendons and muscles becomes too much, it begins to put pressure on surrounding structures resulting in pinched nerves and radiating pain. A pinched nerve is simply any nerve that is being compressed by a structure around it. When it comes to the upper limb the source of the pinched nerve can be anywhere from the neck, shoulder, elbow, wrist, and hand.
This article will discuss some of the common issues that may cause hand and wrist discomfort. Since many injuries or conditions can cause the same set of symptoms, it’s best to consult with a trained professional to deduce where the discomfort is coming from.
Neck and Shoulder Conditions
Thoracic Outlet Syndrome
It may seem strange but the neck and shoulder could be a potential starting place for the pain you feel in your hand and wrist. The nerves that supply the hand and wrist originate from a common area just off the spine called the brachial plexus. The nerves from this plexus split and travel from your neck, through the muscles in the shoulder joint and continue down through your elbow until they reach your fingertips.
At our neck and shoulder it is common for some of these nerves to be compressed by tight scalene and pectoralis minor muscles in a condition called neurogenic thoracic outlet syndrome. Your scalene muscles run along the side of your neck and attach along the top of your shoulder and ribs. Your pectoralis minor muscle is in your chest and starts along your rib cage and attaches to the front of your shoulder. When these muscles are tight they may compress the nerves of the brachial plexus and you may feel the symptoms travel the full length of your arm down into your fingers.
It is common to see tight scalene and pectoralis minor muscles in individuals with a forward head and shoulder posture. In this posture we let our heads drop forward towards the ground and let our shoulder blades slide up and forward along our ribcage. This posture has been coined as ‘text neck’ as we have seen an increase in this posture with the global popularity of mobile devices. If you are reading this off your cellphone, tablet or laptop computer there is a good chance you are in this posture!
Ways to reduce symptoms
The MoveSafe ‘Big 3’ healthy posture and movement element of Shoulders Anchored is targeted at reducing this hunched forward posture. To anchor your shoulders imagine pulling
your shoulder blades down along your ribcage into your opposite back pockets. This posture will balance your head over top of your shoulders and keep the pressure off of your brachial plexus.
MoveSafe uses several exercises that reinforce a Shoulders Anchored posture. Rolling your shoulders back and down during a Shoulder Roll can help reset your posture if you have been hunching forward for an extended period of time. The Anti-Slouch Stretch where you anchor your shoulders and pull your hands towards the ground can stretch out your tight pectoralis minor muscles. The Neck Stretch allows you to stretch your scalene muscles as they attach from the side of the neck into the top of your shoulder.
Tendonitis and Epicondylitis
Our elbow joint is a common place for muscular pain. The muscles that control our wrists, hands and fingers originate around the elbow. We categorize these muscles into two groups, flexors and extensors. Our flexors originate just above the bony part on the side of our elbow closest to our body and these muscles allow us to grip things. Our extensor group originates above the less obvious bony part on the outside of the elbow and these muscles let us bend our wrist back and straighten our fingers.
Chronic overuse of these muscle groups may cause two similar conditions; tendonitis and epicondylitis. Tendonitis is inflammation and irritation of any area along a tendon. Tendons are connective tissue that are found at the ends of muscles and attach muscles to a bone. Epicondlyitis is a more specific location for tendonitis that occurs at the elbow joint and is commonly referred to as either ‘Tennis Elbow’ or ‘Golfer’s Elbow’. The inflammation that occurs can cause pain and weakness to travel down the arm into the fingers.
Ways to reduce symptoms
Tasks such as gripping tools for extended periods of time can be very aggravating to our flexor muscles. If you use a hammer, wrench or screwdriver frequently, try wrapping a few layers of thick tape around the handle to widen your grip.
Typing and mousing can be irritating to both the flexor and extensor muscle groups at the same time! Gripping a small mouse or prolonged typing overworks our flexors. Hovering your fingers over the keyboard and mouse when not actively typing will lead to fatigue in your extensor muscles. Use a keyboard and mouse that fit your hand size. Wireless keyboards and mice tend to be smaller in size in order to be more portable. Pick a keyboard that has standard size keys and a mouse that is large enough to fill the palm of your hand and allows you to maintain a fairly straight finger when you click.
The Deep Forearm Massage is an excellent exercise as it increases blood flow which will help flush out inflammation. The Forearm Stretches help relax the forearm muscles that you may hold under tension while gripping or mousing throughout your day. Taking time to do these simple exercises throughout your workday can help your body stay healthy and strong.
Cubital Tunnel Syndrome
Your cubital tunnel is created by a ligament that runs over a small notch in the bone on the inside of your elbow. Through this tunnel runs your ulnar nerve. This is the place you hit when you bump your ‘funny bone’! Hitting your ‘funny bone’ is considered acute compression of the ulnar nerve and we all know that it causes pain and weakness down the side of your forearm into your pinky and ring finger. You can also cause chronic compression if you rest the tip of your elbow on your desk or armrest of your chair. In addition, the ulnar nerve can get irritated by bending your elbow frequently during a task such as hammering. This causes the nerve to rub against the bony notch which leads to inflammation.
Taking frequent Interrupt breaks to reduce time spent with your elbow in a flexed position and sitting with your Shoulders Anchored in your chair will help reduce the risk of irritation of the ulnar nerve through the cubital tunnel.
Wrist and Hand Conditions
Carpal Tunnel Syndrome
From your shoulder to your fingertips there are 32 bones, 28 of those bones are in your hand and wrist. The common location for inflammation in the hands is around the 8 carpal bones. These 8 bones are organized into 2 rows of 4 bones at the base of your hand, connected to the 2 long bones of your forearm; this is your wrist joint. The carpal tunnel is the space formed in between a ligament on the palmar side of your hand and your carpal bones. Through this tunnel runs the nerves, blood vessels, and tendons for your fingers. One very specific nerve that travels through this space is called the median nerve and it supplies your thumb, pointer and middle fingers. Carpal Tunnel Syndrome occurs when this median nerve is compressed due to inflammation in the carpal tunnel which leads to pain and weakness in your thumb, pointer and middle fingers. Many different things can cause the inflammation in the carpal tunnel.
Awkward wrist postures and contact stress are common causes of inflammation in the carpal tunnel. Repetitive awkward wrist postures demonstrated while using tools can create inflammation along the tendons that travel through the carpal tunnel which can lead to a decrease in space compressing the median nerve.
Ways to reduce symptoms
Awkward wrist postures while mousing can create contact stress on the carpal tunnel. When you reach out to the mouse and rest your wrist on the desk this compresses the structures on the underside of your wrist. To reduce this contact stress sit with your shoulders anchored to the back of your chair and keep your elbows bent to around 90° and inline with your body. It is best to support your forearm on your chair armrest as this will allow your wrist to hover above the desk and reduce compression.
You can also find opportunities to take microbreaks such as ‘office yoga’ to reduce periods of contact stress. ‘Office yoga’ is when you rest your hands off the keyboard and mouse (resting on the 5th finger sides of the hands, palms facing inwards) when not actively typing and mousing, to give your hands and wrists a break from contact stress against the work surface. Resting in this neutral position even for a few seconds at a time when thinking or reading, will reduce stress to the hands and wrists.
GUYON’S CANAL SYNDROME
Your ring and pinky fingers are innervated by a different nerve called your ulnar nerve. This nerve travels close to the carpal tunnel but actually passes over it and through a different tunnel called Guyon’s Canal. The ulnar nerve is compressed in the same way as the median nerve in the carpal tunnel but is termed Guyon’s Canal Syndrome. It is also known as ‘Handlebar Palsy’ as it is a common condition for cyclists. The symptoms are the same as carpal tunnel syndrome but it only affects the pinky and ring finger side of the hand. Using the ‘office yoga’ posture when not actively typing and mousing will reduce your risk in the office. If you are a cyclist you may want to add additional padding to your handlebars. Letting go of your handlebars whenever safe to do so will also reduce compression.
DE QUERVAIN’S SYNDROME
Another chronic pain condition in the hand is DeQuervain’s syndrome. This is characterized by pain and weakness in the thumb. It is a tendinopathy caused by overuse of the muscles that control thumb movement. This condition can also be called ‘Gamer’s Thumb’ or ‘Texting Thumb’ as it is common to see in people who play video games, or those who are on their mobile devices excessively. Set timers to facilitate frequent Interrupt breaks or scroll through your phone using your index finger to allow your thumb time to rest. You can also use voice dictation to limit typing while you are texting.
As outlined above there are many different factors that could be leading to your hand and wrist pain and it is possible to have more than one condition at the same time. If you are experiencing pain it is important to speak to a healthcare professional to ensure that the right course of action is taken to manage your discomfort. An ergonomic assessment of your workstation can help assess equipment or behavioural problems that may put you at risk for these common upper body conditions. Contact us to discuss how MoveSafe can help you!