Carpal Tunnel Syndrome ABCs

Carpal Tunnel Syndrome ABCs

A quick overview of carpal tunnel syndrome.

A – Anatomy

The carpal tunnel is s small canal, about the circumference of the index finger, located at the wrist. The tunnel receives its name from the eight small wrist bones, the carpal bones, which form its shallow u-shaped floor. The roof of the tunnel is the transverse carpal ligament that attaches from one end of the “u” to the other. The nine finger tendons that bend the finger joints and the thumb tip pass through the tunnel along with the median nerve.

B – Braces

Wrist braces can be used to position the wrist in the neutral position. The wrist should be flat (not bent forward or back) and straight (the middle flinger in line with the long forearm bones so that the wrist is not angled to one side or the other). For every 15 degrees that the wrist is bent forward or back, the pressure on the median nerve increases. Braces should not be worn all the time or you risk making joints tight and muscles weak. Weak muscles are at risk for greater damage. Braces should be worn at night for positioning and for short periods during the day for aggravating activities. If the injury is acute and very painful, your medical practitioner may advise you to wear braces continuously for a brief period of time (usually about two weeks or so).

C – Compression

With overuse, repetitive activity, or awkward positioning, the nine tendons in the carpal tunnel or their sheaths may become inflamed or the transverse carpal ligament may thicken. This compresses the median nerve in the narrow area of the carpal tunnel. The nerves are responsible for power to the muscles and for sensation to an area of skin. If the nerve is compressed, numbness and muscle atrophy can occur. The median nerve in the carpal tunnel is responsible for sensation to the thumb, index finger, middle finger, and part of the ring finger. It provides power to the thick wad of muscle tissue (the thenars) at the base of the thumb. These muscles are responsible for fine motor control and positioning of the thumb.

D – Decompression

The carpal tunnel release surgery opens up the ligament that forms the roof of the carpal tunnel and decompresses the nerve. When the roof of the tunnel is opened, the nerve has between 20-40% more breathing room. With less pressure, the nerve can begin to heal from compression damage and is better able to tolerate aggravating activities.

E – Exercises

An exercise program of tendon and nerve glides can be helpful in reducing carpal tunnel syndrome symptoms.

F – Fitness

Performing 15-20 minutes of light cardiovascular activity daily can increase oxygen and blood flow out to the hands and help promote healing of injured tissues. A fit body works and heals better than an unhealthy body.

G – Genetics

Studies are now showing that there is a genetic predisposition to develop carpal tunnel syndrome. For those who may be prone to developing such injuries, taking prevention measures is critical. Seek out information on ergonomics, exercise regularly, and practice a healthy life-style to reduce your risk.

H – Hot Packs

Heat increases blood flow. Using hot packs can increase flexibility of stiff joints and reduce aching. It may also increase acute inflammation. Do not use heat on new injuries or inflamed areas. For chronic pain without swelling, it may be helpful. Be careful of burning tissues, especially if sensation is impaired.

I – Ice Packs

Cold reduces blood flow. Ice packs can reduce acute swelling and reduce aching. However, joints will temporarily feel stiffer after using cold packs. Wait until the tissues warm up (20-30 minutes) before using the hands intensely after cold pack application. Be careful of causing an ice burn, especially if sensation is impaired.

J – Job Rotation

Repetitive activity can cause swelling in the finger tendons and place pressure on the median nerve. By rotating through a variety of different activities during the workday, you can reduce potentially damaging repetitive activity.

K – Kick the Habit

Cigarette smoking depletes the tissues of oxygen and delays healing of damaged tissues. Within 2 weeks to 3 months of quitting, circulation improves and lung function increases up to 30% allowing the body to heal damaged tissues more effectively.

L – Laptops

The portability and compact size of laptop computers offer many benefits. However, because the screen and monitor are connected, it is difficult to position the laptop in a good ergonomic position. When positioned ideally for wrist and elbow comfort, the neck is bent forward. When the neck is good alignment, the keyboard is too high for the arms. Change the laptop surface height occasionally to vary position and stretch frequently. Or purchase an external keyboard for your laptop.

M – The Mouse

Position the mouse at the same level of the keyboard and in as close as possible to the keyboard so you are not reaching forward or to the side when using it. Move the mouse by initiating movement through the shoulder and not the wrist. Do not rest the wrists on the table during mouse or keyboard activity. The wrists should glide over the desktop.

N – Numbness

Sensation changes, such as tingling or numbness, are classical symptoms of carpal tunnel syndrome. Numbness is often felt at night because of sleeping position. Many people sleep with their wrists and elbows bent in the fetal position. Using wrists braces to keep the wrists neutral may help alleviate symptoms.

O – Obesity

Obesity is now being linked to carpal tunnel syndrome. Those who are overweight may be more than twice as likely to develop symptoms.

P – Prevention

Preventing carpal tunnel syndrome requires a comprehensive approach in three areas – ergonomic interventions, general and specific exercise programs, and healthy life-style practices.

Q – QWERTY

The QWERTY keyboard design was actually developed to slow down typists who typed so quickly that they tangled the keys on old-style typewriters. With the QWERTY keyboard design, commonly used keys and letters are actually being manipulated by the weakest fingers. Using both hands to perform 2-key functions and using hot keys, macros and “sticky” keys can help to reduce the stress on the hand by eliminating keystrokes.

R – Repetitive Strain Injury

Carpal tunnel syndrome is a specific type of injury (nerve compression) in the general category of repetitive strain injuries. A repetitive strain injury is one that develops from the micro-trauma of daily use (from repetition, awkward position, and stressful use) versus a traumatic injury.

S – Strengthening

Many people with carpal tunnel syndrome report weakness in the hands. Squeezing putty, tennis balls, foam balls or hand grippers can actually increase symptoms. These are the muscles you have been using all day and they may already be inflamed and painful. Instead, place a rubberband around the finger tips and open the fingers against the light resistance. This strengthens the opposite muscles and helps establish muscular balance.

T – Tests

Several common medical tests can help your physician diagnose carpal tunnel syndrome. The tinel’s test is positive when tapping on the median nerve over the wrist causes an electrical shock or tingling sensation. The phalen’s test is positive when holding the wrist in a bent position for one minute reproduces sensations of numbness or tingling in the fingers. A nerve conduction velocity examination tests the speed of the nerve impulse from one point to another. An impulse that travels more slowly than normal is likely to be traveling through a blocked area – or nerve compression site.

U – Ultrasound

Ultrasound is one of many therapeutic techniques used to improve circulation and decrease pain. Other techniques that may be used by a physical or occupational therapist include use of heat and cold, use of electrical stimulation, cold laser, instruction in exercises and stretches, education in ergonomics, and massage techniques.

V – Vitamins

Some studies show that taking vitamin B6 is helpful for reducing symptoms of carpal tunnel syndrome. The B-vitamins play an important role in nervous system function and can help prevent muscle cramps. Taking a B-complex vitamin daily may help to alleviate symptoms.

W – Water

Appropriate water intake of 6-8 glasses a day is important for hydration of the muscle tissues. Muscle function may decrease 20-30 percent when the tissues are dehydrated. Drinking water helps the body flush out toxins, protects joints and muscles, and reduces muscle cramping and fatigue.

X – X-rays

X-rays show bony structure. They do not provide a picture of the soft tissues such as the tendons and the nerves. The doctor will perform other tests to determine if carpal tunnel syndrome is the diagnosis. An X-ray may be taken to rule out fracture or arthritis as the cause of symptoms versus repetitive micro trauma.

Y – Yoga

Some of the many benefits of performing yoga include increasing relaxation and reducing stress, increasing oxygen levels to the body through specific breathing patterns, stretching muscles and increasing flexibility of the joint, and toning muscles. Seek a qualified instructor who has some experience with injuries and can modify potentially irritating or stressful postures.

Z – Zzzzzz’s

A good night’s rest is important to allow damage to heal. Nighttime is when the body is able to repair the damage of micro-trauma.

The Proper Application of a Tennis Elbow Strap

Tennis Elbow Straps, or Counterforce Straps, can be very helpful in reducing the pain of lateral epicondylitis (tennis elbow) or medial epicondylitis (golfer’s elbow).
However, very rarely are people instructed in the proper technique to apply these straps.

The purpose of the counterforce strap is to reduce the tension on the tendinous origin of the muscles that start at the outside of the elbow for tennis elbow or the inside of the elbow for golfer’s elbow. These are the muscles that bend and straighten the wrist and the fingers. The strap helps distribute the tension that the tendon normally receives over a wider area. This allows the tendon to rest and become less inflamed.

To apply the strap for tennis elbow:

  • Rest your hand and forearm flat on the table, palm down.
  • Gently close the fingers.
  • Pull the wrist and fingers back off the table.
  • Do you see the muscle bulge out a bit in the forearm close to the elbow? (You may need to place your other palm over the muscles so you can feel the muscle contract.)
  • This muscle bulge is where the strap should be placed (normally about 2 finger widths from the elbow crease).
  • If the strap has a cushion or pillow, that cushion should be placed right over the muscle bulge.
  • Tighten the strap with just enough tension to feel the strap while the muscle is contracted.
  • When the muscle is not contracted, you should not feel any tension from the strap.

To apply the strap for golfer’s elbow:

  • Rest your hand and forearm flat on the table, palm up.
  • Gently close the fingers.
  • Pull the wrist forward off the table
  • Do you see the muscle bulge out a bit in the forearm close to the elbow? (You may need to place your other palm over the muscles so you can feel the muscle contract.)
  • This muscle bulge is where the strap should be placed (normally about 2 finger widths from the elbow crease).
  • If the strap has a cushion or pillow, that cushion should be placed right over the muscle bulge.
  • Tighten the strap with just enough tension to feel the strap while the muscle is contracted.
  • When the muscle is not contracted, you should not feel any tension from the strap.

Dos & Don’ts:

  • Do wear the strap only during activity.
  • Don’t wear the strap at night while sleeping.
  • Wearing the strap all the time places undue stress on tissues that are not used to the stress and can create new problems.
  • Do not wear the strap if you have numbness or tingling.
  • Do not wear the strap if you have nerve compressions such as carpal tunnel, cubital tunnel, or radial tunnel syndrome.  The tension can make these conditions worse.
  • If the strap seems to increase your pain level, do not wear it.

The Elbow & Repetitive Strain Injuries

Unlike the shoulder, the elbow joint has a tremendous amount of bony stability. The lower end of the long bone of the upper arm (the humerus) meets the two long forearm bones (the radius and the ulna) at the elbow. The majority of the muscles that bend the wrist and the fingers attach to the inner portion of the elbow. The majority of the muscles that straighten the wrist and the fingers attach to the outer portion of the elbow.

The neutral position of the elbow, with the arm relaxed at the side of the body, is with the thumb facing forward and the palm facing toward the body. With the elbow bent, this neutral position is the “handshake” position.
Factors that Contribute to Elbow Pain

  • Repetitive wrist movement, especially with the forearm fully rotated palm-up or palm-down, repetitive rotation of the forearm, and repetitive elbow bending and straightening can all contribute to inflammation of the tendons as they insert into the elbow.
  • Bony and ligamentous grooves and tunnels near the elbow through which the three main nerves that provide power and sensation to the hand pass. The shearing motion or compression of the tendon and nerves as they pass through these tight areas can contribute to repetitive strain injuries.
  • The degree of the elbow carrying angle (the angle of deviation of the forearm bones in relationship to the upper arm bone when the arm is held at the side with the palm facing forward).
  • Maneuvering the arms around a larger upper body when placing the hands on the keyboard is also a factor.

Cubital Tunnel Syndrome

When you hit your “funny bone” you are actually hitting the ulnar nerve as it passes through a bony groove at the inside of the elbow. The nerve is particularly vulnerable as it passes through this superficial groove. Bending the elbow stretches the nerve through this groove tautly. Holding the elbow bent for prolonged periods, such as when holding a phone to the ear or sleeping with the elbows bent, can cause this nerve to become irritated. If you experience aching along the small finger (ulnar) aspect of the forearm and hand, or if you have tingling or numbness in the ring and small finger, it is especially important to avoid positioning the elbow in a bent position, either with activity or at night. Avoid repetitive elbow bending and straightening. Contact a medical professional for treatment.
Tennis Elbow (Lateral Epicondylitis)

Tennis elbow initially begins as an inflammation where the muscles attach to the outside edge of the elbow. Activities that contribute to this inflammation include repetitively pulling back (extending) the wrist and the fingers; repetitively rotating the forearm palm-up and palm-down, especially when holding an object in the hand; and lifting objects with the forearm rotated in the palm-down (pronated) position. Carrying a suitcase, briefcase or laptop backpack are activities that can cause tennis elbow.
Golfer’s Elbow (Medial Epicondylitis)

Golfer’s elbow is similar to tennis elbow, except that it begins as an inflammation where the muscles attach to the inside edge of the elbow. Activities that contribute to this inflammation include repetitively bending the wrist and closing the fingers; performing fine motor activities with the wrist bent, and repetitively rotating the forearm.

The farther away from the body that you perform activity, the more tension that is placed on the tendons where they insert into the elbow.

RSI and Prevention

Positioning

      • Avoid sleeping with the elbow bent more than 90 degrees to reduce the amount of stress on the nerve.
      • Don’t sleep with the hands placed behind the head.
      • Avoid sleeping on your stomach.
      • Use soft pillows under the arms.
      • Wear a sleeve with a pad that protects the elbow or wrap an ace bandage around a small, soft pad.

Computer Use

    • Position the keyboard so that the elbows are open more than 90 degrees.
    • Pad any sharply angled surfaces that the arms rest upon. Or place a folded towel under the arms as a cushion.
    • Don’t lean on the elbows.
    • Avoid repetitive elbow bending and straightening, excessive wrist movement or repetitive forearm rotation.
    • Use a split keyboard, especially if you find that you need to deviate the wrists out of the
      neutral position (middle finger in line with the forearm bones) when placing the fingers on the keyboard. This is particularly important if you have a large elbow carrying angle or a larger upper body.
    • Move the mouse from the shoulder, not the wrist.
    • Take frequent micro-breaks.
    • Stretch often.

And It Hurts…Here…Because? Ergonomic Recommendations

The location of where you are experiencing pain while working at a desk or on a computer can often give clues as to what needs to be adjusted during an ergonomic intervention.  Here is a quick guide of worksite and work-method recommendations that may help when you are feeling pain in a specific area.

Finger Pain – May indicate arthritic joints, a trigger finger, or strain from overuse.  Avoid squeezing the mouse too hard or pounding the keyboard.  Keep a light touch when typing.  Hold your pen lightly when writing.

Thumb Pain– May indicate a trigger thumb or DeQuervain’s Tenosynovitis.  Often occurs from either squeezing the mouse too hard or from tensing the thumb (as if hitch-hiking) over the keyboard keys.  Keep the thumbs relaxed using only the minimal amount of force needed to control the mouse.  When typing, keep the thumbs relaxed and just hovering over the keyboard.  Don’t pound the space bar.  Also, when writing, use a larger-barreled pen and don’t squeeze the pen too tightly.  Keep the thumb tip relaxed and only slightly bent – it is common for people write with their thumb tips bent at an extreme angle.

Wrist Pain or Pain at the Base of the Hand/Thumb– May indicate a tendinitis where the wrist muscles attach (flexor or extensor tendinitis), DeQuervain’s Tenosynovitis, or Carpal Tunnel Syndrome.  These are often caused by swiveling the mouse in or by poor wrist positioning.  Keep the wrist neutral (flat – not bent forward or back or angled side-to-side; the middle finger should be in a parallel line with the forearm).  Initiate small movements to control the mouse from the elbow and shoulder.   Don’t squeeze the mouse too tightly – use only the minimal amount of force necessary to control it.  Check your keyboard size and fit.  Pain over the small finger side of the wrist is often caused by the outward angulation of the wrist required to rest your hand on the home keys.  Using an ergonomic split keyboard is a quick-and-easy way to provide neutral wrist positioning.

Elbow Pain – May indicate an inflammation where the forearm muscles attach into the upper arm bone at the elbow – Medial or Lateral Epicondylitis.  Can also be caused by several nerve compression syndromes that occur near the elbow – Cubital Tunnel Syndrome, Radial Tunnel Syndrome.  Check out the positioning of the keyboard height and mouse location.  When working at a computer, your ear, shoulder and elbow should be stacked in a vertical alignment.  If your elbow is not relaxed at your side, you may need to change positioning by lowering the keyboard surface or getting in closer to your desk.  The elbow should not be bent at more than a 90 degree angle while using the computer.  A mouse that positions the arm in a more neutral “hand-shake” position may also be helpful.  Don’t swivel the mouse from the wrist.  Also, keep the hand relaxed on the mouse and use only the smallest amount of force necessary to activate the mouse click.  Don’t hold the index finger stiffly over the mouse (as if pointing) and don’t pound the mouse buttons, especially with a straight finger.  Rather, keep the index finger slightly bent and lightly touching the mouse.

Shoulder Pain – Often caused by reaching forward for long periods of time for the keyboard or mouse.  When working at a computer, your ear, shoulder and elbow should be stacked in a vertical alignment.  If your elbow is not relaxed at your side, you may be reaching forward causing strain on the arm muscles.  It takes work to hold the arm in this position for long periods of time even if the work itself is not too forceful.  To keep the upper arm muscles more relaxed, you may need to lower the keyboard surface or get in closer to your desk.  Check your chair.  Are you sitting back in the char?  Does it provide proper lumbar support and seat depth?  Look at the arm rest height.  You may need to lower the arm rests in order to keep the shoulders relaxed.

Neck Pain, Eye-Strain & Headaches – Often caused by poor positioning of the monitor.  Position the monitor directly in front of the keyboard so you are not twisting the body while using the computer.  Check out the height and distance of the monitor.  It may need to be adjusted so that you can clearly see the monitor print without tipping the head forward or back.  Avoid using bifocals while on the computer.  If you work extensively from copy, keep the copy in front of the monitor or directly to each side.  Use a tray that holds the copy close to monitor height to avoid repetitively looking up-and-down from the copy to the monitor.  Use a phone headset to avoid cradling the phone between the shoulder and the ear if you need to type and talk at the same time.

Pain-Free Mousing

When performing ergonomic assessments, the main factors that I have found that contribute to mousing pain include:

  • Mouse Positioning
  • Mouse Movement
  • Muscular Tension When Using the Mouse
  • Forearm Position

Here are some tips to help reduce your risk of developing a repetitive strain injury or tendinitis from mouse use.
MOUSE POSITIONING

Causes of Pain

  • Reaching forward for the mouse onto a desk that is higher than the keyboard.
  • Reaching for a mouse placed to the far side of the keyboard.

Tips for Preventing Pain

  • Position the mouse in a more comfortable and ergonomic location
    • Use an attachable mouse holder that adjusts to fit over numerical key pad (if you do not use the 10-key) or as closely to it as possible.
    • Or use a keyboard bridge over the numerical keys if you do not use the 10-key portion of the keyboard.
    • Or use a keyboard station such as the Contour Roller Pro which has a rollerbar mouse that is positioned immediately below the space bar of the keyboard.

MOUSE MOVEMENT

Causes of Pain

  • Excessive wrist or arm movement when activating the mouse.
  • Planting the wrist down and swiveling the mouse using wrist motion.
  • Planting the wrist down placing pressure against the carpal tunnel.
  • Bending the wrist backward (extended) when using the mouse.

Tips for Preventing Pain

  • The mouse should be at about the same level of the keyboard and positioned as closely to the keyboard as possible.
  • Avoid reaching forward, up, or out to the side when using the mouse. Position the mouse to avoid these movements (see mouse positioning tips).
  • Activate the mouse by using small movements from the shoulder and elbow muscles rather than the wrist muscles.

Ergonomics

  • Keep the shoulders relaxed.
  • The elbow should be held loosely at the side in a direct line under the shoulder.
  • The wrist should be held in a neutral position (not bent forward or back or angled to one side or the other).
  • Do not plant the wrist down on that desk or on a wrist rest. Glide the wrist over surfaces always maintaining the neutral position.

MUSCULAR TENSION WHEN USING THE MOUSE

Causes of Pain

  • Forcefully squeezing the mouse between the thumb and small finger.
  • Forcefully activating the mouse buttons or switches.

Tips for Preventing Pain

  • Hold the mouse as lightly as you can while still maintaining control.
  • Keep the fingers held loosely against buttons and switches, not floating tensely in the air.
  • Do not pound mouse buttons or forcefully squeeze switches. Use only the lightest force necessary to activate controls.
  • Using a wireless mouse can eliminate the tension of pulling against the cord (even these small tensions add up by the end of the day).
  • Use a mouse and mouse pad that can be switched easily from the right to the left hand to share the work load between the two hands.
  • A keyboard station such as the Contour Roller Pro that incorporates a rollerbar mouse eliminates the need to hold the mouse.
  • Research mousing options such as the NoHands foot-activated mouse or a head-activated mouse placed in a baseball cap.
  • Perform forearm and wrist stretches throughout the day.
  • Gently stretch the thumb into the hitch-hiking position.

FOREARM POSITIONING

Causes of Pain

  • The forearm rotated into the palm-down position for long periods of time.

Tips for Preventing Pain

  • Vertical mice are good choices as the hand shake position with the forearm neutral rather than palm down can relieve forearm stress.
  • Stretch into the palm-up position throughout the day.

A Quick Comparison of Carpal, Cubital and Radial Tunnel Nerve Compressions

Three peripheral nerves provide power and sensation to the hand and arm.  The following is a quick comparison of the most common sources of pain caused by compression syndromes of these nerves.

nerve paths

Carpal Tunnel Syndrome

  • Nerve Affected:  Median
  • Location of Compression:   Wrist
  • Numbness and/or Tingling:  Usually in the Thumb, Index, Middle & Half of Ring Fingers
  • Pain:
    • Usually in the Thumb, Index & Middle Fingers
    • A band of pain around the wrist
    • Pain in the muscles at the base of the thumb
    • Pain radiates up the forearm
  • Likely Cause (activity related):
    • Frequent gripping/squeezing/holding of tools
    • Gripping or pinching tools or objects for a period of time
    • Finger movement with the wrist held at an awkward angle
  • Prevention:
    • Avoid sustained or repetitive grip and pinch
    • Maintain the wrist in a neutral (straight) position with activity
    • Avoid leaning on or putting pressure against the front of the wrist of the base of the hand
  • Splinting:   A wrist brace that  holds the wrist in the neutral (straight) position at night

Cubital Tunnel Syndrome

  • Nerve Affected:  Ulnar
  • Location of Compression:   Elbow
  • Numbness and/or Tingling:  Usually in the Ring & Small Fingers
  • Pain:
    • Usually in the Ring & Small Fingers
    • Pain in the hand muscles on the small finger side of the hand
    • Pain radiates up the forearm and into the elbow along the small finger side
  • Likely Cause:
    • Leaning on the elbow or pressure against the forearm along the small finger border
    • Frequently bending and straightening the elbow, such as when pulling a lever
    • Holding the elbow bent for long periods of time, such as when sleeping or holding a phone to the ear
    • Forceful elbow extension (straightening) activities, such as rowing, gym activity, push-ups
  • Prevention:
    • Avoid leaning on the elbow or putting pressure on the forearm muscles
    • Avoid holding the elbow bent more than 90 degrees for any length of time
    • Avoid repetitively bending and straightening the elbow
    • Avoid repetitive or forceful elbow extension activities
  • Splinting:   A soft pad or elbow support that holds the elbow in a mostly straight position at night

Radial Tunnel Syndrome

  • Nerve Affected:  Radial
  • Location of Compression:   Muscles on the back of the forearm near the elbow
  • Numbness and/or Tingling:  Uncommon
  • Pain:
    • Usually in the elbow and forearm muscles
    • Pain may radiate down the arm into the wrist and the back of the hand
    • Pain may radiate up the arm towards the shoulder
  • Likely Cause:
    • Computer mouse activity, swiveling the wrist and forceful mouse “clicking”
    • Holding the fingers tensely extended over the computer keyboard
    • Forcefully bending the wrist forward and back
    • Repetitive twisting movements, such as when using a screwdriver
    • Carrying or lifting heavy objects, particularly with the forearm pronated (palm rotated down)
  • Prevention:
    • Maintain the wrist in a neutral position while using the computer mouse
    • Don’t hit the keys or click the mouse forcefully and keep the fingers relaxed over the keys and mouse
    • Avoid repetitive and forceful wrist movements or twisting movements
    • Avoid heavy lifting, especially with the palm facing down, such as carrying a suitcase or heavy briefcase
  • Splinting:   A wrist splint that holds the wrist neutral may be helpful when performing stressful activities

Radial Tunnel Syndrome

As a certified hand therapist, I often treat people suffering from the symptoms of carpal tunnel syndrome (CTS). A less commonly known injury, but one that we are seeing more frequently in the clinic, is Radial Tunnel Syndrome (RTS). If you are experiencing an aching or burning sensation in the back of the forearm or over the back of the wrist or hand, you may have symptoms of RTS rather than CTS.

Anatomy

The radial nerve is one of three main peripheral nerves that provide sensation and power to the arm and hand (the other two are the median nerve and the ulnar nerve). The radial nerve leaves the spinal cord at the neck and travels down the arm and into the back side of the forearm. In the forearm it passes through the supinator muscle, the muscle that turns the palm up (such as when using a screwdriver).

The radial nerve is responsible for providing sensation to the back side of the forearm and the back of the hand. It is also responsible for providing power to the muscles that pull the wrist back and straighten the fingers at the large knuckle joint.

Causes of Radial Tunnel Syndrome

As the nerve travels down the arm, repetitive or forceful movements can cause friction at several sites along the nerve pathway as it passes through muscles and ligament bridges. Repetitive or forceful movements can also cause swelling in the tissues that surround the nerve. This compresses the nerve, pinching it and causing sensations of aching, burning, numbness and tingling.

Symptoms of Radial Tunnel Syndrome

Symptoms of RTS include an aching or burning pain over the back side of the forearm and/or into the back of the wrist. There may be tenderness over the back of the elbow and forearm close to the elbow. Pain may become worse with activities that require a lot of wrist movement (such as manipulating the mouse), finger movement (such as clicking the mouse), and palm up movements (such as using a screwdriver). With pressure against the tender area close to the elbow, you may experience a tingling or radiating pain. The arm may feel tired and heavy.  An aching pain may radiate down the arm into the hand or up into the shoulder.  The back of the hand, the index finger knuckle, and the muscular space between the index finger and the thumb may feel swollen.

Things to Help Prevent and Control Pain from RTS

If you are experiencing symptoms of RTS, here are a few things you might try to help you reverse the symptoms.

  • Rest as best as you can from the activities that are causing the problem.
  • A vertical mouse that places the forearm in a neutral position (the “handshake” position) may be helpful.
  • Do not swivel the mouse with wrist movement.
    • Keep the wrist neutral (straight and level, not bent forward or back or angled to either side) when typing and using the mouse.
    • Control the mouse by using the larger shoulder and elbow muscles to move it.
  • Keep the fingers relaxed on the keyboard and mouse.
    • Don’t forcefully straighten or lift the fingers while typing or clicking.
    • Use the least amount of pressure necessary to activate the keyboard and control the mouse.
  • Use a wrist brace to limit wrist movement and to help keep the muscles of the forearm relaxed.
  • Take frequent micro-breaks.
  • Use cold packs and hot packs.
    • A cold pack placed over the forearm muscles several times a day can help control swelling from overuse.
    • Hot packs can help improve flexibility.
    • Both can temporarily relieve pain.
  • Gently stretch the forearm muscles.
  • Avoid the following:
    • Heavy lift, grip or activities that twist the forearm.
    • Using a screwdriver   (Use electric tools whenever possible.)
    • Picking up luggage.
    • Weight-lifting.
  • Be careful of using tennis elbow straps that can place additional pressure on the radial nerve.
  • Seek medical attention if symptoms do not rapidly improve.

RTS is often confused with tennis elbow. Tennis elbow is an inflammation of the tendons as they attach on to the lateral epicondyle (the bony bump on the outside edge of the elbow). The tenderness associated with RTS is often a few inches farther down the forearm, more on the muscle than on the bone. A tendinitis pain is often sharper with activity and, unless it is a severe case, lessens with rest. Nerve pain, such as with RTS, can be more of an aching, burning pain that may become more severe after activity or at night. When seeking medical attention, be specific with your description of symptoms so that you can help your doctor diagnose the problem accurately.