Pain & Numbness in Your Hands Is Not Always Carpal Tunnel Syndrome
For many people, “Carpal Tunnel Syndrome” is any symptom that produces pain, numbness or tingling in your hands.
If you “Doctor Google” the condition, you will read that it caused by impingement of the Median Nerve where in enters the wrist, is characterised by a burning and painful sensation that can be brought about from repetitive stress movements and is often worse at night, severe at night to even wake you up.
But what if I told you that the majority of “Carpal Tunnel Syndrome” cases that I see are not Carpal Tunnel Syndrome at all? What if I told you that there are multiple reasons why you can experience tingling or burning in your hands? That is what I’m going to describe for you in this article to hopefully give you a better idea about what Carpal Tunnel Syndrome is, what it isn’t, what the other possibilities are, and what you need to do about it.
The Insane World of Carpal Tunnel Syndrome "Experts"
"Carpal Tunnel Syndrome" is often not a hand problem at all, but originates from a problem with the nerves in your upper and lower cervical spine (neck). My frustration on Carpal Tunnel Syndrome goes back several years but was sparked by a client I worked with recently who had a failed Carpal Tunnel surgery. In other words, her neurologist diagnosed her with Carpal Tunnel Syndrome and performed the surgery which cuts open the ligaments of the wrist to make more room for the Median Nerve.
Unfortunately, the surgery did not change her symptoms. When I met her, my first question was, “Where in your hands do you feel it?” Her answer was, “Its always been along the outside of my little finger.” Here’s the problem: that type of pain distribution is NOT the Median Nerve, which is the one that is involved with true Carpal Tunnel Syndrome!
Therefore, a Carpal Tunnel decompression surgery would not work. Duh! … And this is a neurologist - a “specialist” whose job it is to know the difference between the Median Nerve and the Ulnar Nerve, which is what my client was actually describing.
Sure enough, once we figured out what the actual problem was, we were able to make progress when her previous surgery did nothing. Of note, the reason why you will see me annotate "Carpal Tunnel Syndrome" through this article series is the because I want to make a clear distinction that the tingling, burning, numbness or "pins and needles" sensations in the hands may not the true Carpal Tunnel Syndrome.
This case is not the first time I’ve witnessed such a major mis-diagnosis. I wouldn’t be so upset if it was a difference of opinion on what the medical treatment or health procedure was in order to address the condition. The problem is that it is basic neurology! You don’t need to attend the first year of medical or chiropractic school to learn this stuff. Its actually pretty simple.
The Major Players in "Carpal Tunnel Syndrome"
There are 4 levels to consider when it comes to nerves in the hand.
- Spinal Cord
- Spinal Nerves that exist the neck
- Brachial Plexus
- Peripheral Nerves
To keep it brief, the nerves that supply your shoulder, arm, forearm and hand originate from your spinal cord and from the nerves in your neck. Nerve roots from the C5-T2 levels at the base of your neck combine and criss-cross like a major city highway in a web called the “Brachial Plexus” located between your neck muscles and collarbone.
These various nerve fibres are redistributed and recombined into peripheral nerve branches then descend past the elbow and wrist into the hand. Irritation to any of these nerves will cause problems further down the chain, and by understanding what the nerve distribution is it allows you to pinpoint where the problem is coming from.
The 3 major peripheral nerves of the hands are the Median (purple), Ulnar (green) and Radial (Red) Nerves. True Carpal Tunnel Syndrome is of the Median Nerve only. Median Nerve. It is formed by nerves that exit the neck from C5-T1, transmits through the middle portion of the elbow and then enters through the middle of the wrist. It supplies sensation for the thumb, index and middle fingers on the palm-side only. The backside of the hand is supplied by a completely different nerve!
- Radial Nerve. It is formed by nerves that exit the neck from C5-T1, transmits through the outside back of the elbow and then enters through the backside of the wrist. It supplies sensation for the thumb, index and middle fingers on the backside of the hand only, which is the exact opposite from the Median Nerve.
- Ulnar Nerve. It is formed by nerves that exit the neck from C7-T1, transmits through the middle portion of the inside elbow and then enters through the inside of the wrist. It supplies sensation for the ring and little finger on the palm and backside of the hand.
Pretty straight forward so far? These are the three major major peripheral nerve distributions if something if affecting the nerve at the wrist of elbow. However, if you have a nerve interference occurring farther upstream such as in the Brachial Plexus or in the neck, you can experience mixed findings.
For example, burning or tingling on the tips of the fingers only. Or a sharp sensation on the inside of the little finger but not the ring finger.
The C5-T1 nerves that originate from the neck form the Brachial Plexus and become the Median, Ulnar and Radial Nerves. C6 Nerve Root. It is the primary sensory distribution for the thumb and index finger on the palm and backside of the hand. … So do you see that this is not exactly the same as either the Median or Radial Nerve?
- C7 Nerve Root. It is the primary sensory distribution for the middle finger on the palm and backside of the hand.
- C8 Nerve Root. It is the primary sensory distribution for the little finger on the palm and backside of the hand.
Of course, there are additional places where you can experience tingling in your hands: for example the ring finger. However, these zones are more variable and are supplied by a combination of nerves, which make them less precise to analyse.
The zones I've identified here are known as “pure nerve patches,” and they are of paramount importance in the differential diagnosis among different types of abnormal hand sensations. And this brings me to a topic of critical importance: the phenomenon known as “Double Crush Syndrome,” which I will address in the next article.