Carpal Tunnel Syndrome VS Cervical Radiculopathy
By: Dr. Amanda Boccio
It’s just before lunchtime, and you’ve had a busy morning at the office. Calls have been coming in non-stop, so you’ve had the phone clenched between your right ear and right shoulder as you simultaneously work at your computer. You start to notice a faint pins and needles sensation in your right index finger, and your forearm starts to cramp and stiffen up. You hang up the phone, shake out the hand and notice how tight your neck and shoulder feel from hunching over the keyboard. “Thank goodness I can take a break to move and stretch out”, you think to yourself. “It’s been so crazy at work, I can’t tell if I’ve aggravated my disc bulge from two years ago, or if I’m starting to get carpal tunnel!”
Patients commonly seek advice from their health care provider when they experience numbness, tingling or pain in the hand or upper extremity. The key to developing an effective treatment plan to address these symptoms is to find the source of the problem.The nerves that provide sensation, power muscles, and elicit pain in the upper extremity exit the spinal cord as nerve roots in the neck, or cervical spine. These nerves can be irritated in several predictable locations, especially at the wrist, as they traverse from the neck to the fingertips. Irritation of the 7th cervical nerve root in the neck and irritation of the median nerve at the wrist can both cause symptoms into the hand. How can we determine the difference between carpal tunnel syndrome and a cervical spine issue when symptoms seem to overlap?
Carpal Tunnel Syndrome is the compression of the median nerve at the wrist. Symptoms include pain, numbness, tingling and weakness typically affect the palm, thumb, index, middle and part of the ring finger. These symptoms can be caused by arthritis in the wrist, repetitive motion, or even swelling and fluid retention during pregnancy. With a true carpal tunnel syndrome, symptoms are often aggravated by repetitive hand and wrist motion such as with typing, gripping a screwdriver, or even using equipment that vibrates- like a snow blower. Patients will complain of numbness and tingling when they sleep, especially if they curl their wrists and hands under the pillow. They will have the urge to “shake out” their hand upon waking in the morning. If symptoms persist, weakness in grip strength or clumsiness with fine motor activities may result. Carpal Tunnel Syndrome can be treated conservatively with manual therapy, modalities, forearm and wrist stretching exercises, and night splinting.
Cervical Radiculopathy is a condition where hand and arm symptoms are caused by compression or irritation of the nerve roots exiting the spine in the neck. Symptoms include pain, changes in sensation, muscle weakness and diminished reflexes in a predictable pattern based on which nerve is affected. The cervical nerve roots can be irritated by common neck conditions including disc bulge or herniation, and arthritis. Degenerative changes in the cervical spine that occur with aging include decreased disc height, and formation of bone spurs. Decreased disc space combined with bony hypertrophy leads to narrowing of the spaces for the cervical nerve roots. Mechanical impingement of these nerves can lead to symptoms into the arm and hand. C6-C7 disc pathology, or degenerative changes in this motion segment impinge upon and irritate the C7 nerve root. This is the most commonly affected nerve root- and it just so happens to overlap the areas of the hand and arm innervated by the median nerve.
When hand symptoms are caused by cervical radiculopathy, patients often have concurrent neck pain, stiffness and decreased range motion. Pain, numbness and tingling in the hand are often reproduced with neck extension and rotation (like when turning your head to check your blind spot in the car) or prolonged sitting with poor posture (like the office worker described above). Conservative management is very effective for symptoms caused by cervical radiculopathy. Treatments include cervical traction, chiropractic adjustments, soft tissue therapy, modalities, stretches and exercises to improve posture.
Differentiating between carpal tunnel syndrome and cervical radiculopathy can be challenging. At the Sports & Spinal Wellness Center, we are more than happy to work with you to determine the root cause of your symptoms and formulate a treatment plan to get you back to feeling well. As always, if you have questions about the article, please feel free to contact me at 518-869-3415. Follow us on Facebook or visit our website at www.sportsandspinalwellness.com.