Here is a common scenario that we see in the clinic. Patient comes to us with wrist pain. They may or may not have seen a doctor and been prescribed with “carpal tunnel.” Here is the problem. Just because you have wrist pain doesn’t mean you have carpal tunnel. I’ve found that people get misdiagnosed all the time. The most common injuries that get prescribed as carpal tunnel are either wrist osteoarthritis, or cervical radiculopathy. Let me give you a couple of tips to help you self-diagnose, if this patient is you.
Is it Really Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome (CTS) is a VERY specific diagnosis. If you have true “carpal tunnel,” you will have complaints of pain and/or numbness in the first three fingers (thumb to middle) on the palm side of your hand. You might have some pain in the palm side of your wrist too where the median nerve is getting compressed. An orthopedic test that we use in the clinic is called Phalen’s test.
If you compress the wrist joint, it should start to intensify your numbness and pain IN YOUR HAND. If you do this test and it doesn’t reproduce your symptoms, or if you have symptoms that are not consistent with what I described, you probably don’t have CTS.
What do I Have?
So you did the Phalen’s test and it didn’t reproduce hand pain. Or, you have pain in other parts of your arm and hand. Now what? The two most common diagnoses that I see associated with CTS are wrist arthritis and radiculopathy. Here is how you tell which of the two you may have.
Wrist arthritis is common and does hurt a lot. Think of how much your wrist moves in a day, especially in your dominant hand. The wrist is 8 tiny little bones, and each one can show signs of degeneration. When a joint degenerates, the bones rub on each other and that will lead to intense pain. That is why people get joint replacements in their hips and knees. Unfortunately, no one has developed a wrist joint replacement yet (golden opportunity for anyone reading BTW).
Here is how you can tell if you have wrist arthritis vs. CTS. Perform the Phalen’s test again from before. If you have pain in the wrist, try performing the reverse movement placing your palms together. If that position lessens your wrist pain, and you don’t get any symptoms into your fingers, you probably have wrist arthritis.
Radiculopathy is a fancy medical term for “sciatica” in your arm. What is happening is a peripheral nerve is getting pinched in your neck and giving you symptoms down your arm and into your hand. Carpal Tunnel Syndrome is a specific compression of the median nerve in your wrist. That is why the symptoms should only be in your hand after the point of compression. If you are having tingling/pain in your hand but not in your first 3 digits, you could have an irritation of one of the other two nerves in your arm (radial and ulnar nerve). Here is a nice nerve distribution map of your hand.
If you need to figure out if you have radiculopathy here are a couple of nerve tension tests to try. If either of these tests reproduce your symptoms, you have radiculopathy, not CTS.