Is This Carpal Tunnel or What?

Tom the producer (00:01)
Hello, it's Tom the producer, and this is After Injuries. In the last work-related injury episode, we talked about that one bad lift, that one instant at work, and what to do when your low back suddenly goes or grabs.

Today we're talking about something slower and sneakier. You didn't drop a box on your hand, and you didn't smash your wrist in a machine. You didn't fall on an outstretched arm, but instead, over weeks or months, maybe years of doing the same tasks at work, you've noticed, your wrist or hand ache by the end of the day. Certain fingers tingle or go numb, especially at night.

You have to shake your hands out after typing or scanning. And your grip feels weaker than it used to. And there's not one accident date you can point to.

If you've caught yourself thinking, I think my job is slowly wrecking my hands, but I don't know what to call it or who I'm supposed to talk to, then this episode is for you. We're going to talk about what work-related hand and wrist repetitive strain injuries, or RSI, look like when that story is.

not just RSI and it needs medical evaluation, and where chiropractic care can fit in hand and wrist problems and where it doesn't, and how to search for a chiropractor who actually treats hands and wrists from work, not just backs in general. And this is

And this episode is, of course, general information, not personal medical or legal advice for you. Nobody's examined you, and we don't know your full history. You're just using this to sharpen your questions and decisions with your own local providers. Section one. It never popped, it just crept up. Now let's make sure we're talking about your situation.

Before you listen to this whole thing. So you might spend your day typing and mousing in an office, call center, or from your home, or you're scanning items at a checkout or in a warehouse, gripping tools, drills, or vibration-heavy equipment, handling small parts on an assembly line, using a knife, shears, or other hand tools in a kitchen or trade.

No one's asking you what's the date of your accident because there wasn't one. What you've noticed instead is a pattern. At first, your hand or wrist just felt a bit tired at the end of the day. Then it became a dull ache that shows up earlier and earlier in your shift. Maybe your thumb, index, or middle finger tingles or go numb, especially at night.

You might wake up and feel like you have to shake your hands out. Gripping or lifting things, a gallon of milk, a pan, your child feels weaker or more painful than it used to. And you might have heard phrases like carpal tunnel, tendonitis, or repetitive strain injury, but nobody has really sat down and explained what they mean or what to do about them. So that's what we're gonna do next.

Section two, what hand and wrist repetitive strain injuries really are. You'll hear a lot of themes, you'll hear a lot of terms thrown around. RSI or repetitive strain injury, repetitive stress injury, overuse injury, carpal tunnel syndrome, wrist or thumb tendinitis.

So let's simplify. A repetitive strain injury in the hand and wrist is usually irritation or damage to muscles, tendons, or nerves from repeated motions or constant use, particularly without enough breaks or recovery. And a few common patterns from work are first carpal tunnel problems.

Under carpal tunnel problems, we've got the median nerve getting compressed or irritated as it travels through a tight space in the wrist. People feel numbness, tingling, or burning in the thumb, index and middle fingers, usually often worse at night, or when the wrist is bent for a while. And they may drop things, feel clumsy, or wake up needing to shake their hand out.

Then second, there's wrist and thumb tendinitis. and that's a pain along the thumb side of the wrist over the back of the hand. It's aggravated by gripping, lifting, or repeated thumb motions like texting, scrolling, or certain scanner grips. By scanner, think warehouse and checking lots of boxes all day. And you might feel creaking or catching with movement.

And third, there's general overuse aching, And that's a mix of muscle tension, joint stiffness, and mild nerve irritation. Your whole hand and wrist just feel beat up by the end of the day. In many jobs, this happens because you're asking your hands and wrists to.

First, do the same movement hundreds or thousands of times. Second, work in awkward positions with your wristband or fingers stretched. Third, gripping too hard or for too long. And fourth, doing all of that with very few real breaks.

You don't need to prove which exact structure is irritated to start making better decisions, but recognizing that your pain is tied to repetition and load, not a single trauma, helps frame what kind of care and changes might help. Section three, when it's not just RSI, safety first. So just like with backs, we need to separate, quote,

This is annoying and limiting, unquote, from this might be more serious. So hand and wrist pain is usually not a medical emergency, but there are situations where you should prioritize medical evaluation before you think about chiropractic or conservative care as a main solution.

So take it seriously and get medical help first if there was significant trauma. You did drop a box on your wrist. You did fall on your arm. You did slam your hand in the door. A heavy object hit or crushed your hand? Yes. That's an injury.

Or you have rapidly progressive weakness, you suddenly can't grip it all, or you're dropping everything, or the muscles at the base of your thumb are visibly shrinking over weeks, not years, you need to see a doctor.

Or if there are signs of infection or systemic illness, like red, hot, swollen joints or tissues, or a wound in the area that looks infected, fever, feeling unwell, or multiple joints flaring, see a doctor. or

If nerve symptoms are severe and constant, like continuous numbness, burning, or shooting pain that doesn't change with position, or symptoms marching up the arm rapidly, those situations may require imaging, blood work, nerve testing, or a referral to a specialist, not just conservative care.

So for this episode, we're going to stay in the lane where your symptoms came on gradually, and there's no major trauma or deformity, or your hand, wrist pain, and tingling are very clearly tied to how much and how long you use them at work. And calm down at least somewhat with rest. That's where conservative care, including chiropractic, in some cases might be reasonable to consider.

Section four, where chiropractic can fit for hand and wrist problems. A common question is: don't chiropractors just work on backs? What do they have to do with my wrist or my hand? Well, yes, many chiropractors do treat extremities, including hands and wrists, especially when there's a clear mechanical and overuse story.

Especially when there's a clear mechanical and overuse story. Here's what chiropractic care might look like in that context. Section 4.1, looking beyond just the wrist. Your hand and wrist don't exist in isolation. The nerves that supply your hand come from your neck, travel through your shoulder and elbow, and then into the wrist and palm. The way of your shoulder, elbow, and neck.

The way your shoulder, elbow, and neck move can affect how much tension or compression ends up at the wrist. A good exam for hand and wrist complaints should include the following: neck and upper back motion joint checks, shoulder and elbow assessment, specific testing of wrist and hand joints, and soft tissue.

Basic neurological checks for sensation, strength, and reflexes in the arm. A chiropractor working in this space might use spinal adjustments or mobilizations in the neck, upper back if they find restrictions there. They might use gentle wrist and hand mobilizations or adjustments if specific joints are stiff or misaligned in a way that seems relevant. The goal is not to crack everything.

The goal is to restore more normal motion where it's limited and reduce nerve irritation upstream and around the wrist. Section 4.2: Soft tissue work around the wrist and forearm. In repetitive strain injury, the muscles and tendons in your forearm and hand are often overlooked.

A chiropractor might use myofacial release on the forearm flexors and extensors, thumb or tool based work on tight bands of muscle, gentle stretching or traction at the hand or wrist. None of this is magic, but it can decrease local pain and tightness, improve your tolerance for movement.

And make it easier to do the exercises and ergonomic changes that actually create longer-term change. Section 4.3 activity changes and how you use your hands at work. So if the problem was caused by how you use your hands, then any realistic plan has to address how you use your hands.

A chiropractor who really understands RSIs should ask, What exactly do you do with your hands and wrists all day? How many hours per shift? What does your keyboard or scanner grip look like? Are you doing this five days a week, night shifts, overtime?

Then they should help you think about task modification where possible, reducing or breaking up the most aggravating motions, and micro breaks, short pauses every so many minutes to move your hands and wrists differently. If no one talks to you about what your job actually requires, it's very hard to fix a work-related RSI for more than a few days at a time.

Section 4.4 home exercises, self-care. Good conservative care almost always includes things you can do yourself. And that might include first specific stretches for wrist flexors and extensors, nerve gliding exercises, if appropriate and instructed, or grip and thumb strengthening in a controlled way.

Or shoulder and upper back exercises to support better arm mechanics. Or shoulder and upper back exercises to support better arm mechanics. And you won't need a bodybuilding program. You need a few targeted movements that first gradually increase your hand and wrist capacity. Second, help you tolerate the work you still need to do.

And third, reduce the second chance that symptoms flare every time that work gets busy. And third, reduce the chance that symptoms flare every time work gets busy. Section 4.5, what chiropractic is, not for carpal tunnel type problems. One important note here: chiropractic care doesn't widen the tunnel in your wrist the way surgery aims to.

What it can potentially do in some mild to moderate cases is improve mechanics in the neck, shoulder, elbow, and wrist, reduce muscle tension and tissue irritation that add pressure to nerves, reduce muscle tension and tissue irritation that add pressure to nerves, help you adjust your activities and ergonomics so the nerve is under less stress.

There are people who respond well to that, and there are people whose nerve compression is too advanced, and they need imaging, they need nerve testing, or a surgical opinion. A chiropractor who is honest about that difference who can say,

We'll try conservative care for X weeks, but if you don't change in these specific ways, I want you to see a neurologist or surgeon. That is the chiropractor you want on your team. Section five, work injury reality when there's no single date.

Now let's zoom out to the work injury system. With a single accident, you can say I hurt my back on March 2nd when I lifted that box. With hand and wrist RSIs, your story might sound like: I've been doing this job for years, but the numbness and pain really started in the last six months. Or it's clearly worse on workdays and eases a bit on the weekends. Or it ramped up after we got new equipment or after my workload changed.

Different places have different rules, but often conditions like carpal tunnel or wrist tendonitis can be considered work-related when job tasks are a major contributing factor. And because there's no one accident, how you describe your tasks and how early you report becomes more important. So that might mean first letting your supervisor or HR know as soon as you suspect a work can connect.

Letting your supervisor or HR know as soon as you suspect a work connection, even if you can't name a single date.

And being specific about tasks, typing X hours a day, scanning X items, gripping tools, working in cold environments, et cetera. And being consistent about that story with every provider you see. Again, I'm not giving legal advice, but if you think your hand or wrist problem is work-related and you're not sure how to navigate that, your options might include.

A asking your employer or occupational health department how to report gradual onset injuries. B calling your state's workers' comp information line if you have one. C talking to a workers' comp attorney if things start to look complicated. The Cairo's role is clinical. Examine, treat where appropriate, document what they see, and know when to loop in other providers like imaging.

Section six, how to search for a hand and wrist savvy chiropractor. So let's say you're in that RSI lane, not the emergency medical lane. So you're reporting things appropriately at work. You've decided conservative care is worth exploring, and you're open to chiropractic as part of that. How do you find someone who actually treats hands and wrists, not just low backs?

6.1, use more specific search terms. Instead of searching chiropractor near me, you're going to want to try carpal tunnel chiropractor, your city, or wrist pain from typing chiropractor, your city. Or hand numbness from work, chiropractor, your city.

Or finally, repetitive strain injury, chiropractic, your city, and descriptive terms like that. And these kinds of searches are more likely to pull up chiropractic clinics that explicitly talk about carpal tunnel type issues, mention wrist and hand pain, and discuss repetitive work-related problems versus general wellness.

Section 6.2, what to look for on their website. So you'll click through a few clinics and you'll scan for hand and wrist content pages or sections about carpal tunnel, wrist pain, hand pain, or repetitive strain of the upper extremities. And you'll look for evidence.

That they and you'll look for evidence that they treat extremities, mentions of shoulder, mentions of elbow, wrist, and hand, not just spine. Discussion of ergonomics or workplace factors. That might include articles about keyboard or mouse setup, workstation posture, brakes, or tool use.

Then work injury language that includes repetitive strain, not just falls and crashes, but also repetitive stress or overuse at work. If a clinic's entire online presence is we treat back and neck pain, and there's nothing about hands, wrists, RSIs, that doesn't automatically mean they can't help, but it does mean you'll have to ask them specific questions before you bother showing up on premise.

Section seven, questions to ask before you book. So once you've narrowed it down to two or three clinics that look promising, give them a call. And you can use these actual questions. You can say, Hi, I have a hand and wrist symptom that seemed to be related to repetitive work. I'm trying to figure out if your clinic is a good fit. Can I ask you a few questions?

Then ask first question: Do you regularly treat work-related repetitive strain injuries in the hands and wrists? You want to hear the following. Yes, we see that fairly often, or we see a lot of carpal tunnel type and wrist overuse problems. Not just, sure, we treat everything with no specifics.

Question two, do you treat wrists and hands directly or do you only adjust the spine? Here you're trying to confirm whether they actually examine and treat wrists and hand joints in soft tissue and are comfortable with extremity work, not just spinal adjustments. If they never touch wrists and hands, that's not who you're looking for in this context. Question three.

What else do you do besides adjustments like soft tissue work, exercises, ergonomic advice? A strong answer would include soft tissue approaches for the forearm and hand, a plan to give you specific exercise or stretches, and at least a conversation about your work setup or your tasks.

Again, if they say we adjust your spine three times a week, that's a limited approach and not for work-driven RSIs specifically. Move on to question four. If my hand or wrist problem is being handled as a work injury, can you help with documentation or work notes if appropriate?

So here you're looking for someone who is comfortable documenting what they see, can write basic notes about restrictions or modifications, and is open to communicating with your other providers when needed. If they openly shut down at the if they immediately shut down at the idea of paperwork, it's important for you to know up front. Question five. In what situation would you refer me to another provider, like a neurologist or a hand surgeon?

You want them to have clear referral lines, such as you want them to draw clear lines for when they refer out, such as progressive weakness or muscle wasting, persistent severe numbness or pain despite conservative care, or suspicion of something more serious than an overuse problem. If the answer is essentially, no, we fix everything ourselves, that's a red flag.

Section eight, bringing it together. So let's pull this first part around. And we've been talking about hand and wrist from repetitive work, the slow burn injuries that are not tied to one dramatic accident. But to do what you do thousands of times at your job, the big takeaways are repetitive strain injuries in the hand and wrist are usually about load and repetition, not a single moment of trauma.

And not every hand story is just RSI. Rapid weakness, big trauma, infection, signs of severe or constant nerve symptoms need medical evaluation.

And chiropractic care can sometimes help in mild to moderate, appropriately selected cases by addressing joint mechanics, muscle, and tendon tension, and the way your neck, shoulder, and wrist all work together, and by helping you change how you use your hands. For work-related RSIs, how you describe your job tasks and how early you report can matter a lot, especially if you want it recognized as a work injury.

When you look for a chiropractor, when you look for a chiropractor, don't just look for closest. Look for someone who actually treats hands and wrists, asks about your job, and knows when to refer on to someone else.

In part two, we're going to move up the chain and talk about shoulder overuse from work, stocking, reaching, lifting, and all the ways your job can quietly beat up your shoulders over time and how to think about chiropractic in that context.

Thanks for listening to this one and take care of your hands. Future you still needs them for pretty much everything. And don't forget to like or subscribe on YouTube or at after injuries.com.

This is Tom the producer. This is after injuries. We'll talk soon.