The Deception of Carpal Tunnel Syndrome (and How to Help It)

©2025 T. Agnew-craiyon.com

Failed carpal tunnel release (surgery) revealed another diagnosis. Twelve patients “with CTS” who didn’t improve after release — subsequent manual therapy tests identified other neurologic/soft tissue disorders (i.e., the issue wasn’t the wrist). — Mayo Clinic ProceedingsScienceDirect

In 2024, when Mötley Crüe drummer Tommy Lee developed carpal tunnel syndrome (CTS), surgery at the wrist helped correct the pain and numbness. In Lee’s case, wrist nerve entrapment from overuse in back-to-back tours probably caused the condition.

Like most, he probably was not doing exercises to help prevent CTS while he toured.

During my years of clinical work and medical writing, clinicians often overlooked CTS symptoms from the cervical region and brachial plexus. I wrote about case histories of people who had CTS surgery at the wrist yet still had pain. This distinction is important and can help avoid costly surgeries and even bring relief faster, but how?

If your wrist is numb or painful, I aspire to give you hope based on science, my own experience, and common sense.

CTS Explained

Carpal tunnel syndrome is one of the most prolific (and frustrating) nerve compression disorders, making up nearly 90% of all focal mononeuropathies. Obesity, hypothyroidism, diabetes, rheumatoid arthritis, et al., also contribute, yet a lack of clarity surrounds that 90%.

CTS develops from median nerve compression at the wrist within the carpal tunnel, the area of the wrist with many ligaments, tendons, and nerves sandwiched between the radial, ulnar, and metacarpal bones.

Symptoms include numbness, pain, tingling, and difficulty clasping objects. It sucks. If you have no arthritis or autoimmune disease, chances are it’s temporary unless the overuse continues with no therapy.

Repetitive wrist movements such as typing, playing an instrument, or a misaligned wrist and hand ratio while using a PC mouse contribute to irritation.

If It’s Not in the Wrist, Where Is It?

Surgeons annually perform approximately 400,000 to 600,000 carpal tunnel wrist surgeries in the United States (as my orthopedic friend once told me, “It’s my bread and butter.”) While some get relief, it’s not always the best choice before ruling out other possibilities. For example, cervical radiculopathy (nerve root compression in the neck) often mimic CTS symptoms.

Some studies show that only around ten percent of patients experience issues only at the wrist. It’s common that impingement from soft tissues of the brachial plexus and neck musculature exacerbates the symptoms. Chiropractors and orthopedists call suspected nerve root compression of the spine and wrist impingement double-crush syndrome.

Brachial Plexus and Posture-Related Causes of CTS

The thoracic outlet in the upper thorax is a congested passageway channeling nerves and blood vessels from the neck into the arms. Here’s what doctors won’t tell you: Tight musculature and ridged fascia sheets can form an almost vacuum-like closure on blood vessels, nerves, and lungs.

The interscalene triangle sits at the base of the neck, shaped by the anterior scalene muscle, the middle scalene muscle, and the first rib. The roots of the brachial plexus, which carry nerve signals to the arm, and the third segment of the subclavian artery, which supplies blood to the upper limb, flow through here. When these tissues are tight, compression can develop — and it’s precarious.

I’ll show you how to stretch this area.

Different layers of fascia surround the thoracic cavity and envelop our muscles. I never saw a case of CTS that did not involve muscle and fascia.

Thoracic outlet syndrome (TOS) is a straining of the brachial plexus — whether through disk compression or soft tissue — causing numbness and pain in the wrist.

When this nerve branch is involved in sheer forces, such as in a car accident, damage can cause numbness in the arms and wrist, or even paralysis.

How to Prevent and Help Heal CTS and Brachial Plexus Disorders

In nearly all the cases of CTS I wrote about, patients adopted poor posture working habits and neglected weekly routines to strengthen the wrist, open the thoracic cavity, and stretch the carpal tunnel. Although Lee blamed overuse from drumming, it is still unclear whether anyone showed him therapy protocols before the CTS diagnosis.

One of the most common faults in today’s tech-savvy world is “closed body” positions and poor wrist to hand ratio angles. While I wrote about closed body postures here, I’ll repeat that these postural distortions involve internally rotated arms, kyphotic (head forward) cervical, and an anteriorly collapsed frame (look at the posture of a gamer-teenager).

This is the worst posture to have, and it kills your health faster than anything else (almost). A closed body collapses around your internal organs (including your heart), not ideal.

Exercises designed to address closed body postures and to create more space in the thoracic outlet and wrist are prudent. Here’s how to do them (for a complete protocol for some of these exercises, see the Dynamic Flexibility video).

1. Thoracic Extension. This exercise helps “open” the anterior body and reverse the indelible pressure on internal organs, and also create space in the brachial plexus. You must perform this simple movement daily, especially if you sit for long periods of time.

   
   

How to do it: Lie on your stomach with your hands behind your lower back. Exhale and squeeze the scapula toward the spine, while lifting the chest and looking up. Don’t hold your breath! Repeat 3X10 times.

2. Cervical Stretches. It’s important to lengthen the scalenus muscles (muscles on the anterior neck) as mentioned, the brachial plexus and the roots of other nerves meander through the interscalene triangle.

How to do it: Seated, rotate the head approximately 30 degrees. Actively bring your ear to the shoulder while keeping the angle. You’ll feel the pull from the clavicle, and you might feel tingling in your wrist (a good sign). Breathe throughout. Repeat 3X10 times. Note: you may also move the head at different angles to target other muscles, and even go the opposite direction (ear to the chest, above) to target the upper trapezius.

3. Wrist Flexibility and Strengthening. If you are a writer, gamer, or perform movements that tax the wrist, you must maintain this tunnel by creating a space in the wrist. With the arm extended in front, start palm up and clasp the hand. Pull down and feel the stretch at the wrist.

If you have suspected CTS, go slow until the tissue warms up. You can also move the wrist and hand in circles to create blood flow, and you can stretch your wrist with a closed fist to target the metacarpal bones (a closed fist produces a sliding in these small bones).

To strengthen, use a tennis or a toy ball, squeeze the ball in flexion with your arm extended completely (this pulls the fascia taught and makes the exercise more effective).

Then, work each digit separately, actively squeezing the ball with each digit (you will cry when you get to the pinky finger). You should do at least three sets of 10 reps with each exercise, repeated 3–4 times per week.

Next, focus on extension exercises — always perform these after flexion movements (again, with an extended arm). You can use a rubber band or purchase an extensor band. Wrap the band around the fingers and open the hand into full extension. As with the ball exercise, you can work each digit separately, including the thumb.

Using a wrist roller: If one exercise helps solve CTS, it’s this one. To strengthen the entire wrist, forearm, and shoulders, this one exercise does it all. While you can buy an apparatus like this, you can also make one from PVC pipe. Rotate the pipe both clockwise and counterclockwise for 10X each. Keep the arms extended (you will cry). This targets the extensors and flexors of the arm and wrist. Try and keep the shoulders and body relaxed.

4. Fascia Squats. This incredible exercise pulls on the bands of fascia from head to toe and helps expand the thoracic cavity. In this movement, you gently pull from the fascia in your wrist through the body. This is not a muscle exercise, but a fascia exercise.

Stand relaxed with your legs apart, knees bent. Lift your arms out to the sides and hold them there. Imagine pulling up from the occipital (bony area behind your skull) and down with your tailbone. Lower into a slow squat until you feel your torso bend forward, and come back up. It’s important to keep the pull out from the arms, head, and pelvis as you perform the movement. Repeat 2–6X.

5. Fix poor work postures. For PC and mouse use, adjust your workstation so your elbow is at ninety degrees and your hand and wrists stay lined up. Stop slouching. Keep the chin in toward the spine, but not in a forced manner. Pull up from occipital and down on the pelvis (after a while, this becomes automatic). Get a standing desk to alternate between postures.

To Wrap it Up

If you have some numbness and pain in your wrist, it’s time to be proactive — CTS and thoracic issues are avoidable when caught early. Don’t fall into the surgery black hole if you can avoid it.

For starters, try adding thoracic extension to your week and see what happens. I suggest taking a posture picture sideways before starting, then four weeks later. What do you see? You should see an open body.

Second, add the wrist roller and make weekly exercises part of your work protocol. It’s a powerful exercise that works.

If you have suffered for a long time with tightness and pain in your wrist, rule out radiculopathy from other regions with image tests. Remember, some research suggests that only around ten percent of suspected CTS is in the wrist.

Pull up, pull out, restore. Create space by opening the body.