Injuries and Medical Advice: Carpal Tunnel

Q:
I feel pins and needles in my first three fingers. I think I have pronator-teres syndrome? Could this be related to using a screwdriver? Climbing?

— Arnie, South Africa

A:

You may have generated pronator-teres syndrome. There is also a chance you will contract leprosy. I have seen pronator-teres syndrome twice in 15 years, but one of my medical comrades has seen leprosy four times in the same period so I am thinking leprosy is twice as common.

I appreciate that climbers, given the muscular development and general load put through their forearms, are candidates for nerve-compression syndromes. The truth, however, is that nerve entrapment in the forearm, and in the arm generally, that could be attributable to climbing is rare.

Numbness in the hand is more likely to be carpal-tunnel syndrome, which is the most common nerve-compression problem in the arm, usually seen in people such as carpenters who use tools all day. Climbing is not a significant catalyst. If you have overt weakness pronating the hand (turning your hand from palm up to palm down while keeping the rest of the arm stationary) then pronator-teres syndrome is somewhat more likely.

Although surgery is an option for carpal-tunnel syndrome, your first port of call should be to a PT; chances are your wrist is rather tight and would benefit from being loosened up. Bracing the wrist usually compounds the problem.

The nerves of the forearm can be impinged at various points. Signs and symptoms that vary from pins and needles as you are feeling to muscle wasting and weakness are grounds for further investigation. A nerve conduction study or an MRI is the investigation of choice.

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