Helping Hands Heal since 2005
How Emotions and Carpal Tunnel are Related
From Dr. Z - Carpal tunnel syndrome specialist
How Emotions and Carpal Tunnel are Related
Scientists already now know that emotions and carpal tunnel syndrome are definitely related. Admittedly, it sounds odd. But being stressed-out really can give you carpal tunnel syndrome. Exactly how these two problems are linked together is probably not what you think.
Mood & pain: one kind of cause & effect
When I ask patients about the emotional stresses in their personal lives, they usually say,
"Why do you ask?"
I'm not being nosy. It's vital information in their establishing their diagnosis. That's because I happen to know that stressful emotions and carpal tunnel are intimately linked.
Everyone knows that physical pain affects mood. Nothing surprising there. Whether the pain is from a headache or a broken arm, our mood is affected to some degree.
Carpal tunnel syndrome is no different. It’s a condition generally associated with severe hand pain or intolerable numbness.
So it’s obvious that carpal tunnel pain can make people miserable. But what if carpal tunnel pain didn’t appear yet? What if you're only prone to getting carpal tunnel (say, it's in your family history) but it just hasn't happened yet?
Can your emotional state encourage pain to appear? The amazing answer is “Yes”.
What is carpal tunnel syndrome?
Before going any further, it’s important to know what carpal tunnel syndrome is. Note that the proper name is “carpal tunnel syndrome”, although most of the world simply calls it “carpal tunnel”.
Basically, it’s a neurological disorder . It happens as a result of a series of events within a narrow space deep inside your wrist joint. That space is called the carpal tunnel , which is where the name of the condition comes from.
Symptoms of carpal tunnel syndrome usually begin gradually. In fact, they generally develop so slowly that patients hardly notice there’s a problem at all.
The major symptoms of carpal tunnel syndrome are felt in the hand or fingers:
At first, fingers may feel numb or tingly, especially at the fingertips. Other people may feel pain as the first sign that the condition has begun. Still other patients first feel soreness, burning or itching. Some may feel their fingers and hand are puffy, even though they're not.
Most times numbness and tingling appear first, and in the fingertips. But pain symptoms usually start off in the thumb area. As carpal tunnel syndrome advances, the numbness and tingling worsen. And the pain will feel sharper or more piercing. Sometimes pain shoots through the wrist and up the forearm, like an electric shock. Sometimes, the pain shoots toward the fingers.
In time, patients complain they've developed clumsy hands or fingers. It’s difficult to button shirts, tie a shoelace or pick up small objects like coins. The hands also feel weak, so it's difficult to open a jar or turn a doorknob. With more severe stage carpal tunnel syndrome, patients may lose sensations of hot and cold in the fingers.
Symptoms can go from barely noticeable to severe within 1 month. But typically it takes 6-12 months for symptoms to be so bad that patients seek medical help.
That’s also about the time when symptoms in the opposite hand usually appear. This is called bilateral carpal tunnel syndrome.
The wrist is a crowded area
To understand the relationship between emotions and carpal tunnel, it’s necessary to appreciate a key feature of wrist anatomy. That is, the intense crowding of structures inside the wrist joint.
The center of this tightly-packed area is the narrow carpal tunnel space or passageway. The walls of the passageway are comprised of wrist ligaments and bones – all of which are very rigid structures.
The two main structures inside the passageway are the median nerve and flexor tendons . The median nerve is one of main nerves to the hand. It sends sensations to the brain like touch, pain, and vibration. The median nerve also transmits signals from the brain to move the fingers.
The flexor tendons are rope-like structures connecting the muscles of the forearm to each finger. One tendon makes one finger move (“flex”) whenever its corresponding forearm muscle contracts. All of the tendons make the fingers curl and grip.
The median nerve and tendons are packed tightly together. It’s like a fist full of drinking straws. Let's say one straw represents the median nerve while the others represent the tendons. Your clenched fist represents the stiff bony wall of the carpal tunnel passageway. All of the crowding within this confined space means there’s no room for anything to expand.
How crowding inside the wrist causes symptoms
Carpal tunnel syndrome begins when the flexor tendons inflame and swell. But there isn’t much room for swelling due to the stiff walls surrounding the tendons and median nerve. Going back to the drinking straw analogy, the packing is so tight that nothing can move or expand.
As a result of tendon swelling, pressure is exerted against the median nerve. That force compresses the nerve. With more and more swelling, the tendons eventually crush the nerve.
Risk factors causing carpal tunnel syndrome
Wrist Anatomy
Family history
Repetitive hand or finger activity
People who perform repetitive grasp-and-release motions are more prone to getting carpal tunnel syndrome. This is the " repetitive stress" risk that many doctors attribute to getting this condition. Jobs infamous for having carpal tunnel are:
- guitar player
- assembly line worker
- transcriptionist
- power tool user
- dental hygienist
- hair stylist
- cashier
- graphic artist
- carpenter
- fine artist
Likewise, rapid and repeated finger movements also put you at risk. That’s why gamers, sonographers, and computer keyboard users have a high incidence of carpal tunnel syndrome.
Metabolic disorders
Metabolic disorders also put you at higher risk for getting carpal tunnel. The most notable are rheumatoid arthritis and diabetes.
Pregnancy also increases the risk several fold. In fact, it occurs in over 50% of women in their third trimester. Pregnancy-related carpal tunnel usually goes away after childbirth in about half of women.
The reason all of these conditions are linked with carpal tunnel is due to fluid distribution . Changes in the body’s fluid balance usually impacts the joints. Therefore, more fluid pressure inside the wrist joint will harm the median nerve.
A patient might be predisposed to carpal tunnel. Perhaps their wrist is already at the threshold of median nerve compression by actively swelling tendons. Then any
added
pressure inside the carpal tunnel space (as due to pregnancy) can trigger full-blown symptoms.
Poor Sitting Posture
Poor sitting posture is an often-overlooked contributor to carpal tunnel syndrome And it’s the real focus of this article. You'll see how stressful emotions and carpal tunnel syndrome have a common link.
The National Institutes of Health warns that sitting for long periods of time is harmful. Specifically, we know that sitting at a computer workstation results in a higher incidence of carpal tunnel syndrome.
Why? There are two main reasons:
- Rapid & repetitive finger typing
- Poor posture
We already discussed the direct link between repetitive moments and carpal tunnel. But when it comes to poor posture, the relationship is a bit murkier.
We know poor posture can result in head, neck, shoulder, arm, and hand pain. Nearly everybody's experienced that just by typing at a keyboard a lot.
With any muscle strain, the location of the pain depends on which muscles you strained. Moreover, other muscle groups try to compensate (or balance) forces created by the strained muscles. That compensation, in turn, strains additional muscle groups which are also trying to balance forces.
There are numerous muscle groups that must work together for optimal balance. The illustration above shows 6 primary forces needed just to balance the shoulder blade and arm.
Muscle groups trying to balance a strain is like your car being out of alignment. Wheel misalignment transmits everywhere, causing the entire car to shake and rumble.
For example, let's say you have neck muscle strain. Most of the forces in your upper body (neck and shoulders) are then transmitted downward, to your upper arms, lower arms, and ultimately to your wrists. The wrists are the final major joint to balance all of the stressful postural forces in the upper body.
As a result, any compensation by upper body muscles will put strain on the wrist’s anatomy. The result is almost certain disturbance of the carpal tunnel passageway.
When any force disturbs the normal environment of the carpal tunnel - even just a little - it impacts on the amount of pressure against the median nerve.
Those forces that compensate for upper body muscle stress are the underlying link between poor posture and carpal tunnel syndrome.
Effects of emotions on the body
At first glance, emotions and carpal tunnel seem completely unrelated. How can happiness, sadness, anxiety or stress influence your wrist joint? But as we saw, the common link is poor sitting posture.
Emotions like anxiety and stress are tightly linked to hunching and slouching while you're seated. But scientists don’t know if we slouch because we’re stressed or we’re stressed because we slouch.
Embodied cognition
This relationship is the essence of the field of embodied cognition. It concerns how our body and mind influence each other. In other words, it means our mind can influence how our body reacts, and our body can influence how our mind reacts. The two are connected in definite yet mysterious ways.
The emotion of particular interest here is stress . For decades medical science has documented the effects of stress on amazingly diverse body parts, from the heart to the kidneys. To date however, no direct link between stress and acquiring carpal tunnel syndrome is known. However, the indirect link (via poor posture) is very strong.
The typical stressed-out worker
Everybody is familiar with this: work deadlines and pressure to perform result in stress and anxiety. Getting the job done quickly and properly is paramount - or else!
One consequence is that while at their workstations, most people don’t focus on anything but the job. Maintaining good posture is usually completely ignored.
In fact, the stressed-out, slouching or hunched-over typist is the typical image of today's office worker. Slouching and hunching are the very definitions of poor posture. These positions tense muscles in the upper body and disturb the natural anatomy.
The tense muscles produce unbalancing forces in the upper body. In order to compensate, the body ultimately transmits the stressful forces downward, toward the wrist joint. Hence, the carpal tunnel space is disrupted.
The puzzle is complete
If you're on the verge of getting carpal tunnel, look out!
Conclusion
At first, it doesn't seem like your daily psychological troubles can be related to any kind of horrible hand pain or numbness. But when I explain the connection to patients, nearly everyone is surprised by the relationship. Essentially, stress and anxiety are linked to having tense muscles. Whether such emotions cause poor sitting posture or poor sitting posture causes the emotions is unknown. But the result is the same. That is, unbalanced upper body forces transmit down the arm to the wrist joint. This can increase the chances of acquiring carpal tunnel syndrome, particularly if you’re already at risk (predisposed). Therefore, all doctors should appreciate the intimate link between emotions and carpal tunnel syndrome so that patients can be treated effectively.