Wrist Pain and Carpal Tunnel Syndrome - Causes, Self-Care, and When to Seek Treatment

Wrist Trouble Is a Modern Affliction - Computers and Phones Overwork the Hands

Typing on a keyboard, working a mouse, flicking through text on a smartphone. The wrists of a modern adult are forced through tens of thousands of repetitive movements in a single day. Now that display work on computers and tablets (called VDT work in Japan until 2019) sits at the centre of most jobs, people complaining of tired, aching hands and fingers are anything but rare. Wrist pain and numbness tend to get written off as simple overuse, yet the treatment differs enormously depending on the cause. Left alone, the problem can lead to loss of grip strength and difficulty with everyday movements, so identifying the cause early matters.

Carpal Tunnel Syndrome - A Compressed Median Nerve

The carpal tunnel is a tunnel-shaped structure on the palm side of the wrist through which nine tendons and the median nerve pass. Carpal tunnel syndrome is what happens when pressure inside that tunnel rises and the median nerve is compressed. The condition affects roughly 3 to 5 per cent of the general population, and it is 3 to 5 times more common in women than in men.

Why It Is More Common in Women

The cross-sectional area of a woman's carpal tunnel is smaller than a man's, so the nerve is physically easier to compress. On top of that come risk factors specific to women: swelling during pregnancy, the hormonal shifts of menopause (thickening of the tendons as oestrogen falls), and hypothyroidism. That changes in hormonal balance affect symptoms in the wrist is not as widely known as it should be.

Typical Symptoms

Numbness and pain arise in the thumb, index finger, middle finger and the thumb-side half of the ring finger. Symptoms worsen at night and in the early morning, and shaking the hand brings relief (the flick sign). As the condition advances, the muscle at the base of the thumb (the thenar muscle) wastes away and problems with fine movement appear: being unable to open a bottle cap or fasten a button.

Self-Checks You Can Do at Home

Phalen test: put the backs of both hands together, bend the wrists to 90 degrees and hold for 60 seconds. Numbness in the fingers is a positive result. Tinel sign: tap lightly on the palm side of the wrist, over the carpal tunnel. An electric-shock sensation shooting into the fingertips is a positive result.

Tenosynovitis (De Quervain's Disease) - Inflamed Tendons on the Thumb Side

De Quervain's disease is a condition in which the sheath carrying the two tendons that move the thumb (the extensor pollicis brevis and the abductor pollicis longus) becomes inflamed. It develops through movements that use the thumb over and over: operating a smartphone one-handed, holding a baby, handling a knife while cooking.

How It Differs From Carpal Tunnel Syndrome

The location of the pain is different. De Quervain's disease is marked by pain and swelling confined to the thumb side of the wrist (around the radial styloid process), and numbness is not usually part of the picture. Closing the fingers over the thumb and bending the wrist towards the little finger sends a sharp pain through the area (the Finkelstein test).

TFCC Injury - Pain on the Little-Finger Side of the Wrist

The TFCC (triangular fibrocartilage complex) is a cushioning structure on the little-finger side of the wrist that stabilises rotational movement. It is injured by movements such as turning a doorknob, wringing out a cloth or hitting a backhand in tennis. Where there is pain on the little-finger side of the wrist that gets worse when the wrist is twisted, suspect a TFCC injury. MRI gives a definitive diagnosis, but mild cases often improve with support-brace immobilisation and rest. Arthroscopic surgery is considered for severe cases.

Risk and Prevention by Occupation

Desk Workers

When the keyboard and mouse sit in the wrong places, the wrists take an excessive load. Put the keyboard at elbow height so that the wrists are not bent back. Place the mouse close to the body and use it at a position that does not raise the shoulder. It is also effective to switch to an ergonomic keyboard or a trackball mouse. In fact, optimising the desk environment pays off not only for the wrists but also in preventing stiff shoulders.

Heavy Smartphone Users

One-handed flick input puts a heavy load on the tendons of the thumb. Spread that load with a few adjustments: switch to holding the phone in both hands, make use of voice input, and type longer text on a computer. Simply alternating which hand holds the phone at regular intervals already reduces the concentrated load on one side.

Parents of Young Children

Holding a baby keeps a load of 3 to 5 kilograms on the wrist while it is held in a fixed position. Reduce that load by using a baby carrier, using a nursing cushion, and adjusting how you hold the child so that the wrist is not bent backwards.

Wrist Stretches and Self-Care

Wrist Flexion and Extension Stretch

Stretch one arm out in front of you and use the other hand to pull the fingertips towards you, extending the wrist. Hold for 15 seconds. Next press the fingertips downwards to flex the wrist. Hold for 15 seconds. Three sets on each side. Do this between tasks, every one to two hours.

Tennis Ball Massage

Press a tennis ball against the muscles of the forearm (the muscles that move the wrist are in the forearm) and roll it slowly. This loosens adhesions in the fascia and eases the load on the tendons. Use enough pressure to feel a pleasant ache, for two to three minutes.

Icing and Rest

In the acute phase, while the pain is strong, wrap an ice pack in a thin towel and hold it against the affected area for 15 to 20 minutes, three to four times a day. It helps to immobilise the joint with a wrist support or splint and to limit the movements that provoke pain.

Wrist Care by Decade

Your Twenties and Thirties

Long hours on computers and smartphones put this group at high risk of tenosynovitis. Ergonomic improvements to the working environment are the most effective measure. While symptoms are still mild, this is the time for building the habit of stretching and taking breaks.

Your Forties and Fifties

For women, the hormonal shifts of menopause send the risk of carpal tunnel syndrome climbing sharply. Do not dismiss numbness in the hand as poor circulation on your own judgement; if symptoms continue for more than two weeks, see an orthopaedic clinic. Books on wrist health are a useful reference as well.

Your Sixties and Beyond

Deformity of the joints (wrist osteoarthritis) joins the picture, and compound pain becomes more likely. Because maintaining grip strength is directly tied to independence in daily life, keep up grip training within the range that does not hurt, such as squeezing a rubber ball. Heberden's nodes and Bouchard's nodes, in which the finger joints become deformed, are common in women after menopause and are thought to involve the decline in oestrogen.

When to See a Doctor, and the Treatment Options

See an orthopaedic clinic if two to four weeks of self-care brings no improvement, if the numbness persists, or if grip strength has clearly fallen. For carpal tunnel syndrome, mild cases are treated with splint immobilisation and steroid injections, while severe cases are treated with carpal tunnel release, performed as day surgery. Carpal tunnel release is done under local anaesthesia: an incision of 2 to 3 centimetres is made in the palm and the transverse carpal ligament is divided. The fingers can be moved from the day after the operation, but full recovery of grip strength takes one to three months. For tenosynovitis, steroid injections are often strikingly effective. In every case, the earlier it is dealt with, the faster the recovery. It is worth deepening your knowledge of self-care with books on wrist pain.