Hand weakness / numbness

[Will Morris]

As much as I would like to resume my training, not sure if I want to go through the risk of it (despite the low failure rate) when my hand is normal without training.

Okay, so the end stage treatment for carpal tunnel syndrome is a 45 minute outpatient procedure that may keep you out of work for three days. The risk of ending up having to have a 45 minute procedure is enough to invite the risk of the metabolic and systemic effects of a prolonged period of time without training.

[jfsully]

Get a good exam from a neurologist who is a neuromuscular specialist. It sounds like you’ve had EMG, which should readily diagnose a median vs radial vs cervical vs plexus vs whatever kind of nerve problem, if the performing doc is good.

And don’t let Rip operate on your carpal tunnel to fix your “radial nerve shit” for god sakes. That’s the wrong nerve!

If you only get symptoms after training, you should get the EMG after training when you have symptoms.

You can search online for nerve distribution diagrams and see which fits your symptoms the best, but a good exam by a smart neurologist is the best bet for diagnosis. There is a numbness pattern for sensation and a weakness pattern for strength that correlates with each nerve distribution. Here’s a sensory diagram: Google Image Result for https://content.healthwise.net/resources/12.1/en-us/media/medical/hw/h9991344_001.jpg

If you do have carpal tunnel syndrome, you should first get wrist splints. Wear them at night, and for as much of the daytime as you can manage. Might avoid surgery entirely! You should probably get some wrist wraps for lifting too.

[Mark Rippetoe]

Right. Median nerve. Sorry. Won't send you a bill this time.

[Will Morris]

Get a good exam from a neurologist who is a neuromuscular specialist. It sounds like you’ve had EMG, which should readily diagnose a median vs radial vs cervical vs plexus vs whatever kind of nerve problem, if the performing doc is good.

And don’t let Rip operate on your carpal tunnel to fix your “radial nerve shit” for god sakes. That’s the wrong nerve!

If you only get symptoms after training, you should get the EMG after training when you have symptoms.

You can search online for nerve distribution diagrams and see which fits your symptoms the best, but a good exam by a smart neurologist is the best bet for diagnosis. There is a numbness pattern for sensation and a weakness pattern for strength that correlates with each nerve distribution. Here’s a sensory diagram: Google Image Result for https://content.healthwise.net/resources/12.1/en-us/media/medical/hw/h9991344_001.jpg

If you do have carpal tunnel syndrome, you should first get wrist splints. Wear them at night, and for as much of the daytime as you can manage. Might avoid surgery entirely! You should probably get some wrist wraps for lifting too.

Doctor JFSully, I'm not sure he necessarily needs a referral out to a specialty provider. Since he already has had an EMG which apparently showed electrodiagnostic evidence of sub-clinical carpal tunnel syndrome, he would probably do just fine with a standard FP/FNP/PA/General Practitioner. The Phalen's Test demonstrates solid specificity and acceptable sensitivity, and, if he self-reports having to shake his hands during repeated tasks to bring about relief, that meets the diagnostic physical exam criteria for CTS.


I asked for the lifting video because I would almost bet my next paycheck that his hands are in end range wrist extension with the bar near the MCP joints instead of on the thenar eminence. Also, because I'd bet my paycheck that he does not use wrist wraps.


To the OP, what the good doctor said is absolutely right. First line treatment for Carpal Tunnel Syndrome is night wrist splinting, wearing wrist splints during aggravating or repetitive tasks, and that is enough treatment for the vast majority of people. But, I had a Carpal Tunnel Release as a part of my Ulnar Collateral Ligament Reconstruction. They had to harvest my Palmaris Longus out of my other arm, and I have never, ever had any issues with it. It was fine immediately after surgery....and, I had electrodiagnostics performed pre-surgery which showed mild Carpal Tunnel Syndrome in that hand.

[chalky]

Doctor JFSully, I'm not sure he necessarily needs a referral out to a specialty provider. Since he already has had an EMG which apparently showed electrodiagnostic evidence of sub-clinical carpal tunnel syndrome, he would probably do just fine with a standard FP/FNP/PA/General Practitioner. The Phalen's Test demonstrates solid specificity and acceptable sensitivity, and, if he self-reports having to shake his hands during repeated tasks to bring about relief, that meets the diagnostic physical exam criteria for CTS.


I asked for the lifting video because I would almost bet my next paycheck that his hands are in end range wrist extension with the bar near the MCP joints instead of on the thenar eminence. Also, because I'd bet my paycheck that he does not use wrist wraps.


To the OP, what the good doctor said is absolutely right. First line treatment for Carpal Tunnel Syndrome is night wrist splinting, wearing wrist splints during aggravating or repetitive tasks, and that is enough treatment for the vast majority of people. But, I had a Carpal Tunnel Release as a part of my Ulnar Collateral Ligament Reconstruction. They had to harvest my Palmaris Longus out of my other arm, and I have never, ever had any issues with it. It was fine immediately after surgery....and, I had electrodiagnostics performed pre-surgery which showed mild Carpal Tunnel Syndrome in that hand.

About 6 months months ago, I started back on just low bar squats starting with just the bar and worked my way back up to 120kg over a span of couple months. During that process, the numbness slowly came back but I was able to reduce it by wearing some wrist wraps and wait for it. ......gloves, although this was only temporarily and the numbers still continued.

In terms of wearing splits during the night, I did do it for a couple months but not sure if it really helped? Without doing any weight training, I don't get any sort of numbness at all even after waking up.

But

[jfsully]

Doctor JFSully, I'm not sure he necessarily needs a referral out to a specialty provider. Since he already has had an EMG which apparently showed electrodiagnostic evidence of sub-clinical carpal tunnel syndrome, he would probably do just fine with a standard FP/FNP/PA/General Practitioner. The Phalen's Test demonstrates solid specificity and acceptable sensitivity, and, if he self-reports having to shake his hands during repeated tasks to bring about relief, that meets the diagnostic physical exam criteria for CTS.


I asked for the lifting video because I would almost bet my next paycheck that his hands are in end range wrist extension with the bar near the MCP joints instead of on the thenar eminence. Also, because I'd bet my paycheck that he does not use wrist wraps.

You’re right, the EMG probably did give us the answer already. The reason I suggested Neuro eval is that OP seems to have doubt about the diagnosis, and the symptoms as described are not classic CTS. Better to trust an actual exam than subjective typed descriptions.

If it were me, I would skip the neurologist and wear splints at night and wrist wraps for lifting, and see how it went. Most CTS release goes swimmingly, like yours, but non-surgical treatments are better, if they work.

Or, OP could continue asking message boards for “years” instead of trying something. I guess some people prefer that. So, OP should either try splints and wraps or head to the Neuro and/or the surgeon. Either would be better than spending more time at the keyboard trying to solve a mystery that can’t be solved by typing (and with CTS maybe getting worse with each key click).

[Will Morris]

You’re right, the EMG probably did give us the answer already. The reason I suggested Neuro eval is that OP seems to have doubt about the diagnosis, and the symptoms as described are not classic CTS. Better to trust an actual exam than subjective typed descriptions. Agreed. The described symptoms are kind of nebulous. I really get the heebie-jeebies when I see someone come in with reduced muscle tone or atrophy of the thenar eminence. If that isn't occurring, night splints and activity modification are the soup-de-jour for treatment.

If it were me, I would skip the neurologist and wear splints at night and wrist wraps for lifting, and see how it went. Most CTS release goes swimmingly, like yours, but non-surgical treatments are better, if they work.I think I may have to accept the fact that my recovery was perhaps a bit different from other people because I, too, am different from most people.

Or, OP could continue asking message boards for “years” instead of trying something. I guess some people prefer that. So, OP should either try splints and wraps or head to the Neuro and/or the surgeon. Either would be better than spending more time at the keyboard trying to solve a mystery that can’t be solved by typing (and with CTS maybe getting worse with each key click).

I sincerely appreciate you jumping in here and contributing.

[chalky]

The neutrologist I saw on a number of occasions threw the same hospital that I've been seeing for my Crohn's didn't give me much faith. It was actually different neurologist over the period and there weren't able to give a definite diagnosis.

But forgetting that for now, what sort of wrist splints are we taking about for weightlifting as the ones used at night time are quite bulky and would make gripping the bar quite difficult?

Are wrist wraps sufficient?

[jfsully]

Yes, wrist wraps for training. Splints at night and whenever else you can manage. If you are at a keyboard for work, make sure your ergonomics are good (wrists straight or slightly flexed while typing).

And while training be diligent about keeping wrists straight and not in extension on press and squat.

[chalky]

I also assume any exercise involving wrist extension like power cleans and front squats should be avoided?