Carpal tunnel syndrome is well treated if it is caught before the nerve has sustained permanent damage. For an athlete, this means changing the technique and load in time, and in case of persistent symptoms, do not postpone the examination. The editors explain how to reduce the risk, what tests doctors use and at what stage a specialist is needed.
Prevention: technique, load, recovery
The main principle of prevention is to reduce long-term pressure on the carpal tunnel. The pressure in it is minimal when the wrist is in a neutral position, and increases with pronounced flexion or extension. Therefore, in training, you should pay attention to the position of the hand: when pressing, keep the wrist flat over the forearm, and not "bent" back.
For exercises with a large extension of the wrist - push-ups, front squats, handstands - it is useful to use supports or dumbbells instead of palms on the floor, improve mobility gradually and do not increase the volume sharply. Wrist wraps should support the joint in heavy sets, but not be tightly tightened throughout the workout.
Cyclists are advised to adjust their posture so that the weight of the body does not lie mainly on the hands, use gloves with gel inserts, regularly change the position of the grip on the steering wheel. For climbers and athletes who work a lot on grip, it is important to gradually increase the load and plan rest days for the hands.
Outside the hall, the risk increases when working on a computer, using the phone and playing smartphone games. An ergonomic workplace, a neutral position of the wrist when working with a keyboard and mouse, breaks every 30-60 minutes are simple measures that reduce the total load. Weight control, treatment of hypothyroidism and diabetes are also part of prevention.
Early signs and self-observation
The first symptoms usually appear at night: a person wakes up due to numbness or tingling in the thumb, index and middle fingers, shakes the hand - and the feeling goes away. Over time, the symptoms also appear during the day: while holding the steering wheel, the phone, a book, after reaching for a grip.
- Nocturnal numbness of the fingers, which passes after shaking the hand.
- Tingling with prolonged wrist flexion.
- Clumsiness: difficult to fasten buttons, hold small objects.
- Weak grip, dropping objects.
- The little finger is usually not involved—this helps distinguish it from ulnar nerve damage.
At this stage, it is useful to analyze the changes in recent weeks: has the amount of grip training increased, has the technique changed, or has swelling appeared. Athletes who have started taking hormonal drugs, especially growth hormone, should consider that they may be the cause, which is directly stated in the official instructions for somatropin.
A night splint that fixes the wrist in a neutral position is a simple and safe remedy for mild symptoms. A Cochrane review by Page et al (2012) found that splinting may provide short-term relief, although the quality of the evidence is limited. A splint is not a substitute for an examination if symptoms persist for more than a few weeks.
A symptom diary helps the doctor: when does the numbness occur, which fingers are involved, is there a connection with certain exercises, with medication, with swelling. This takes a few minutes, but speeds up the diagnosis.
Diagnostics: clinical tests and instrumental methods
The diagnosis of carpal tunnel syndrome is primarily clinical, that is, it is based on symptoms and examination. The review by Padua et al. (2016) and the clinical guideline of the American Academy of Orthopedic Surgeons (AAOS, 2016) describe several provocative tests that the physician performs at the appointment.
| Method | Essence | What it shows |
|---|---|---|
| Tinel's test | Tapping above the carpal tunnel | Tingling in the fingers supports the diagnosis |
| Phalen's test | Maximum wrist flexion for 60 seconds | The appearance of symptoms supports the diagnosis |
| Durkan test (compression) | Finger pressure on the area of the canal | Reproduction of symptoms |
| Electroneuromyography (EMG) | Measurement of nerve conduction velocity | Confirmation and assessment of severity |
| Ultrasound of the median nerve | Cross-sectional area measurement | Thickening of the nerve, identification of causes of compression |
Electroneuromyography remains the most accurate method of assessing nerve function. It allows you to confirm the diagnosis, determine the degree of damage and exclude other causes - cervical radiculopathy, polyneuropathy, ulnar nerve damage. ENMG is almost always performed before the operation.
To find the causes, the doctor can prescribe tests: TSH to rule out hypothyroidism, glucose or HbA1c to assess diabetes, rheumatological markers if arthritis is suspected. If there are signs of acromegaly or a person has used growth hormone, the level of IGF-1 is evaluated. In order to interpret the results, it is important to inform the doctor about all medications.
Treatment and when to consult a doctor
For mild and moderate symptoms, treatment is usually conservative: reduction of provoking loads, night splint, treatment of the underlying condition (hypothyroidism, diabetes), discontinuation of the drug that causes edema, if possible. A Cochrane review by Marshall et al (2007) found that topical corticosteroid injection provided short-term relief that exceeded the placebo effect.
If conservative measures do not help, symptoms are constant or there are signs of nerve damage, consider surgical decompression — dissection of the transverse ligament of the wrist. The operation is performed by an open or endoscopic method; most patients report significant relief. The return to hand strength training is gradual and is discussed with the surgeon.
See a doctor without delay if the numbness becomes permanent, there is noticeable weakness of the grip, muscle wasting at the base of the thumb, or the symptoms increase rapidly. These are signs that the nerve is being damaged and the window for full recovery is narrowing.
Acute symptoms after a wrist injury (fractures, dislocations), sudden weakness of the arm with speech impairment or facial asymmetry (possible stroke), as well as numbness spreading to the entire arm with neck pain require urgent examination. In the planned order, it is worth contacting if night symptoms last more than 2-4 weeks despite a change in workload.
Editorial conclusions
The prevention of carpal tunnel syndrome is a neutral position of the wrist during exercises, a gradual increase in grip loads, proper adjustment of equipment and ergonomics outside the gym.
The diagnosis is made clinically based on the symptoms and tests of Tinel, Phalen and Durkan, and is confirmed by electroneuromyography and ultrasound. It is important to find and treat the causes — hypothyroidism, diabetes, edema, the influence of drugs, primarily growth hormone.
Permanent numbness, weakness, and atrophy of the muscles of the thumb are grounds for immediate medical attention.
The editors also recommend reading our materials on the causes of carpal tunnel syndrome in athletes, on the side effects of growth hormone and on the prevention of hand injuries in strength sports.
List of used literature
- Padua L, Coraci D, Erra C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016;15(12):1273â1284.
- American Academy of Orthopaedic Surgeons. Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline. Rosemont, IL: AAOS; 2016.
- Page MJ, Massy-Westropp N, O'Connor D, Pitt V. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;(7):CD010003.
- Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007;(2):CD001554.
- Atroshi I, Gummesson C, Johnsson R, et al. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153â158.
- Liu H, Bravata DM, Olkin I, et al. Systematic review: the effects of growth hormone on athletic performance. Ann Intern Med. 2008;148(10):747â758.
