Is My Wrist Pain Carpal Tunnel or Arthritis?

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.

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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:

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. 

Cervical Radiculopathy:

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.

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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. 

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Injuries Are a Good Thing

I know it sounds crazy, but getting injured is sometimes a blessing in disguise. No one wants to get injured, obviously, but an injury is your bodies ‘check engine light’. The pain signal is your body saying “We have a problem and you need to fix me.” This theory doesn’t apply to a fracture, car accident, or some other injury of that nature. I’m talking about the gradual injury that comes on over time, or the injury that just pops up out of nowhere. 

Why Do I Get Pain?

If you get hurt, it hurts! I know, that was profound. Let’s talk about why it hurts when you get injured. We have millions of nerves running through our bodies. 

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These nerves bring information from our body to the brain, telling our brain what we are feeling and what we are doing. The brain then processes this information (like a giant computer) and tells our bodies if that is okay, and/or how to move differently to avoid it. The brain is receiving so much information all the time that it needs to be selective about what is really a problem. For instance, if you touch a hot pot, your nervous system tells you to MOVE! That is a preservation loop that doesn’t even reach your brain because it would take too long. In most cases though, your brain is allowing you to move and do things that are slightly problematic because it isn’t the biggest problem on the problem list. In most cases it’s not life threatening. 

As a result you are always compensating and getting through life. After a while though, you are slowly building up inflammation due to the compensatory movements. Eventually it gets to the point where it does become a problem that your brain can’t ignore anymore. It will then throw up the red flag (pain) and say “Hey, we’ve been compensating because I didn’t think it was a problem. Well...I was wrong. So now you have a problem, and you need to fix me.”

Why Injuries are a Good Thing

This brings me back to what I was saying about injuries being a good thing. If you didn’t get injured you would never know you have been moving wrong and compensating. I will give you my real life example. I love golf and wish I was professional so I could play 36 holes a day and get paid for it. That is not my reality though, so I am forced to play infrequently on the weekends. About a month ago I was taking a swing and BANG, pain in my elbow. I was very upset (I would have written something worse but this is a family show). I waited all winter long, and through the rain that would never stop, and now I have elbow pain! It forced me to look at my swing and what I was doing wrong. The silver lining is now I have an improved swing that will not put strain on my elbow so I can play more with less risk of injury. If I didn’t get injured I would have never known that. 

So what does this all mean for you? If you have pain, stop working around it. Try to figure out where the pain is coming from and fix it. There are so many different screening processes that we use as PTs that highlight compensations you didn’t even know you had. If you work on balancing out your strength and flexibility issues, you are far less likely to have your check engine light come on when you least expect it. 

If you have any questions please contact me or make an appointment right here on the OrthoCore Physical Therapy website!. Thank you for reading. I hope your check engine light stays off.

Running with Knee and Back Pain

So, I’ve been running more lately. To anyone reading this that knows me, knows that comes as an enormous surprise. I used to be a huge runner (3-4 times/wk) but, running and I fell out of love when I started to get injured. My knees and my back were always bothering me. I was getting tired of showing up to work and feeling worse off than my patients. Instead of working on the flexibility and strength deficits that I had, I decided to just stop running. Not exactly what I would recommend to any of my patients but, effective at eliminating my pain nonetheless.

Well I’m back on the team! I credit my return to three things. 1. Like most other people who run, it’s easy to just get out of the house and run. It doesn’t require driving anywhere, or signing up with any gyms, etc to participate. 2. I can do it with my kids in a stroller. I get to spend more time with them, and it gives my wife a little break (double bonus). 3. I was intrigued when I saw that “Headspace” had a running packet. To those of you who don’t know, Headspace is a meditation app. I’ve been using it for a while now and the running specific pack piqued my interest. I was pleasantly surprised it actually made it really enjoyable to run. It didn’t feel like the mental struggle that I remember from the past.

Unfortunately, with my renewed love of running, my knee and back pain returned as well. It’s like when you get back together with an old girlfriend and realize part of the reason why you broke up was her annoying best friend. Well this time the friend isn’t going to break us up again. Instead of running from my problems (see what I did there), I’m going to address them and make sure that I can keep my feet on the road.

My main issue (as is the case with many runners) is that I have very tight hip flexors and IT bands. Those muscles run in the front of the hip and can restrict your hip extension and stride length.

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The problem with the hip flexors, and the reason why I get back pain, is that they anchor at the lumbar spine. When they are tight, your spine will flex with every stride and put excess pressure on your spine causing pain. The IT Bands run all the way down to your knee. When they are tight they will pull your knee out of alignment. That misalignment with every step will eventually lead to pain. Hence, the reason why I get knee and back pain when I run.

The good news for me (and anyone reading this with similar problems) is that it’s really easy to fix. All I have to do is stretch those muscles regularly to keep my body aligned and moving properly. Here is my favorite hip flexor and IT band stretch. If you are stretching pre-run then perform 15 repetitions holding the stretch for just a couple of seconds. If you are stretching post-run then hold for 30 seconds to a minute and perform the stretch a couple of times.

I hope this helps you stay flexible and keeps your feet on the pavement. If you have any questions please contact me here at OrthoCore Physical Therapy. Otherwise, HAPPY RUNNING!

Foot Pain Due to Flat Feet

I know this comes as no surprise but I’ve been treating a lot of feet lately. Apparently when you open a second office with a Podiatrist that is bound to happen. A majority of feet problems that I see are due to flat feet. About 12% of the population have flat feet. That might not seem like a lot but when you consider the amount of people in the world, that’s a lot of fallen arches.

Most foot problems, that are due to flat feet, stem from weakness in the arches of the feet. There are a group of 9 small muscles in the foot that help to create and maintain the shape of the arch.

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Just like any other muscle in the body, if you don’t use it you lose it. The hard part about people with flat feet is that the muscles are constantly on stretch. A muscles that is constantly stretched, is going to be weak. So you are really fighting an uphill battle. The other difficult part for most people is they don’t know how to strengthen their feet. What do you do? Put a tiny dumbbell around your toes and do curls? As much as I would love to see people try that, it wouldn’t be effective. Here is one of my favorite exercises to do to strengthen the intrinsic muscles of the foot (crazy socks not required, but recommended).

If you perform this exercise regularly it will help to strengthen the foot muscles and start to build up your arch. If you have a really flat foot, I also recommend wearing a foot orthotic to give a little extra support and bring the arch up to where it belongs.

I hope this helps to keep your piggies from aching and get you up and on those feet pain free. If you have any questions please contact us . Thanks for reading!