Suzie Says...Got a Tingly Hand?
Ok, so there's a lot that can cause tingly hands, and I won't bore you with all of the alternatives now, however here I am referring to the type of tingly/painful (or numb) that you get when you have what's called Carpal Tunnel Syndrome (CTS).
Here’s a quick guide to treating or managing CTS. It is the most common peripheral nerve entrapment syndrome that people suffer from, and I have met several fellow travellers who have suffered from it. It's a bugger! As a bike rider the exercises below are good to do regularly anyway.
What is the issue? What is the 'Carpal Tunnel'?
Your Carpal Tunnel is a small passage in your wrist made up of bones and ligaments (things that attach bones to other bones).
The Median nerve, which controls sensation and movement in the thumb and first three fingers, runs through the carpal tunnel along with tendons (tendons attach muscles to bones) to the fingers and thumb (see the picture with the fancy visual explanation...legally obtained from Google).
So basically, in CTS the nerve gets squished a bit when it passes through the carpal tunnel. Not great! As you can see the median nerve is quite important...imagine what you couldn't do if it didn't work...keep it clean people!
Who will likely get CTS?
About 1 in 10 people will suffer from CTS at some point, which just shows how common it is. Often it comes out of nowhere and can be termed 'idiopathic' i.e. no specific cause.
Swelling in the area, hormonal changes, and manual activity can contribute to increased nerve compression. Other things that may increase your risk of getting CTS include diabetes, menopause, hypothyroidism, obesity, arthritis, and pregnancy, so put the cakes and pies down, look after yourself and try to avoid the things that can be avoided. Sadly, not everything is avoidable.
Symptoms of CTS:
The main symptom is pain, (surprise, surprise), and some tingling and numbness, but in severe cases you can get weakness in the muscles that the median nerve goes to (supplies), and that can make your muscles look a little sorry for themselves and make your hand feel weak. Unfortunately, even in very mild cases you can get symptoms.
Another thing to remember is that in mild cases, symptoms often just occur in the hand however in more severe cases, it can spread to the forearm, upper arm, and sometimes even the shoulder! This can make you think you have lots of stuff wrong with you and really needs proper assessment.
Some easy tests you can do:
Tinel’s test : tap over the median nerve at the wrist for 1 minute (see picture below).
Phalen’s manoeuvre : forced compressive wrist posture (prayer or reverse prayer) for 1 min (see picture below).
Sorry if you looked like a moron doing these (maybe do them in private). Results are said to be positive (indicating you may have CTS) when symptoms occur during the test. Ideally much more specific tests need to be undertaken with better specificity and reliability, but these will do for a quick and easy self-test.
What to do
First, change those pesky aggravating habits, e.g. limit wrist movement and reduce heavy work activities .
Use ergonomically friendly work tools as this can be useful in reducing median nerve stress, ie stuff that helps stop your wrists from being bent all the time.
The main thing is to keep everything moving and 'gliding'.
There are some common tendon gliding exercises that can really help, try these different hand positions:
Full fist...........(Go through these movements smoothly about 10 times, at least 3 times a day).
Neural gliding for the Median nerve.
Start in the position above (Position 1) with your elbow bent and the back of your hand near your head/neck. Also have your head tilted away from your hand.
Slowly and smoothly move to Position 2. Your head should move to the upright position and your elbow should open up to about 90 degrees i.e. slowly moving away from your head.
Then continuing slowly and smoothly, move to Position 3 above. Your elbow should be completely straight and extend the wrist (ie bend it back), at the same time moving your head towards the arm you are exercising.
Do the nerve glide around 3-5 times, 2-3 times a day. Make sure you DO NOT HOLD any of the positions, just move slowly and smoothly through the different postures (ie smoothly through positions 1, 2, 3, 2, 1, 2, 3, 2, 1..........).
If any of the above exercises make your symptoms worse, STOP. Just do the exercises that are comfortable but do not push into pain or cause yourself pins and needles or numbness.
This is not a quick fix...don´t expect the exercises to work overnight! Anyway, if you're on a bike a lot, it´s probably a good idea to do these exercises reasonably regularly anyway to keep everything moving well.
Link to YouTube video of the test and exercises for CTS - https://youtu.be/89QI4yodO_o
Other possible forms of treatment if seeing a healthcare professional:
Musculoskeletal manipulation including massage and mobilisation of the wrist joint
A recent study reported that 'evidence indicates that physical therapy is as effective as surgery to treat this condition' (number 2 in references below), so do try the exercises, regularly and daily!
Another study also showed that 'kinesio taping around the wrist would be effective in improving functional level and decreasing pain intensity and paresthesia (pins and needles/odd sensations/numbness) in patients with moderate CTS' (number 3 in references below).
Please remember: If it's really bad, talk to a pharmacist/Doctor about some kind of pain relief.
What NOT to do:
Do not sleep with wrists bent (I know, you're asleep, it's hard)! Some people have found wrist splints can help at night and can be purchased 'off the shelf' in chemists etc.
Do not keep wrists bent and static for long periods of time e.g. reading/writing with chin on hand...move it!!
Do not keep doing heavy work and activities that really bring on symptoms, e.g. pushing up a lot with the heel of the hand...revisit the Karma Sutra for better bedroom options to.
Do not keep putting up with it if it's getting worse and worse...it will need a professional opinion and treatment.
It is NOT no pain, no gain.
If all else fails, a nice cool beer will help! (FYI: Not evidence based...please consume alcohol sensibly).
Sources of recent evidence based information include:
Padua, L., Coraci, D., Erra, C., Pazzaglia, I., Loreti, C., Caliandro, P., and Hobson-Webb, L. (2016). Carpal Tunnel Syndrome: clinical features, diagnosis and management. Lancet Neurology, 15: 1273-1284.
Fernandez-de-Las-Penas, C., Cleland, J., Palacios-Cena, M., Fuensalida-Novo, S., Pareja, JA., and Alonso-Blanco, C. (2017). The Effectiveness of Manual Therapy Versus Surgery on Self-reported Function, Cervical Range of Motion, and Pinch Grip Force in Carpal Tunnel Syndrome: A Randomized Clinical Trial. Journal of Orthopaedic and Sports Physical Therapy, 47(3): 151-161.
Eraslan, L., Baltaci, G., Yuce, D., and Erbilici, A. (2016). Does Taping Affect the Rehabilitation of Patients With Carpal Tunnel Syndrome? A Randomized Controlled Trial. HAND. 11(1): 133S.
Please note, although it can be difficult when travelling, it's often beneficial to get a physiotherapy/professional assessment where possible, especially if symptoms are persisting or worsening.
Please e-mail me at firstname.lastname@example.org for any constructive comments/feedback or questions.