Carpal tunnel syndrome

This is a very common cause of hand pain.

Carpal tunnel syndrome is due to nerve “entrapment.” The thumb and next fingers are affected, but never the little finger.

Here hand pain, pins and needles, numbnes and weakness result from pressure on the “median” nerve in the carpal tunnel at the front of the wrist.

carpal tunnel anatomy

The tunnel is formed by the wrist bones at the back and a postage stamp sized band (flexor retinaculum) stretched across the front.

The diagnosis is usually made on the symptoms above, affecting any of your thumb and the next three fingers. The little finger is spared.

On physical examination, symptoms can be produced by holding the hand bent forward for a minute or so.

One of the thumb muscles supplied by the median nerve can be tested for strength. Opponens pollicis is tested thus...

Opponens pollicis muscle strength test

Your thumb must stay directly above your index finger, not stray out from above the palm. Feel how strongly you can push it up, and compare with your other hand.

Weakness of Opponens pollicis is a good sign of carpal tunnel syndrome.

Confirmation by nerve conduction studies can be done if there is doubt.

This test is carried out by electrical stimulation of the nerve and measurement to see if the nerve is carrying the message at the correct speed, across the wrist.

Alternative tests are ultrasound imaging or MRI of the nerve in the carpal tunnel. These show the swelling disturbing the nerve.

Causes of carpal tunnel syndrome

Many things can cause the swelling responsible for this pressure, including inflammation (rheumatoid arthritis,) trauma (using the hand as a hammer or using jack hammers,) vitamin B6 dependency and an osteopathic lesion in the neck (a joint “out,”) etc.

The last cause involves a disturbance of the little nerves controlling the blood vessels in the wrist area.

The nerves tighten up the tiny veins, so fluid leaves the blood vessels and causes swelling.

Doctors may be unaware of the role of spinal joint subluxations, so a check by a chiropractor is in order.

Dr. Robert Maigne first described the phenomena of swelling, writing

"It is common to note areas of infiltration of the skin in radicular neuralgia."

Regarding carpal tunnel syndrome, he wrote..

"Yet in a certain number of cases where diagnosis of the carpal tunnel is revealed....one can obtain remarkable improvement by a cervical manipulation."

His book is "Orthopedic Medicine, a new approach to vertebral manipulations," Maigne and Liberson, 1972 Charles C. Thomas pub. pp 46, 242.

Checking your cervico-thoracic junction

You can check the overall movement of your neck and the various muscles, but do not be put off by having no neck pain or tenderness. Sometimes the joint responsible is not sore, just stiff.

Ask someone to look at the line taken by your spinal bones, as you sit bent forward with your head down and straight (not turned.)

Is the line pointing to the middle of your neck? If not, an osteopathic lesion at the base of your neck is likely.

Observation of cervico-thoracic junction

There is a photo of this finding on the thoracic outlet syndrome hand pain page.

Cervical nerve root pressure

Similar symptoms in the hand, but not including thumb pain and involving the little finger, are likely to come directly from where the neck joins your thoracic spine.

Here a nerve root may be pressed on as it leaves the spine.

Over to the ulnar side of your hand - the pinky

It gets more complicated too. You can have both mechanisms operating. This is called the double crush syndrome, with your poor nerve damaged at both the neck and wrist.

In this case all fingers are involved in the hand pain.

Carpal tunnel syndrome treatment

This may be thyroid hormone replacement, a wrist splint, diuretic pills, cortisone injection into the carpal tunnel, vitamin B6, treatment of your spine or even surgery.

You should ensure that the cause has been adequately looked for. There is no "one size fits all" answer.

From hand pain to pain just in your thumb - but where from?

From hand pain back to home pain page

Is it your wrist rather than your hand - wrist pain, fractures

Do you feel the cold, get constipated - see thyroid page

Out to the end of your hand, to sore fingers

Rheumatoid arthritis - a potentially serious cause of hand pain

Stiff fingers and hands for at least one hour in the morning, is a clue to this condition. When you make a fist, there should be a dip between each of your knuckles. The swelling of the metacarpo phalangeal joints in RA, fills in this dip. The proximal interphalangeal joints are also likely to be the site of spindle shaped, symmetrical swelling and tenderness. Symmetry between right and left sides is also a feature of this condition. Early treatment to avoid permanent joint damage, is important. If you suspect this, a checkup is in order. Your doctor may order blood tests, called CCP antibody, ESR and CRP.

Other inflammatory arthritis diseases can affect one's hands

Arthropod born viruses, human infectious viruses and autoimmunity can all cause multiple joints to become inflamed.

In Australia, Ross River virus and rubella are well known viral causes. Disseminated lupus erythematosis (DLS or SLE) is a relatively common autoimmune example.

Vitamin B6 requirements can be considerable

You can be short of vitamin B6 (pyridoxine) despite normally adequate intake.

The gut damage in "leaky gut syndrome" allows macromolocules easier access to the tissues, but also interferes with absorption of properly digested food.

In particular there may be irregular absorption of different amino acids. These are the building blocks of proteins, and we need to have all of them available at the same time to achieve protein synthesis.

Only 10 are essential as we can make the others ourselves, and in this situation we need to do a lot of this - swapping amino groups between different AAs.

This last process requires vitamin B6, here in excess of the amount available from an average good diet.

Leaky gut syndrome is commonly caused or aggravated by food and chemical intolerance and candida, so these may need looking at.

The original book on vitamin B6 treatment is "Vitamin B6 - The Doctor's Report" by John Ellis & James Presley.

Scalds and burns first aid treatment

If you ever have the misfortune to have this happen, milk with iceblocks is very good immediate treatment. Even just milk straight out of the refrigerator will do.

Immerse the burnt part and feel the relief. The hand pain stops almost immediately. If you can't immerse it completely, cover with a hand towel and drip ice milk over this continually, collecting it in a tray for reuse.

Every quarter of an hour or so, remove the burnt part from the milk to see if the pain returns. If it does, continue the treatment, until finally the pain has settled.

Years ago a patient spilled recently boiled water into his rubber gumboot. He had to sit up all night before he could take his foot out of the milk without pain returning.

The reason for milk rather than water, is to prevent the skin from taking up water during the treatment. Blisters do not develop unless they happened before the treatment was started.

Bitten hand

Bites from dogs and cats are less likely to get infected than human bites . Our saliva has up to 50 species of germs capable of infecting bites. Rest and elevation (above the level of our heart) are important. Homeopathic aconite and Bach flower rescue remedy are good for the initial fright and aconite and ledum for helping the injury to recover.


Is there something else you would like to read about?
This search button will bring up anywhere on this site your words are mentioned...


Custom Search


The contactpage.


Is there something else you would like to read about?
This search button will bring up anywhere on this site your words are mentioned...


Custom Search


The contactpage.

The finger bones are called phalanges and the joints between them interphalangeal joints, proximal closer to palm and distal at end, abbreviated PIP and DIP. The PIP joint is half way down each finger.

If you are interested in a home study course on examination of the spine, please send me your e-mail address by the contact form.