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Good Hand Health Tips

November 10, 2015

Wrist Pain: Are Your Symptoms Wrist Tendonitis or Symptoms of Carpal Tunnel?

Given that we use our hands so much, is it any wonder we develop wrist pain? Beauticians, typist, diabetics, pregnant women, assembly line workers and massage therapists are at a higher risk of wrist pain.1 In this article we look at the wrist pain caused from Tendonitis and Carpal Tunnel Syndrome. Both these conditions are commonly caused by cumulative stress on the wrists and hands.

Hi, it’s Coach Cathy and I’m a massage therapist and educator. Three years ago I was delusionally inspired by an obituary of a 94 year old massage therapist. She was giving four or five treatments a week up to her passing. I thought, wow, if she could do that then surely this year I could add an extra day of massage therapy. Wrong! What started off as some vague and intermittent morning numbness progressed to constant tenderness and zinging over the thumb pad, fingers 2-4 and a noticeable reduction in grip strength.

wrist-Pain-Carpal_Tunnel_Syndrome_reference Blausen.com staff
A hand orthopedist diagnosed my wrist pain as Carpal Tunnel Syndrome with tenosynovitis of my finger flexor tendon. After 25 years of repetitive hand motions combined with force and my overly enthusiastic drive to massage and teach, I too had damaged my wrist. Fortunately, these experiences lead me to coach others on caring for their hands.

What can go wrong with tendons?

TENDONITIS is inflammation of the tendons. Because tendons are less vascularized and innervated than muscles, you may not feel the damage to a tendon as quickly as you would to a muscle. Repetitive wrist and finger movement combined with force makes the tendon more susceptible to injury. Symptoms characteristically occur in the base of the thumb or cause pain in the wrist. Rest will improve the symptoms and movement will aggravate. Injury can occur to the tendons of the finger flexors passing through the carpal tunnel or to the tendons of the finger extensors on the back of the wrist. Pacing your workload and resting the hands from repetitive work, home chores or manual hobbies allows for adequate healing time from normal tendon micro tears. Without adequate healing time, edema, scar tissue and a chronic wrist pain cycle can build.

TENOSYNOVITIS is an inflammation of the synovial sheaths surrounding the tendons. In my carpal tunnel, for example, the connective tissue forming the sheath and the synovial fluid lubricating the tendon of the long finger flexor had become irritated and dried out. I could actually hear the tendon popping in the tunnel during wrist flexion. Tenosynovitis is also a common problem affecting the carpometacarpal joint at the base of the thumb.

TENDONOSIS is a chronic tendon condition involving degenerative changes in the tissue without inflammation being present2. Acute tendonitis and tenosynovitis can lead to chronic tendonosis. Uneven scarring can lead to a weaker tendon, which can lead to a chronic cycle of injury and re-injury. Regardless of the diagnosis, adequate recovery time is needed for any tendon injury. The sooner the problem is addressed, the better the outcome.

What can go wrong in the carpal tunnel?

Two of the problems occurring in the narrow carpal tunnel involve the tendons and the median nerve. As discussed above, tearing and irritation can occur when tendons are repeatedly pulled across a joint or rubbed together. The tear-and-repair cycle is a normal routine3. However, without adequate recovery time or proper joint alignment, the fascia doesn’t have time to reknit itself before you tear the fascial network again. In the tight and busy intersection of the carpal tunnel, the median nerve can be squeezed.

The squeeze play on the median nerve occurs in at least two ways. First, when the fascia fuzz thickens, the nerve can adhere to the surrounding tissue. When the nerve is restricted from gliding in its fascial sheaths the body may create inflammation. The already snug carpal tunnel is then further crowded with inflammatory fluids.

When there’s too much fluid and too little nerve glide, compression of a nerve can occur. A true Carpal Tunnel Syndrome is caused from compression of the median nerve in the carpal tunnel. The resulting pain, numbness, tingling or weakness affects the thumb and fingers 2-4.
carpal tunnel anatomy median nerve entrapment

What can I do now to avoid wrist pain?

  1. Do stretching exercises.
  2. Take rest breaks.
    Between tasks take micro-breaks (at least three minutes each) with your hands resting, palms up, on your lap.
  3. Change positions frequently.
  4. Maintain good posture and wrist position by:
    Keeping your spine upright and elongated.
    Keeping your wrists in a neutral position with little flexion or extension.
  5. Wear hand and wrist warmers.
    Keep your hands and wrists warm. This is especially important first thing in the morning. Wearing wristbands or fingerless mittens keep your wrists warm.
  6. Meet with employers to improve workload and pacing.
  7. At home replace tools and handles with more ergonomic ones.
    Handles that are textured are less likely to slip in your grip. Less slip equates to less gripping effort.
    Handles, clubs or racquets that are broader generally allow a more relaxed, handshake-style of gripping.
    Pinching movements, such as holding a needle or a key, require more effort. Instead, use a grip that folds all of your fingers toward your palm while keeping the wrist straight.

key_holder
Exercise and behavior modifications are the golden standard for prevention and recovery from cumulative stress disorders4. So take care of your wrist pain today!

P.S. For more self-care tips now, sign up for the free guide to COOL TOOLS FOR FAST RELIEF. Do you see the sign-in box at the top of this page?

References

  1. http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm
  2. http://www.ncbi.nlm.nih.gov/pubmed/11895810 Karim Kahn, et al., “Time to abandon the “tendinitis” myth: Painful overuse tendon conditions have a non-inflammatory pathology,” BMJ, 2002; 324:626-627.
  3. Laurianne Greene and Richard Goggins, Save your Hands! The Complete Guide to Injury Prevention and Ergonomics for Manual Therapists, 2nd ed. p.13. http://www.saveyourhands.com/about-injury-prevention-book
  4. http://jama.jamanetwork.com/article.aspx?articleid=188150 Marian Garfinkel, EdD; Warren Katz, MD et al, “Yoga-Based Intervention for Carpal Tunnel Syndrome A Randomized Trial,“ Journal of American Medical Association, 1998; 280(18): 1601-1603.

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