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Everyone and No One Has Carpal Tunnel

By Sara Calabro

Yogis, writers, tailors, hair cutters, software engineers, carpenters, baristas… For many of these people, wrist pain is the bane of their existence. Ask, and most will tell you they have carpal tunnel. However, in a high percentage of cases, this ubiquitous diagnosis for workplace-induced wrist pain is false.

Most people whose jobs cause or worsen wrist pain are not dealing with true carpal tunnel syndrome. Rather, they are dealing with trigger points caused by repetitive strain on the arm and hand muscles. These trigger points mimic the symptoms of carpal tunnel and can be completely eliminated with acupuncture.

Who Really Has Carpal Tunnel?

True carpal tunnel means that the median nerve, which runs from the forearm through a passageway in the wrist to the hand, is compressed. This compression causes pain, numbness and tingling, and sometimes weakness in the wrist, arm and hand. Structural malformations that compress the median nerve are not necessarily unusual—for example, a wrist fracture or inflammation from arthritis can crowd the area—but they are not as common as carpal-tunnel statistics would have us believe.

So why is a false diagnosis of carpal tunnel syndrome problematic? Initial medical treatment for carpal tunnel includes wrist splinting, NSAID drugs and cortisone shots. Not great, but no more harmful than conventional pain management for any other condition. But with carpal tunnel, when these measures don’t work, people turn to surgery relatively quickly because their condition often threatens their livelihood.

Acupuncture could save a lot of people from unnecessarily going under the knife.

Which Trigger Points Cause Wrist Pain?

Trigger points in the following muscles can mimic the symptoms of carpal tunnel syndrome:

If wrist pain is mainly on the back of the wrist, there may be trigger points in one or several of the wrist extensor muscles—extensor carpi ulnaris, extensor carpi radialis brevis and extensor carpi radialis longus. Pain from extensor ulnaris trigger points tends to concentrate on the pinky side of the wrist while radialis brevis trigger points refer pain to the center of the wrist and slightly down the hand. Radialis longus trigger points, in addition to wrist pain, refer pain to the outside of the elbow. (See picture at left.)

For inside-of-the-wrist pain, an acupuncturist may suspect trigger points in the hand flexor muscles—the flexor carpi radials and flexor carpi ulnaris (see picture at right). The pronator teres (not shown), whose trigger points refer pain to the thumb side of the inner wrist up into the forearm, also can be involved.

Another forearm muscle, the palmaris longus (not shown), can harbor trigger points that cause pain and tingling in the inner wrist and up into the forearm. Accompanying hand pain can help differentiate this muscle. The palm is the primary referral area for trigger points in the palmaris longus, so in addition to wrist pain, there also would be pain in the center of the palm.

Trigger points directly in the hand, in a muscle called opponens pollicis (not shown), can cause lower wrist pain on the thumb side of the inside crease. Trigger points in this muscle are common in people whose hands and especially thumbs are very active. For example, the opponens pollicis is one of the first places acupuncturists look when people complain of BlackBerry thumb.

While most wrist pain comes from trigger points in the arm and hand muscles, the scalene muscles of the neck also can play a role. Trigger points in the scaleni can cause back-of-the-wrist pain that extends into the fingers, as well as thumb-side pain on the inside of the wrist. This type of wrist pain is distinguishable by the accompanying upper arm, back or chest pain (see picture at left).

Trigger points in another upper-body muscle, the pectoralis minor (not shown), can cause referred pain to the wrist. Most pain from pectoralis-minor trigger points is at the front of the shoulder, but there is a common spillover pattern that extends down the inside of the arm and wrist, all the way into the ring and pinky fingers.

Why Go With Acupuncture for Carpal Tunnel?

Considering the risk-benefit ratios of various wrist-pain treatments, acupuncture should be a first-line option rather than a last resort.

Acupuncture is safer than NSAIDs and cortisone shots, and it actually eliminates the pain source rather than temporarily masking symptoms. Compared with surgery, acupuncture is cheaper and less invasive, and has a higher probability of providing relief in people who don’t have a structural malformation (i.e., the majority). In relatively rare cases of true carpal tunnel syndrome, acupuncture can help manage post-operative trigger points that form in scar tissue and surrounding fascia.

Wrist pain burdens our system not only in the form of medical expenses but also lost wages. Before labeling it all carpal tunnel, let’s look to acupuncture for a new perspective on this prevalent problem.

Photo by Sara Calabro
Trigger-point images from Myofascial Pain and Dysfunction: The Trigger Point Manual

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Comments

Bianca Beldini
Reply

AcuTake, how I LOVE these articles written on Trigger Points! As an Acupuncture Trigger Point myofascial pain specialist, I completely agree with your article on utilizing these specific muscles to relieve hand /palm / intrinsic palm or digit pain. Most “carpal pain” patients have an overuse injury that mimics what is generically termed as “carpal tunnel”.

I would go one step beyond treating their symptomatic area (e.g treating the forearm flexors for palmar pain or treating the extensor muscles for dorsal hand / wrist pain) and also take a look at their cervical spine and the way they hold their upper body posture. Most patients will present with a forward head, rounded shoulder positioning and have tight musculature of the upper traps, levator scapulae and splenius capitis/cervicis muscles. Releasing the tight postural muscles will round out a treatment beautifully as it focuses on treating the root structural asymmetry as well as the distal symptomatic area.

Proper stretching techniques of the forearm and neck for a home program combined with trigger point release Acupuncture treatments could really change the need for pharmaceutical drugs, unnecessary cortisone injections and of course as you mentioned, surgery!

Ashley
Reply

could base of thumb twitching be connected to these issues? i’ve noticed unusual twitching in the base of my right thumb for the past few weeks and wonder if it’s connected to yoga or some other exposure? thanks for this informative article!!!!

Sara
Reply

Hey Ashley. Hopefully others will chime in here but I’d say it could definitely be related. Also check out this article on thumb pain. Specifically, scroll toward the end and look at the picture of the trigger-point referral pattern for the adductor pollicis muscle. I didn’t mention that one in this wrist-pain article but you’ll see that the pattern centers right at the base of the thumb.

Thanks for reading,
Sara

Doug
Reply

Great article and so true. I used to have a clinic devoted to Carpal Tunnel and I always treated the forarm muscles and scalenes/thoracic outlet with acupuncture and massage. It always worked.

I think even those few with “true carpal tunnel,” the problem still comes from the muscles of the forarm. If those muscles and tendons are tight and inflammed, they impinge on the nerve and/or reduce the space in the tunnel itself.

Jeff
Reply

If I have had a nerve conduction study and seen a neurologist who has determined that I have severe CTS in my right hand, should I still consider acupuncture? …or would this be a bonafide “rare” case of CTS?

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