Don’t Pinch Me

I have carpal tunnel syndrome, badly and in both hands. When it is aggravated, I can’t hold my phone, read, or drive a car without pain. I have had to give up riding my bicycle and playing classical guitar.

Not surprisingly, I was planning on getting surgery to release the carpal ligament. I’m rethinking that idea because the root of the problem may not be in my wrists.

What is Neuropathy?

Carpal Tunnel Syndrome is a symptom of neuropathy. All forms of neuropathy have one thing in common: nerve damage in the peripheral nervous system, meaning outside the brain and spinal cord, causing a change in how your nerves work. It can affect your sensory nerves (how you feel), motor nerves (how you move), and your autonomic nerves (how your body functions, such as breathing).

Neuropathy along right-side chest following a sports injury (large blue region)

Neuropathy along right-side chest following a sports injury (large blue region)

Neuropathy is caused by many diseases and conditions, ranging from diabetes to vitamin D deficiency to injury to repetitive motion to kidney diseases to inflammation. The two most common symptoms are either loss of feeling (such as with diabetes) or pain (such as with carpal tunnel syndrome). Additionally, neuropathy is commonly caused by pinching, entrapment, or compression of a nerve or nerves.

For example, inflammation of the carpal ligament puts pressure on the median nerve, causing tingling and pain in the palm and fingers. A nerve may become “pinched” in the hip due to extended periods of immobility under stress. (Actually, pinching is not accurate: rather, nerves are typically compressed, or squeezed, due to swelling in surrounding tissue.)

Diagnosing Neuropathy

Neuropathy can be challenging to diagnose correctly, depending on the root cause, the specific point of nerve damage. Often, the nerve damage occurs at one place, but the symptoms occur further along the nerve path where the nerves terminate or in the regions they control. For example, if a nerve becomes compressed as it exits the spinal column, it may cause symptoms in the shoulder, along the arms, or, even, down a leg.

Think about that last paragraph from a medical treatment standpoint. It’s very important: Nerve compression can occur at one place but cause symptoms somewhere else.

This is different than, say, cutting your finger with a knife. You cut your finger, and your finger hurts—right where it has been cut. The damage and the symptoms occur at the same place. The diagnosis of the pain producing cause is simple. Not so with neuropathy.

This is apparent through thermography, which examines your body’s heat signature for medical diagnostic purposes. The location of inflammation and nerve compression typically show up “hot,” and the areas affected by the compressed nerves typically show up “cold” by comparison.

If the compression occurs near the end of the nerve or along the nerve, the symptoms and compression may both express an elevated temperature.

Nerve damage or compression may also be diagnosed through nerve conduction studies, called electromyography, which consist of transmitting electrical currents through a nerve and measuring the electrical flow. This is generally only done if a neuropathy is highly suspected, such as with diabetic patients.

“Cold” right knee (left side) from compressed nerve, and corresponding sympathetic distress along left leg (right side)

“Cold” right knee (left side) from compressed nerve, and corresponding sympathetic distress along left leg (right side)

A client may complain of pain at one location, but if his body is expressing a low temperature at the symptom location and an elevated temperature further up the nerve, very likely the client is experiencing some form of neuropathy.

Here is why this is important: Providing treatment at the location of the symptoms will not solve nerve compression occurring at a different location. The normal medical practice is to treat the location of the body expressing symptoms. A compressed nerve in a different location may remain untreated, and the symptoms will return once the treatment wears off.

Treating Neuropathy

Treatment for neuropathy depends on the cause and location of the neuropathy. Nerve damage caused by diabetes will require treating the diabetes. Nerve damage caused by injury will require treating the injury. These neuropathies likely need medical attention.

However, many neuropathies are self-treatable or treatable through non-medical intervention, such as through use of ergonomic office equipment, non-steroidal anti-inflammatory supplements, and moderate exercise with flexibility enhancing movement. Supplementing your diet with flaxseed may reduce inflammation causing nerve compression. Steroid (e.g., lidocaine, prednisone) shots may help temporarily because they reduce inflammation. Acupuncture, too, may be beneficial.

Before any intervention plan, however, know whether or not you are experiencing neuropathy and the root cause of the neuropathy, such as the actual location and cause of the nerve compression.

The best advice is this: Make sure you are treating the root causes, not the symptoms. This means checking for neuropathy if you have pain or the absence of feeling. The cause may not be where you have symptoms.

Now, to return to the start: Why am I reconsidering carpal tunnel surgery? I have symptoms in my hands and fingers, and when the carpal tunnel is highly aggravated, I can have pain up my arms and, even, into my shoulders. After all, the same nerve in my wrist runs up my arms to the base of my neck.

Hot spots in wrists and shoulders, corresponding cold hands

Hot spots in wrists and shoulders, corresponding cold hands

Thermal scans show that my hands and wrists are “cold” compared to the rest of my body, but they also show “hot spots” in the inside of my elbows and the front of my shoulders, right where the median nerve runs.

As I monitor my activities while experiencing symptoms, my elbows are generally bent and bearing weight or under pressure, such as when holding a book or phone, holding on to the steering wheel, holding the neck of my guitar. Thus, my symptom analysis confirms what the scans show. What I thought was carpal tunnel syndrome may be pronator teres syndrome, which has a very different treatment.

Carpal tunnel surgery will relieve the pressure in my wrists, but if the root cause is nerve damage or compression in my elbows, the surgery will not solve the problem, only delay the return of the symptoms. By finding out the root problem, I have avoided a pointless surgery, which is good. Also, now that I have a better idea about what may be causing my pain, I can explore options to treat the real cause.

More information:

http://www.medicalnewstoday.com/articles/147963.php
http://www.webmd.com/pain-management/guide/neuropathic-pain
http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/

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