Wrist Pain

Perhaps the most well known wrist condition is carpal tunnel syndrome. This is characterised by numbness or pins & needles into the hands especially at night. In the worst cases the grip strength will become weak as well especially the thumb and forefinger. The carpal tunnel is formed between the small bones of the wrist (carpals) and the connective tissue running across is (flexor retinaculum). Blood vessels and the median nerve pass through the tunnel so if it becomes too narrowed then they get restricted and cause the symptoms described above.

Common causes of carpal tunnel irritation are repetitive strain to the wrist particularly with lots of computer work if the wrist is resting on a desk or table. Also pregnancy, diabetes and rheumatoid arthritis can lead to increased swelling in the tunnel. Excessive tightness of the forearm flexor muscles from overuse particularly with manual jobs can also contribute. It is important that you also get the rest of the arm and neck checked as there can be other regions of nerve compression besides the wrist and your symptoms may suggest a nerve other than the median being compressed which would be a different condition e.g. handlebar palsy, a compression of the ulna nerve common in cyclists.

What can we do? Firstly performing a thorough assessment to correctly identify which nerves are being irritated and at which points in the arm or neck in order to guide the correct management approach. There is no point in having carpal tunnel surgery if you don’t really have carpal tunnel syndrome, this may sound obvious but you’d be surprised how often this happens. Secondly manual therapy can help stretch and reduce tension in the carpal tunnel as can kinesiotaping.

What can you do for yourself? There are some stretches you can do shown below, also it is important to identify the aggravating factors and try to reduce or avoid them. For example computer workers can get a foam pad to rest their wrists on and take regular breaks from resting their wrists on any surface.

What does the evidence say? The NICE guidelines do not offer any guidance on carpal tunnel syndrome. The Bronfort report rates the evidence for manipulation/mobilisation of the wrist as favourable. A Cochrane review found wearing a neutral splint was better than no splint or an extension splint and another cochrane review suggested yoga may be more effective than splinting. Surgery does appear to be more effective than splinting although there are significantly more side effects.

Exercises for carpal tunnel syndrome: These exercises will also serve as good general exercise for most wrist and hand conditions. The main aim is to reduce tension in the forearm muscles particularly on the medial side (inside) of the forearm. Stretches should be held for up to 30 seconds and done daily for the best effects.

Wrist stretches – With the arm out straight use the other hand to bend the wrist back to stretch the flexors (pull on the finger tips to stretch the palm as well) and the opposite way to stretch the extensors.

wrist stretches

Carpal tunnel stretch – The picture below shows a partner performing the stretch but there’s no reason you can’t do it to yourself with one hand working on one side of the wrist at a time. Simply bend back your wrist and gently massage from the mid-line of the carpal tunnel area outwards towards the base of the thumb and little finger.

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