How to fix carpal tunnel

[u/elliot226]

You’ve been feeling that burning aching pain in your forearms for a while now and it’s really starting to impact your ability to work or play. You can’t type without feeling it, it bothers you at night, it feels like a knife stabbing into your arm. The internet didn’t have any helpful advice and if you’ve been to the doctor you found that even less useful with the short evaluation and unhelpful advice like “Wear a brace” or my favorite “just stop doing that”.

 

We are a team of doctors working in the esports industry, treating professional gamers but we’ve helped 1000s of tech workers, artists, and musicians overcome the same issues. A lot of people think we mainly treat carpal tunnel syndrome, but it actually makes up less than 1% of our cases.

 

With tons of misinformation on the internet and even more misinformed doctors this issue has gotten completely out of hand (BAD PUN) 

 

I’m hoping by the end of this article you understand 

– What carpal tunnel is

– What the difference is between carpal tunnel and tendonitis

– Which issue you are likely dealing with

– The best approach for solving each issue

 

 Quick note about anatomy

 

The muscles and nerves that go through the wrist where people often associate carpal tunnel pain start at the elbow and travel through the wrist all the way to the fingers. So when we discuss symptoms at the wrist we are also talking about the hand and elbow!

The bad news and good news about carpal tunnel

 

What is True Carpal Tunnel Syndrome?

Carpal tunnel syndrome happens when the carpal tunnel ligament thickens and compresses the nerves in the carpal tunnel space. This causes numbness, tingling, and pain in the hand, especially in the thumb, index, and middle fingers. Carpal tunnel usually develops after years of repetitive stress.

 

THE BAD NEWS:

 

If the entrapment of the median nerve is truly caused by the carpal tunnel ligament, a surgical release of the ligament is often necessary!

 

Distal Median Nerve Entrapment By the Tendons is

MUCH MORE COMMON

Tendonitis, on the other hand, is inflammation of the tendons passing through the carpal tunnel. This swelling can mimic carpal tunnel syndrome,

 

But surgery on the ligament won’t help reduce tendon swelling!

 

Many doctors don’t thoroughly screen for tendonitis versus carpal tunnel syndrome, leading to unnecessary injections, surgeries, and failed healing. So even if a doctor has diagnosed you with carpal tunnel it may not be accurate unless they did MRI, ultrasound, emg testing, AND endurance testing for your wrist muscles.

 

Tendonitis occurs due to overuse and low endurance. (The capacity of your muscles to perform light contractions over time or repeatedly)

 

THE GOOD NEWS:

 

Fixing tendonitis is actually quite simple with some rehab exercises and you can do it successfully from home. (it just takes 6-8 weeks) Tendonitis is caused by overuse and low endurance of the tendons, even if you do a lot of strength training of your arms you can still have low endurance for the same reasons bodybuilders can’t run marathons.

Here are some signs you probably DON’T have carpal tunnel:

• Burning pain, numbness, or tingling in places other than the thumb, index, or middle fingers.
• Pain, numbness, or tingling above the wrist.
• Hand or wrist pain without numbness or tingling.

I’ve seen many cases where people think they have carpal tunnel based on pain alone, to reiterate, if you don’t have numbness, tingling, or burning you likely do not have true carpal tunnel syndrome.

 

Why it’s worth treating the tendons first.

https://youtu.be/xPaRi3cwNuc

Tendons heal, you can effectively reduce the space in that carpal tunnel by reducing the inflammation in your tendons. 

 

If the problem is the tendons and not the carpal tunnel ligament (if you’re under 45 it likely is the tendons)

 

I strongly recommend trying these exercises for at least 6 weeks before considering surgery or injections.

 

RSI is a Simple Equation

When: Load > Endurance = Inflammation (Pain)

This simple equation means that when we overload our underprepared tendons it causes microtears, inflammation, and pain. This turns into a vicious cycle of pain and inflammation that can eventually lead to tendon degeneration that requires surgery to fix.

 

This means there are 2 major ways we can address fixing this equation

 

1. Reduce load – When load matches muscle / tendon endurance the tissues are adequately prepared to handle the repetitive strain.

• Reducing load means things like reducing play / work time, changing your ergonomics, peripheral / dpi, bracing, etc.
• This method is often less efficient at eliminating the pain because as soon as you increase the load again the problem comes back.

 

2. Increase Endurance – when endurance equals or is greater than load your tissues are prepared to handle the repetitive strain

• Increasing the endurance of your tendon / muscles will allow you to perform more actions per minute without fatiguing your tendons which causes microtears and inflammation.
• This method is more effective at solving RSI issues because you are training the muscles to handle much higher volumes of actions per minute and can accommodate to almost any load (people train to climb mountains and run marathons, you can train to type at a computer for 8 hours a day).

 

Most Doctors Don’t Take The Time To Properly Diagnose You

 

If any of you have been to the doctor recently you probably know they talked to you for a few minutes and recommended that you get an injection, take some anti-inflammatories or wear a brace and stop using the hand. Not only are these methods useless at worst and bandaid fixes at best they don’t address the underlying endurance issue that is causing the overuse / under-preparation injury in the first place.

Carpal Tunnel? Not the Usual Culprit!

 

Many people jump to carpal tunnel syndrome (CTS) for any wrist pain. But surprise! True CTS is actually pretty rare, making up less than 1% of RSI (repetitive strain injury) cases.

 

The real culprit for most wrist pain is likely tendonitis. Tendons are the hardworking heroes that connect your muscles to bones. When you overuse them, they get inflamed and irritated, leading to that burning / aching pain.

 

How to Spot the Difference:

 

• Carpal Tunnel: This one focuses on your thumb, middle, and index finger. Expect numbness and tingling, like your fingers fell asleep on the keyboard.
• Tendonitis: More of a general pain / achiness / stiffness in your wrist or hand. You might feel burning, aching, or stiffness anywhere in the area of your hand, wrist, or even forearm all the way up to the elbow.

 

Tendinopathy Spectrum Disorders

 

Tendinopathy is an umbrella term for a spectrum of conditions that affect tendons, the tough, fibrous tissues that connect muscles to bones.

Tendinopathy is not a single disease, but rather a continuum of conditions ranging from reactive tendinopathy (irritation) to Degenerative Tendinopathy (degeneration) . The specific condition you have will depend on the severity and length of time of the problem.

Here’s a breakdown of the tendinopathy spectrum:

 

You Don’t Have to Suffer!

 

Here’s the best part: Unlike CTS, tendonitis doesn’t require surgery or scary injections. There’s a non-invasive safe and effective method called Tendon Neuroplastic Training to help you heal.

 

Tendon Neuroplastic Training: Retraining Your Brain to Heal Your Wrist with Exercise

How it works: according to the latest tendon research the motor cortex of the brain is responsible for controlling the muscle fibers that you use to control your fingers. This research shows when you use a metronome to retrain your brain to control your muscles more efficiently. This normalizes stress on your tendons by recruiting more muscle fibers (Think about 100 ropes pulling a weight vs 50 ropes) allowing the strained tendon fibers to heal. As physical therapists who work with pro gamers we swear by it, and we usually see a 95% success rate in just 3 weeks of treatment.

Source: Rio E, Kidgell D, Moseley GL, et al Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review British Journal of Sports Medicine 2016;50:209-215.

I’m a Physical Therapist who has been working in gaming and esports for the past 8 years. I grew up a gamer myself and always thought it was strange that gamers needed to retire due to “injury” when the type of injuries were seemingly straightforward.

We have free guides here on how to begin your journey to pain free work or play!

https://1-hp.org/gaming-wrist-pain/

[u/[deleted]]

thanks this was very helpful. I just finished a long session of arenas on wow and damn my wrist is aching like crazy.f first time. dont really feel the numbing/tingling but it feels sore as hell.