Why are my hands asleep and numb?

maybe it's carpal tunnel

Carpal Tunnel Syndrome (CTS) is common with those that do a lot of computer work, work with their hands (mechanics, etc), and pregnant women. Treatment is pretty straight forward, and tbh not much stuff “exists” to treat it.

I’ll cover basic CTS treatments and what to expect with this condition.

4 treatments we will cover

1. Night Splints

2. Scheduled work breaks

3. Nerve Glides

4. Work station set up

#1 Night Splints

Try to avoid sleeping like this

Night splints are designed to stop you from sleeping with your wrists flexed (above picture). This puts a lot of stress on the wrist, causing or making CTS worse.

Fixing this will often solve 80% of your issues.

I recommend to some to wear their braces all day because they:

• Need the support

• Can’t stop flexing the wrists

The brace does not need to be fancy, anything from amazon will do.

#2 Scheduled Breaks

A common story is increased work demands, especially at a computer. You are using your wrists more, and potentially the stress of work is making healing a challenging.

There’s no formula on how often to take breaks. Start with every 10 minutes and go from there. You may need your braces while you are working.

Carpal tunnel syndrome after having a baby is common since

• your wrists are flexed handling a baby

• babies increase in weight

• sleep is disturbed

• possible hormonal reasons

Healing is slow (~ 3-6 months) because you CAN’T do less work.

#3 Nerve Glides

These are Median nerve glides. To perform them:

• Fingers up, head away

• Fingers down, head towards

• 10-15 reps 2-3x/a day

Pain should not be worse when you perform the next session. If so, you did too many reps or you need to devote more to #1 and #2.

Every 3 days perform 1 set as “tensioners” to start to improve the stretch tolerance to the nerves. They are just the opposite of glides:

• Fingers up, head towards

• Fingers down, head away

#4 Work Space Ergonomics

There are many ways to set your work station up to reduce pain associated with carpal tunnel syndrome

• Keyboard wrist supports

• Split keyboards

• Trackball mouse

• Improving sitting posture

All of these keep the wrist neutral. These are nice to have’s but managing total workload will help the most. Always start there first.

Unfortunately, it isn’t always possible.

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is an irritation of the median nerve in the Carpal Tunnel of the wrist. Wrist flexion and extension change the shape of the tunnel, which can compress the nerve.

Click the picture to learn more about wrist anatomy

This done repetitively can irritate the median nerve and create symptoms (see tweet pic above for pain description)

3 Tests to Diagnose Carpal Tunnel Syndrome

#1 Carpal Compression Test

Apply pressure to the carpal tunnel

#2 Tinel’s Test

Tap the area

#3 Phalen’s and Reverse Phalen’s

Wrist flexion (left) and extension

For the tests to be positive, each of the above tests should recreate YOUR symptoms.

Prognosis for CTS : What to Expect

Three to six months is the textbook answer for full resolution of symptoms since CTS involves a nerve injury. Usually it’s closer to 6, but there’s nuance to that and the thing that will never change is …

Remove the thing that’s irritating it.

With night splints and rest breaks, I’ve seen symptoms from CTS improve in 2-4 weeks. They are not totally gone, but manageable.

After child birth, I’ve seen 3-6 months for full resolution of symptoms. The main reason for that is it’s hard for a new mother to do less work

• Nursing

• The baby gets heavier

• Could have multiple children

I recommend wearing your splints during the day time in this instance, but I understand life happens.

Should I get Surgery for CTS?

Surgery seems to be hit or miss. If your compression is so severe that you may lose function of your hand, then you really have no choice.

Right after surgery people notice reduce symptoms and surgery would be considered a success. It could take 6 weeks up to 1 year(!) for full recovery of hand function.

After the area heals, the size of the carpal tunnel may just go back to its original size, so it’s not uncommon for symptoms to return. That can definitely be frustrating and I’ve seen stats saying

87% of cases return even AFTER surgery

Just be sure if you are going to get surgery to know the entire risks and benefits. Worse case scenario is going back into the SAME situation that caused it.

Summary

Splints and activity modification are the best first line treatment for CTS. Nerve glides can give temporary relief, and work place ergonomics can also help improve activity tolerance. Surgery can be effective, but long term symptoms often come back, which questions the usefulness of surgery.