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Where Carpal Tunnel Pain Hurts Most

From Dr. Z - Carpal tunnel syndrome specialist

Where Carpal Tunnel Pain Hurts Most

For many people, the area where carpal tunnel pain hurts most is the forefinger and thumb. The middle and ring fingers can also be affected, as can the palm of the hand.


Along with the pain, many people feel other symptoms of carpal tunnel syndrome in the same areas. These include numbness, tingling, burning, and soreness.


Pain caused by carpal tunnel can also extend over the entire hand and into the wrist. Sometimes, when grasping an object, pain can shoot into the arm and up to the elbow. Other times, the shooting pain feels more like an electric shock.


This article explains what that pain is all about, when it occurs, and how to treat it.

carpal tunnel symptoms

What does carpal tunnel pain mean?

Carpal tunnel pain in the hand or fingers is just one sign that you have carpal tunnel syndrome. This is a progressive neurological disorder that starts deep inside the wrist joint.


Carpal tunnel syndrome affects over 5 million Americans. In fact, it's one of the most common musculoskeletal disorders in America. But what does the pain mean?


Carpal tunnel pain is the result of a damaged nerve inside the wrist joint. That nerve, the median nerve, is a major nerve of the hand. The damage happens when surrounding flexor tendons (responsible for curling your fingers) inflame and swell. Eventually, the swelling crushes the median nerve, causing all the symptoms of carpal tunnel syndrome.


The tendon swelling around the nerve can be caused by several factors. Chief among them is repetitive straining of the fingers. This is called repetitive stress injury or RSI.


Therefore, the pain you feel is the way your body is saying that carpal tunnel syndrome has begun.

carpal tunnel pain hurts

What types of pain are felt?

Carpal tunnel pain normally follows certain patterns. Those patterns change as the condition worsens.


For the most part, when carpal tunnel syndrome is in the mild stage, pain symptoms are also mild. The main distinguishing feature of mild carpal tunnel syndrome is that pain occurs when your hand is resting, but not working. This distinguishes it from wrist tendonitis, which hurts when your hand is working and not at rest.


You can take this easy self-test to see if you have carpal tunnel syndrome or wrist tendonitis.


Carpal tunnel pain can have different characteristics from person to person. It can be intermittent or constant, widespread or focal. Pain can also vary in intensity. It can range from a simple annoying discomfort to a fearful, punishing pain.


The pain produced by carpal tunnel syndrome can have the following qualities:

 

  • dull
  • sharp
  • aching
  • throbbing
  • burning 
  • pounding
  • grinding
  • shooting
  • deep
  • superficial

 

Most carpal tunnel patients feel more than one of these painful sensations. They can occur at the same time or at different times of the day.

carpal tunnel tingling

What are the stages of carpal tunnel?

Mild stage

The mild stage of carpal tunnel syndrome is when most people believe they simply have an annoying problem when they overwork their hands. They often don't realize they're on the road to a progressive disorder that gets more difficult to treat as time goes on.


The mild stage begins as barely noticeable. Symptoms like pain, numbness or tingling only appear while trying to sleep. Patients have to wake up to shake out the numbness or rub out the pain.


It's possible for this stage to last for years. But more commonly it only lasts for about a month until it worsens. This stage is also the easiest to treat.

Moderate stage

The moderate stage is where carpal tunnel pain or other symptoms are felt during the day. Symptoms are no longer confined just to when trying to rest or sleep.


Symptoms in the moderate stage also generally include loss of grip strength and reduced finger dexterity. Patients begin to drop things or find it difficult to hold items like a coffee cup. Many also feel clumsy tying a shoelace or button a shirt. Picking up keys or coins is awkward.


Usually the moderate stage is when patients see symptoms appear on the other hand as well. This is called bilateral carpal tunnel syndrome. It occurs over 80% of the time.


Without treatment, moderate stage carpal tunnel syndrome can last for several months. It's rare for this stage to last for more than a year before it advances to the severe stage.

pain

Severe stage

Unfortunately, the severe stage of carpal tunnel is when most patients seek help for their condition. It's also the stage that's most difficult to treat. For instance, treating the mild or moderate stages has nearly total success. But treating the severe stage cuts that success rate in half.


The symptoms during the severe stage are similar to previous stages. But they're far more intense. And there is no respite from the constant and unrelenting pounding. Carpal tunnel pain is described as punishing, cruel, fearful, terrifying, grueling, vicious, and killing.


Severe carpal tunnel pain usually is accompanied by crushing numbness. One or both of these symptoms cause many patients to exclaim, "I feel like cutting my hand off!"


Left untreated, severe stage of carpal tunnel syndrome can last months or years. However, treatments are still available even for severe carpal tunnel syndrome.

end stage carpal tunnel

End stage

Just when you thought it couldn't get worse, carpal tunnel can advance to the end stage. This stage of progression is the last stop for this disorder. That's because in prior stages, the median nerve still had some life left within it.


But in the end stage, the median nerve dies. Ironically, with the death of the median nerve, pain is no longer as intense. However, numbness or tingling may persist forever.


Generally, most of your grip strength is gone. The muscles at the base of your thumb (thenar muscles) degenerate, atrophy or "waste". This can be seen where the normally plump bump at the base of your thumb flattens out, wrinkling the skin over it.


Thumb strength is lost as a result. Most times the hand begins to take the form of a claw (called "claw hand").


When carpal tunnel pain diminishes in the end stage it's not good news. It means the condition is no longer treatable by any means (not even surgery).

end stage carpal tunnel

Who gets carpal tunnel syndrome?

Who gets carpal tunnel syndrome? Anybody can get it! But you're at especially high risk if you work hard with your hands. 


The biggest contributor to getting carpal tunnel syndrome is an occupation which requires certain hand and finger motions. These are rapid and repetitive finger motions, forceful or prolonged gripping, prolonged grip-and-release, and prolonged and forceful pinching motions. This means the jobs most likely to result in carpal tunnel are:


How do you relieve carpal tunnel pain?

You can relieve carpal tunnel symptoms like pain and numbness temporarily or permanently. Temporary treatments address the symptoms only. But permanent treatments attack the source of the problem; that is, adhesions on flexor tendons causing inflammation.


Below are the most common carpal tunnel pain relievers. They are listed (top to bottom) from TEMPORARY to PERMANENT relief treatments.

Pain medicines (temporary relief)

nsaids

Oral pain medicines or "analgesics" are common over-the-counter pain relievers. Chief among them are called non-steroidal anti-inflammatory drugs or NSAIDs (Motrin, Advil, aspirin, Aleve, Naproxen). These drugs reduce inflammation which is the cause of carpal tunnel syndrome. 


Pain relief can last for several hours. But the main problem with these drugs is toxicity. The FDA says it's dangerous to use NSAID medicines on a chronic basis (more than a few weeks). The result may be kidney or liver damage, stroke, or heart attack.

Steroid shots (temporary relief)

steroid shot

Steroids like cortisone (used in carpal tunnel shots) are good pain relievers - when they DO work. The Nation al Institutes of Health say that steroid shots are effective in 45% of patients. The other 55% see no relief. Moreover, when steroid shots are effective, their effect last only weeks or months. 


Most doctors will not re-administer cortisone for at least 6 months afterward. And even then, you can only have 3-4 cortisone injections per lifetime. That's because prolonged steroid use can cause problems like osteoporosis.

Ointments (temporary relief)

biofreeze

Topical ointments like Biofreeze and others contain menthol. Mentholated products can provide limited pain relief for up to 3 hours. They also provide a strong placebo effect which can be considerably strong.


It's important to understand that menthol merely acts on pain receptors. It does nothing to address the underlying cause (tendon inflammation) of your carpal tunnel syndrome.

Ice baths (temporary relief)

ice bath for carpal tunnel

The area where carpal tunnel pain hurts most can be the fingers. An ice bath gets to all the fingers quickly. 


Ice baths work well to relieve pain. But the problem is that once you remove your hand from the ice bath, the pain returns in a few minutes.


Some people use contrast baths. This means immersing your hand in cold water and then in warm water, or vice versa. But once again, the pain relief is only temporary.

Acupuncture (temporary relief)

acupuncture for carpal tunnel

Acupuncture needles are inserted where carpal tunnel pain hurts most. The amazing result is that pain disappears instantly. This isn't a placebo effect. The results are verified by multiple scientific investigations. 


But the downside of using acupuncture comes when the needles are removed. In general, pain relief only lasts for a few hours. On rare occasion, patients experience pain relief for more than a day. But the cost of having acupuncture and the rapid return of symptoms make this a less attractive pain relief alternative.

Ultrasound (temporary relief)

ultrasound for carpal tunnel

Clinical studies performed over 2 decades ago confirmed that therapeutic ultrasound (as opposed to diagnostic ultrasound) could relieve the area where carpal tunnel pain hurts most. In fact, the results showed that the median nerve can regain some of its health after 10 days of daily treatment, followed by 5 weeks of twice weekly treatment. 


Unfortunately, these positive results cannot be sustained due to the cost of the treatment. And as the treatment ends, eventually symptoms return. 


It wasn't until years later that ultrasound's beneficial effects were found to be the result of heating the carpal tunnel space. Heat increases circulation and restores the health of damaged tissues

Yoga (temporary relief)

yoga for carpal tunnel

Years of clinical studies have verified that yoga can relieve pain and other symptoms of carpal tunnel syndrome. Yet the effects of yoga on carpal tunnel syndrome are not mysterious.


Yoga exercises are renowned for stretching the restrictions in soft tissues. If the flexor tendons and upper body tissues are stretched, they relieve restrictions. This restores proper balance to the musculoskeletal system. 


Simultaneously, this balance restoration transmits throughout the upper body and into the wrist area. Along with stretches to directly relieve restrictions inside the wrist joint, the imbalance is restored. These factors normalize the anatomy and physiology of the wrist to relieve carpal tunnel syndrome. 


The downside of yoga for carpal tunnel is that it must be performed at least once a day. If the practitioner stops the routine, symptoms will usually return in a matter of days.

Night bracing (permanent relief)

palmar spine brace

You might think that night bracing (or "nocturnal bracing") sounds too simple to help relieve carpal tunnel pain or other symptoms. Yes it's simple, but it's also highly effective.


When we sleep we all unconsciously bend our hands backward. If you have carpal tunnel syndrome, this motion causes compression deep in the wrist. And it's very harmful to the tissues inside the wrist area. A night brace keeps your hand straight (in the "neutral position"). This position avoids compressive damage to the tissues inside the wrist joint.


But not just any brace will work. Those available in pharmacies like Walgreen's, CVS, Rite Aid, and Walmart are not suited for treating carpal tunnel syndrome. In fact, they actually make the condition worse. That's because they all contain a "palmar spine". That hard metal spine pushes into your wrist, further compressing the tissues beneath.


But a certified carpal tunnel brace has no such spine on the palmar surface. Stiffeners are located either above or on the side of the hand. This lets the soft underside of your wrist joint rest without being crushed.

Rest (permanent relief)

rest for carpal tunnel

Rest is nature's way of treating any injury. And carpal tunnel syndrome is no different because it's fundamentally a repetitive stress injury. In theory, if you were to truly rest you hand (literally, never use it) for 4-8 weeks, then carpal tunnel syndrome will disappear on its own. But few people have the luxury of doing that.


Therefore, it's important to rest your hands periodically as you work. Take short breaks (1 minute) from any vigorous hand or finger activities. Also try to avoid activities which strain the hand. That means minimize using a constant grip or pinching motion. Also take rest period between grip-and-release activities.


You know your occupation better than anybody else. Figure out ways to take "mini-breaks" for resting your hands that won't negatively impact your productivity.

Stretching exercises (permanent relief)

exercise for carpal tunnel

Like bracing, this carpal tunnel pain relief treatment seems too simple to be effective. But it is. You can perform certain core carpal tunnel stretching exercises for the fingers and hand which can stop carpal tunnel in its tracks; even severe symptoms.


These exercises are specifically designed to lubricate flexor tendons. They also break up adhesions and restrictions which are the underlying cause of inflammation (and the reason you get carpal tunnel to begin with).


The best carpal tunnel stretching exercises are also quick to do. Combined, they only take 1 minute to complete. That means you can do them while working, during your "mini-breaks". 


Most doctors recommend performing these stretches at least every hour that you're working with your hands. And keep doing them until symptoms disappear; usually in 4-6 weeks.

Massage (permanent relief)

massage for carpal tunnel

The final way to relieve carpal tunnel syndrome permanently is also the most potent of all the remedies discussed above. It's also the treatment most preferred by therapists for their carpal tunnel patients.


Everybody knows what ordinary massage is. But a specific type of deep tissue massage used for carpal tunnel syndrome is called myofascial release massage. 


Comparing ordinary message to myofascial release massage is like comparing knitting to kickboxing. Myofascial release massage rips apart underlying adhesions and restrictions on the flexor tendons which cause carpal tunnel syndrome.


Myofascial release massage is effective for every stage of carpal tunnel syndrome. And it's most effective against carpal tunnel pain. Even end stage patients benefit because numbness, tingling, and weakness symptoms can be reduced significantly.


The downside is that you cannot apply this technique on yourself. It required two hands as well as a  bit of training. But a partner can certainly learn the technique. Moreover, it must be performed twice daily for about 15 minutes. 


On the upside, pain, numbness, tingling, weakness and all of the other symptoms of carpal tunnel syndrome will disappear - usually forever.
carpal tunnel surgery

What about carpal tunnel release surgery?

Contrary to what most patients are told, carpal tunnel release surgery is a temporary treatment. The reason is because surgery does not eliminate the root cause of carpal tunnel pain and other symptoms; that is, adhesions and restrictions on flexor tendons. 


This is why about 50% of patients who had carpal tunnel surgery experience return of symptoms within 2 years. Also, 3% to 25% of patients never see symptoms relief whatsoever after surgery.


In all, less than 25% of patients are satisfied with their results by year 3 because all symptoms have been relieved. This means fewer than 25% of patients see permanent relief.


These published statistics beg the question, "In light of the permanent nonsurgical options available, is surgery worth the cost, pain, and recovery time?

Conclusions

The area where carpal tunnel pain hurts most is usually the thumb and first fingers. Sometimes the pain is accompanied with numbness, tingling, and weakness. Pain may also shoot up your arm to your elbow. Carpal tunnel pain can also be mild or intense, intermittent or constant.


There are several treatment options to relieve carpal tunnel pain. Some are merely temporary pain relievers. But the permanent pain relievers attack the source of the problem, which is tendon inflammation caused by adhesions. Surgery is generally not a permanent treatment option due to the high rate of symptoms return.

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