When To See A Doctor
Consider making an appointment to see a primary care physician if you have numbness, weakness, or pain of the hand, wrist, or arm that interferes with normal activities or keeps you awake at night.
Early diagnosis and treatment can slow or stop conditions from worsening. A doctor can recommend exercises and home remedies to care for your condition. A doctor can also help you treat it before you develop permanent nerve or muscle damage.
Lets Focus On Shoulders
What are the common causes of shoulder pain?
Cody: Rotator cuff tears and shoulder arthritis are two common causes of shoulder pain.
Rotator cuff tears can occur either from a sudden injury, or more gradually over time. The rotator cuff is composed of four muscles and tendons that help elevate the arm overhead. When there is a tear, the patient will notice both weakness and pain with overhead activity.
Shoulder arthritis is typically a gradually progressive problem in which patients will notice both pain and limited range of motion. They may even notice a grinding sensation as the cartilage wears out and the bones start rubbing against each other.
What treatments for shoulder pain do you recommend for pain management and symptom relief?
Cody: This is a great question, because patients are often surprised at how incredibly effective conservative treatments can be. For example, I frequently have patients who come to my office with acute and severe shoulder pain that is often related to bursitis. Patients are sometimes apprehensive about trying physical therapy for a pain that is so severe, but ultimately they are able to return to normal without needing any surgery at all. I love hearing their stories down the road when they tell me they were unsure that physical therapy was going to help them and yet, it truly did.
What are the different levels of severity with shoulder pain and how does a patient know when to see a specialist?
Lets Focus On Carpal Tunnel Syndrome
Carpal tunnel syndrome is a very common issue that many patients have. What causes this condition and how can patients tell if they have it?
Park: Although there are some risk factors to developing carpal tunnel syndrome, there is no one reason why the patient gets this condition. It can lead to numbness and tingling on the thumb, index and middle finger. Symptoms are usually aggravated at night and by keeping the hand and wrist in a flexed position.
What are the different levels of severity with carpal tunnel syndrome and how does a patient know when to see a specialist?
Park: I recommend seeing a specialist when symptoms are becoming more frequent and ideally, before they become too severe. As the syndrome progresses, patients can experience more severe or frequent numbness or tingling that can become almost constant. When the condition becomes severe, the patient may also notice weakness, particularly in the thumb. Through examination and imaging studies, a specialist can determine the severity of the carpal tunnel syndrome.
What treatments for carpal tunnel syndrome do you recommend for pain management and symptom relief?
Park: Conservative measures, such as stretches, exercises, and wrist braces work best in the early stages of carpal tunnel syndrome. I only recommend surgery in severe cases. For example, if patients find no relief with conservative treatments or their imaging studies show severe compression, surgery to release the carpal tunnel may be needed.
Shoulder & Neck Pain From The Carpal Tunnel
Most doctors and the general public are not aware that entrapment of a nerve as far down as the wrist can cause pain in the persons shoulder or neck. This can be the only symptom a person comes in with, i.e. they may not be complaining of numbness, tingling, clumsiness, or any nighttime symptoms. Usually the shoulder pain experienced in a person who is getting it from entrapment of the median nerve in the carpal tunnel is going to be in the area between the neck and the top of the shoulder . Occasionally, it is directly in the neck and sometimes in the general shoulder area. Many people who come in with carpal tunnel syndrome that are over the age of 30 have another problem at the same time as the carpal tunnel syndrome and thus, shoulder pain from motion of the shoulder is more likely to be from impingement syndrome.
Shoulder or neck pain coming from the carpal tunnel typically disappears immediately or almost immediately within a matter of days of the carpal tunnel release surgery. We have no way of determining in advance whether the pain in a persons shoulder or neck is going to be affected by their carpal tunnel release.
Khan, M.I. Carpal tunnel syndrome: A curable cause of chronic neck pain. Contemporary Orthopaedics, August 1988 Vol. 17, No. 2, pp. 29-__.
Kummel, B.M., Zazanis, G.A. Shoulder pain as the presenting complaint in carpal tunnel syndrome. Clinical Orthopaedics, May 1973 92:227-___.
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Symptoms Of Carpal Tunnel And Frozen Shoulder
Carpal Tunnel
The following are the most common symptoms for carpal tunnel syndrome. However, each individual may experience symptoms differently. Symptoms may include:
- Difficulty gripping objects with the hand
- Pain and/or numbness in the hand
- Pins and needles feeling in the fingers
- Swollen feeling in the fingers
- Burning or tingling in the fingers, especially the thumb and the index and middle fingers
You may first notice symptoms at night. You may be able to get relief by shaking your hand. The reason symptoms are worse at night may be related to the flexed-wrist sleeping position and/or fluid accumulating around the wrist and hand while lying flat. Carpal tunnel syndrome may be a temporary condition that completely resolves or it can persist and progress.
As the disease progresses, patients can develop a burning sensation, and/or cramping and weakness of the hand. Decreased grip strength can lead to frequent dropping of objects from the hand. Occasionally, sharp shooting pains can be felt in the forearm. Chronic carpal tunnel syndrome can also lead to wasting of the hand muscles, particularly those near the base of the thumb and in the palm of the hand.
Frozen Shoulder
The main symptoms Frozen Shoulder is:
Frozen shoulder without any known cause starts with pain. This pain prevents you from moving your arm. Lack of movement leads to stiffness and then even less motion. Over time, you become unable to do movements such as reaching over your head or behind you.
What Happens Without Treatment
At first, symptoms of carpal tunnel syndrome come and go, but as the condition worsens, symptoms may become constant. Pain may radiate up the arm all the way to the shoulder. Over time, if untreated, carpal tunnel syndrome can cause the muscles on the thumb side of your hand to waste away . Even with treatment, strength and sensation may never be completely restored.
Carpal Tunnel And Frozen Shoulderare These Two Syndromes Related
- Post author
Are frozen shoulder and carpal tunnel syndromes related? Can they heal naturally, without surgery?
Heres part of a question I received:
Ive both tendonitis AND/OR carpal tunnel along with Frozen shoulder, all stemming from a repetitive stress job related injury, slowly progressed into the Frozen shoulder.
Its been 6 mos now and its all gotten better but get flare ups now on the forearms, and fingers sometimes tingle and lightly numb and top of thumbs get painful but worst right now is probably the Frozen Shoulder pain. Is this normal Ive not healed yet although was on modified duty and now laid off a month?
Im told the MRI and Nerve Conduction tests are NEGATIVE.
Will I heal from these?
The bone Dr. says my next option is shoulder manipulation , followed by more phys. ther. before and after.
Heres my response:
As I understand the procedure, while the patient is under anesthesia, the doctor forcefully moves the shoulder to break up adhesions or restrictions in the jointand stretch the muscles and tendons This is no doubt an expensive procedure and may be covered by your insurance.The other option is to find a neuromuscular massage therapist who can manually manipulate the muscles around the shoulder to cause them to relax.
There may be massage therapists with other training who can also do this work but I am most familiar with Paul St. John-trained NMT or neurosomatic massage therapists. This may only take a few sessions.
Carpal Tunnel Syndrome Vs Cervical Radiculopathy
Carpal tunnel syndrome is not the only condition that can cause numbness and tingling in the hands and wrists. These symptoms can also be caused by problems in the cervical spine.
Watch: Cervical Spine Anatomy Video
Conditions such as a herniated or degenerated disc, cervical stenosis, or cervical osteoarthritis can trigger impingement on the C6 or C7 nerve roots, which originate in the cervical spine and innervate almost the same areas of the hand as the median nerve.
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Because theyre both conditions caused by nerve impingement, both carpal tunnel syndrome and cervical radiculopathy cause similar symptoms: dull pain, tingling, and/or numbness, with occasional shooting pains along the nerve path.
A comprehensive neurological evaluation can help identify whether the symptoms are being caused by carpal tunnel syndrome or a cervical spine condition. In fact, sometimes the two conditions are seen together, as nerve compression at the neck can make the nerves lower down more vulnerable. Clinical evaluation, electrodiagnostic testing EMG, and possibly neck imaging can help put together the pieces of the puzzle.
Treatment: Rest And Immobilization
Underlying causes such as diabetes or arthritis will need treatment. Then your doctor may advise resting the hand and wrist and wearing a brace to limit movement. Night use is important to prevent the wrist from curling during sleep, which can make symptoms flare up. Non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen, along with cold compresses, may reduce pain.
Diagnosing Carpal Tunnel Syndrome
There are several tests your doctor will perform to see if you have carpal tunnel syndrome. The Tinel test involves tapping on the median nerve to see if it causes tingling in the fingers. In the Phalen test, the doctor will have you press the backs of your hands together for a minute to see if this causes numbness or tingling.
Moderate Carpal Tunnel Pain
In themoderatestage of carpal tunnel, pain will usually advance if it’s not treated. In themoderatestage, the painful feelings will be present most of the day, not just when trying to sleep. You even have pain when your hand is resting during the day.
Usually, at this point most people realize they have a big problem. Many begin to wear awrist braceat night. Unfortunately, most people use the wrong typeof carpal tunnel brace.And it ends up doing more harm than good.
During themoderate stage of carpal tunnel, pain may spread to all of the fingers . It may also spread into the palm of the hand. Sometimes pain radiates to the wrist and forearm. This pain usually starts off intermittently, and then becomes constant.
In themoderatestage, as carpal tunnel pain becomes more constant, other problems also worsen. If grip strength and dexterity was a problem before, it’s very significant now. The hand feels clumsy or awkwardalmost all the time.That results in constantlydropping dishes or cups. Sometimes the loss of tactile feelings and strength cause your phone to flop out of your hand. Writing with a pen is very difficult.
Do I Need To See A Neurologist For Carpal Tunnel
A neurologist can determine if you will need surgery to treat your carpal tunnel syndrome. A diagnosis of carpal tunnel syndrome is determined by a neurologist performing a nerve conduction study. The procedure takes approximately 20-30 minutes, and you can get back to your golf game only 6 weeks after the surgery.
What If I Have Surgery
While surgery is an option for carpal tunnel syndrome, most physical therapists do not recommend it however, there are some instances in which a medical professional will deem surgery necessary. If this ends up being the case, you will likely be referred to us following your surgery for rehabilitation therapy. Then, there are very rare cases where we may refer you for surgical consultation.
If surgery is performed, you will have a post-operative physical therapy treatment regimen that includes one or all of the following:
- First, you will be encouraged to participate in exercises that are designed to improve the overall strength of the muscles located in the hand and in the wrist area. As the strength of the muscles in this area improves, the functionality of the muscles will also improve.
- Your physical therapist will encourage you to do carpal tunnel exercises that stretch out the muscles. This aids in optimizing the overall mobility associated with the area, which in turn improves function.
- All surgeries result in some degree of skin scarring. Once you complete the carpal tunnel surgery, you will quickly discover that the skin develops a mark. Carpal tunnel physical therapy includes scar management. This aids in ensuring that the skin remains flexible and is considered to be supple.
- You will be provided with information regarding how to properly position the wrist and the right posture. This will help in reducing compression and issues, such as shoulder pain.
What Causes Carpal Tunnel Pain
Today, we know a great deal about carpal tunnel syndrome. And we know a lot about what causes the various symptoms of carpal tunnel.
Pain, numbness, tingling and other abnormal sensations are the result of nerve damage. At it’s core, a damaged nerve inside the wrist joint causes all of these symptoms.
Carpal tunnel syndrome is a painful and progressive nerve disorder. Doctors technically call it acompressive neuropathy.That means themedian nerve is damaged.
The damaged occurs because nearby tendons inside the wrist joint inflame and push on the median nerve. Nobody is sure why the tendons swell to begin with. But the result is that they swell more and more.Eventually they compress or crush the nerve.
It’s thought the reason tendons swell might be due torepetitive and forceful useof your hands and fingers. That’s why, for instance, typists,hair stylists,carpenters,transcriptionists, auto mechanics,guitar players,and assembly line workers are infamous for getting carpal tunnel syndrome. Actually, anybody with anoccupationthat requires rapid and repetitive hand activity is at high risk.
Is Carpal Tunnel Causing Your Shoulder Pain
Carpal tunnel syndrome is a painful, progressive condition that typically affects the hands and wrists but is not restricted to just these areas. Shoulder pain is also one of the symptoms of carpal tunnel. When you change the position of your wrist and hand to compensate for the pain, it puts excessive stress on the shoulder muscles resulting in pain in the area.
There is no one definitive cause of carpal tunnel shoulder pain and all shoulder pain is not necessarily due to carpal tunnel. That is why it is important to first get a confirmed diagnosis by an experienced pain specialist. Depending on the cause of and severity of your symptoms, your pain doctor in New York may recommend a few conservative or minimally invasive treatments to reduce the pain and increase mobility.
Are You Looking For Relief From Elbow Wrist And Hand Pain
Pace Physical Therapy in San Jose, California specializes in non-surgical neck pain relief and recovery therapies. We pride ourselves on offering the best possible physical therapy available and going above and beyond for our patients. Our highly experienced physical therapist will work with you to improve your function and relieve your pain. We start by assessing the body as a whole. Oftentimes the cause of pain or an injury extends far beyond just the body part or muscle hurting. Without taking a comprehensive look at your entire self, we would be doing you a disservice in fully helping you heal and preventing future limitations. We then move on to fixing your areas of limitation. Dont let your quality of life be diminished by elbow, wrist, or hand pain any longer! If you are looking for a San Jose, CA physical therapist, contact Pace Physical Therapy today to make an appointment and meet with one of our committed team members. We would be delighted to get you back to the safe and physically active life that you deserve! Contact us today to schedule your appointment!
Common Ailment: Carpal Tunnel Syndrome
If youve experienced tingling or a numbing sensation in your fingers, or simply had intermittent pain surface with no obvious injury, you may be in the beginning stages of Carpal Tunnel Syndrome.
This progressive condition is caused by excessive pressure applied to your median nerve , triggered by repetitive stress to the area. Those who work on computers frequently or in jobs that require constant use of the hands are at the greatest risk for developing Carpal Tunnel.
When Is Surgery Necessary For Relieving Carpal Tunnel Pain
Carpal tunnel syndrome is a very common condition that affects the hand and fingers. Its caused by a pinched nerve in your wrist, and symptoms often include pain, numbness, and loss of grip strength.
Anyone can develop carpal tunnel, but your gender, occupation, and some health conditions can increase your risk. Women are more likely to suffer carpal tunnel syndrome, as are people of both genders who have jobs that require typing or other repetitive wrist motions. Vibratory tools are especially linked to carpal tunnel syndrome causation.
There are a number of non-invasive treatments for carpal tunnel syndrome, but the condition doesnt go away on its own and instead gets worse without treatment. If your carpal tunnel pain is severe and limits your daily life, surgery might be your best option.
For the best in orthopedic care and carpal tunnel surgery, turn to the team at Upper Extremity Specialists, a member of Synergy Orthopedic Specialists Medical Group. Kristopher Downing, MD, Daniel Brereton, DO, and our staff serve patients in Chula Vista and La Jolla, California, and we can help you find the right treatment to relieve your carpal tunnel pain.