Had/have carpal tunnel syndrome? Had surgery, it's working out.

[Muse]

I have it, severe, in both hands. First knew I likely had an issue with it over 20 years ago when I had a difficult to diagnose and treat left shoulder problem. That came crucial one day almost 30 years ago while doing my daily 2 mile lap swim. Had to stop and I have never tried lap swimming again. I used to be very aggressive in the pool (I had a reputation!). Before my ~55 minute 2 mile swim I'd spend 1 1/2 hours in the weight room. I was very dedicated to physical fitness. I still am, but I can't do those things like I used to.

A few years later, when I was on COBRA, I was referred to a highly regarded shoulder surgeon. Tried lots of stuff including x-rays, MRI, cortisone shots, PT, we weren't getting anywhere and he sent me to get a nerve conduction study ("EMG"). The guy doing this (probably an M.D.) told me as an aside that it appeared I had some carpal tunnel syndrome going on in there, just an FYI. I didn't think about it too much, but I remembered it. I not long afterward had arthroscopic shoulder surgery, which did a lot to resolve the shoulder pain issues.

I've gotten numbness and tingling in my hands at times in the last 20 years. Especially at night sleeping, also when riding my bicycle. Shaking my hands (I thought) made it go away and I chocked it up to circulation issues, maybe something causes a lack of oxygen, or something pinched a nerve temporarily, and I didn't think much of it.

Almost 2 months ago I felt a numbness at the tip of my right thumb and it hasn't gone away. 1 1/2 years ago I had a really bad sprain of my right pinky and I became acquainted with all 3 hand surgeons at my HMO (Kaiser Permanente) local facility, also, now, a couple of their therapists. That's largely resolved now, although the finger isn't 100%. Well, I messaged the surgeon I knew the best about the numbness and he had me have a nerve conduction study (EMG) on both arms, also the neck area to test for the median nerve being pinched up there. Carpal tunnel syndrome is caused by that median nerve being pinched in the carpal tunnel in the wrist, or maybe up near the neck, or both (called a "double crush"). That nerve shares the space with a bunch of tendons in the carpal tunnel at the base of the hand, almost at the wrist. The space is covered by the carpal tunnel transverse ligament. Over time, the tendons can expand, pinching the nerve, which is what CTS actually is. The affected fingers are the thumb and other fingers except the pinky and the lower 1/2 of the ring finger. Symptoms can vary, tingling, numbness and pain. Also, the strength of the hands can diminish or even largely disappear. I just discovered today that my right dominant hand has much less strength than my left hand, which amazes me. It's undoubtedly because the CTS is worse in the right hand (the EMG test revealed that a couple weeks ago). The test presumably indicated I had no issues of the median nerve being pinch near the neck.

My hand surgeon wanted to operate but I found out today he does open surgery, not the preferred endoscopic surgery, which has better prognosis and quicker recovery time. I figure to have a different surgeon do that, ASAP, because the nerve conduction testing indicated my median nerve has atrophied quite significantly (axon conduction of 1.8 mv compared to normal 7-8 mv, not sure about the units, but I think that's what the doctor said).

I figure I'll have carpal tunnel surgery soon, endoscopic, first in the right hand, which is in worse shape. I today ordered a couple of braces to wear on my arms so I can sleep better at night. I figure those will also help in keeping what nerve integrity I have now, prior to the surgery. My hand surgeon told me that the surgery entails severing the carpal tunnel ligament, which expands the carpal tunnel space by ~1cm, effectively increasing the cross section of the carpal tunnel by 30%. He said that the cut ligament develops scar tissue and that surgeons who go in there, say, a year later can't even tell where the incision was made. Those facts convinced me that the surgery is a good idea! Hopefully, I can regain a lot of the lost nerve quality I've lost. Nerves are slow to heal, though, so it could take years.

After my surgeon recommended surgery I did some research and see a ton of stuff (especially Youtube), guys saying do this and that, stretches, exercises, that supposedly resolve CTS. I had a phone conversation yesterday with the surgeon and he said there isn't data to support that. I figure since my right hand median nerve axon conduction is already so lean I better just go with the surgery or I'm risking more serious damage than I already have.

 

[Muse]

For anyone considering CT surgery, this (don't think you need to be a member to see this page):

https://healthy.kaiserpermanente.org/northern-california/health-wellness/health-encyclopedia/he.endoscopic-carpal-tunnel-surgery.hw212492

 

[Heartbreaker]

Maybe late for you, but I have been a heavy Mouse user since the 1990's and had lots of related right shoulder/hand issues.

My solution was first to switch to left hand mouse use, then I started getting left hand/shoulder issues.

So then I went dual mouse. Now I always set up my computer with two mice, one on each side of the keyboard and I switch between them to share the load. It has helped a LOT...

 

[Torn Mind]

I believe that part of the reason carpal tunnel occurs is musclar. The extensor digitorum gets no love for its entire life(most massage therapists will NOT be able to deal with it because Swedish is about relaxation and gliding strokes, while deep tissue is more focused on the bigger muscles) and thus gets "knotted up". Not easy to stretch and the triggers can be a bit tough to get to.

Indications of it being shortened is if you try to fully extend your fingers, the tendons bulge out in the middle finger joint and refuse to extend backwards.

Extensor digitorum

The extensor digitorum (Latin: musculus extensor digitorum) is a superficial, long and slim muscle of the forearm that extends between the humerus and fingers.

anatomy.app

 

[itsmydamnation]

I believe that part of the reason carpal tunnel occurs is musclar. The extensor digitorum gets no love for its entire life(most massage therapists will NOT be able to deal with it because Swedish is about relaxation and gliding strokes, while deep tissue is more focused on the bigger muscles) and thus gets "knotted up". Not easy to stretch and the triggers can be a bit tough to get to.

Indications of it being shortened is if you try to fully extend your fingers, the tendons bulge out in the fingertips continue to flex and refuse to extend backwards.

Extensor digitorum

The extensor digitorum (Latin: musculus extensor digitorum) is a superficial, long and slim muscle of the forearm that extends between the humerus and fingers.

anatomy.app

I found frozen ~600ml ( whatever that is in freedom units) soft drink bottles with different shapes/ curves and great for tendon and muscle stimulation in the forarms. But i don't know how many people are able to put themselves in that must discomfort by choice ( way worse then foam rolling) But that's only the start to break up tissues and try drive fresh blood to the tendons. the real answer is strength training.

 

[Torn Mind]

I found frozen ~600ml ( whatever that is in freedom units) soft drink bottles with different shapes/ curves and great for tendon and muscle stimulation in the forarms. But i don't know how many people are able to put themselves in that must discomfort by choice ( way worse then foam rolling) But that's only the start to break up tissues and try drive fresh blood to the tendons. the real answer is strength training.

I basically use my other hand. The positioning requires the tight hand to go "down" and rotate until you feel some pull. The the other hand feels out the painful or tender spots and apply pressure. If I got a spot, the muscle shakes violently upon pressure.

Results in my fingers feeling loose like they were in middle or high school.

The real cause of "gorilla arm' is precisely muscles.

 

[Brainonska511]

If you have bilateral carpal tunnel (as in similar in both hands), and you do end up getting surgery, you should consider asking them about the potential of having amyloidosis. Some types can cause carpal tunnel and joint issues because of deposition of amyloid fibrils.

But do consider trying to get it corrected, regardless of the underlying cause. Nerve damage isn't something that gets readily better if you delay.

 

[dingster1]

Had it. Right hand dominant and worst side, so got that one done first, then left. Surgery was good, recovery quick. I’m an xray tech so I’m always gonna have issues with arthritis though.

 

[Muse]

If you have bilateral carpal tunnel (as in similar in both hands), and you do end up getting surgery, you should consider asking them about the potential of having amyloidosis. Some types can cause carpal tunnel and joint issues because of deposition of amyloid fibrils.

But do consider trying to get it corrected, regardless of the underlying cause. Nerve damage isn't something that gets readily better if you delay.

I already have significant nerve damage, clearly. 20% of normal "amplitude" in the median nerve axon in my dominant hand sounds very alarming to me. I hope that will improve over time after the release surgery.

Amyloidosis (am-uh-loi-DO-sis) is a rare disease that occurs when a protein called amyloid builds up in organs. This amyloid buildup can make the organs not work properly. Organs that may be affected include the heart, kidneys, liver, spleen, nervous system and digestive tract.

I think it highly unlikely I have that. My blood work is virtually uniformly great and AFAIK I have no known abnormality in any of those organs.

My thinking right now is to undergo endoscopic carpal tunnel release surgery on both hands ASAP (the worst one first, the other when the first is pretty well usable). I am due to phone-converse with the operating surgeon one week from today. If I can, I will ask to have him call me earlier. Yes, I'm antsy. Today I am due to receive a L/R set of wrist braces which should at least help me sleep better. Getting a good night's sleep has been a struggle for me. Waking up from tingling hands has been an issue for me for quite some time. I got up at 3AM today with tingling in my left hand (the right was in the brace given me by my hand surgeon, not the one who will operate on me). I will maybe take a nap later so I can make it through the day, not unusual for me.

 

[Muse]

Had it. Right hand dominant and worst side, so got that one done first, then left. Surgery was good, recovery quick. I’m an xray tech so I’m always gonna have issues with arthritis though.

I have severe arthritis in both hands, mostly at the thumbs, is my sense of it. Had them x-rayed. My hands now seem to be my main health concern. I have other issues that "come and go," but the hand issues appear to be chronic. The CTS can be addressed surgically, the prognosis for that is to me pretty much unknown. I don't know to what extent the nerves can recover. The left median nerve is in much better shape than the right, however, according to the EMG data. The odd thing is that I didn't realize that CTS was serious issue for me some 2 months ago. I think I need a new PCP.

 

[Brainonska511]

I already have significant nerve damage, clearly. 20% of normal "amplitude" in the median nerve axon in my dominant hand sounds very alarming to me. I hope that will improve over time after the release surgery.

Amyloidosis (am-uh-loi-DO-sis) is a rare disease that occurs when a protein called amyloid builds up in organs. This amyloid buildup can make the organs not work properly. Organs that may be affected include the heart, kidneys, liver, spleen, nervous system and digestive tract.

I think it highly unlikely I have that. My blood work is virtually uniformly great and AFAIK I have no known abnormality in any of those organs.

My thinking right now is to undergo endoscopic carpal tunnel release surgery on both hands ASAP (the worst one first, the other when the first is pretty well usable). I am due to phone-converse with the operating surgeon one week from today. If I can, I will ask to have him call me earlier. Yes, I'm antsy. Today I am due to receive a L/R set of wrist braces which should at least help me sleep better. Getting a good night's sleep has been a struggle for me. Waking up from tingling hands has been an issue for me for quite some time. I got up at 3AM today with tingling in my left hand (the right was in the brace given me by my hand surgeon, not the one who will operate on me). I will maybe take a nap later so I can make it through the day, not unusual for me.

It doesn't really show up in typical blood work, and there are a few different types, caused by different proteins. I just went to a conference on the topic of one of these types of amyloidosis, and the physicians all noted it can be more frequent than previously believed, and bilateral carpal tunnel is an early warning sign.

However, given your symptom time scale, it may not be that, but they should check if they do the surgery. It would be simple for the surgeon to send to pathology

 

[Muse]

It doesn't really show up in typical blood work, and there are a few different types, caused by different proteins. I just went to a conference on the topic of one of these types of amyloidosis, and the physicians all noted it can be more frequent than previously believed, and bilateral carpal tunnel is an early warning sign.

However, given your symptom time scale, it may not be that, but they should check if they do the surgery. It would be simple for the surgeon to send to pathology

Thanks. I will bring this up when I have the opportunity to talk to him, as of now in 7 days.

 

[Muse]

It doesn't really show up in typical blood work, and there are a few different types, caused by different proteins. I just went to a conference on the topic of one of these types of amyloidosis, and the physicians all noted it can be more frequent than previously believed, and bilateral carpal tunnel is an early warning sign.

However, given your symptom time scale, it may not be that, but they should check if they do the surgery. It would be simple for the surgeon to send to pathology

I did have a normal EKG done on me in the summer of 2019.

 

[Brainonska511]

I did have a normal EKG done on me in the summer of 2019.

That's good to hear. There are some forms that are more neuropathic than heart-related. I do doubt that it could be an amyloidosis, like ATTR, but it is worth asking about if only because you have the carpal tunnel to a similar degree in both wrists. Some physicians aren't as aware of the changing research landscape as they've learned a lot over the last 15 years and the true prevalence is still largely unknown.

 

[Muse]

That's good to hear. There are some forms that are more neuropathic than heart-related. I do doubt that it could be an amyloidosis, like ATTR, but it is worth asking about if only because you have the carpal tunnel to a similar degree in both wrists. Some physicians aren't as aware of the changing research landscape as they've learned a lot over the last 15 years and the true prevalence is still largely unknown.

After that EKG, maybe a couple weeks later (?), I had a stress test EKG and the practitioner said the result was "really impressive." I suppose they came up with a VO2 Max, I should have asked what it was, but I was likely unaware of the metric at the time. I could probably ask them for it. This was Sept. 2019.

I'll have that question about amyloidosis on my list for the conversation this coming Friday.

 

[pmv]

I'm confused by the definitions of these things - are carpal tunnel and RSI the same thing?

I'm pretty sure I don't have and haven't had Carpal Tunnel Syndrome, but I have had, several times, some sort of frozen shoulder issue (where I could barely move my arms for a couple of months, and struggled to find a non-agonising position to lie in to sleep), plus twice had weird very painful strained muscles around my abdomen (that the first time was misdiagnosed as a possible kidney problem, and the second time as possible appendicitis or even a hernia).

Each time they eventually got better of their own accord, though in one instance they needed a course of NSAIDs (which worked wonders). I have the sense that all these sorts of intractable muscle-pain/inflammation problems are similar, and maybe they are in the same general category as RSI or CTS?

I also suspect they were connected to the hypothyroidism (that apparently I had at a 'sub-clinical' level for decades before it got bad enough to need levothyroixine - I read that there's some debate as to whether the sub-clinical form can actually cause symptoms, and also that the condition itself increases the risks of these sorts of inflammation problems).

 

[Muse]

I'm due for endoscopic CTS surgery on right hand in 9 days. Trying to get ready, it's a little mysterious what can/should I do to not have to think "I wish I'd done this (in preparation)..." I don't expect assistance. I'm used to preparing my own meals and cleaning my dishes in the sink (no dishwasher).

 

[Muse]

If you have bilateral carpal tunnel (as in similar in both hands), and you do end up getting surgery, you should consider asking them about the potential of having amyloidosis. Some types can cause carpal tunnel and joint issues because of deposition of amyloid fibrils.

But do consider trying to get it corrected, regardless of the underlying cause. Nerve damage isn't something that gets readily better if you delay.

I did this today. I was reading a study...

Luca Padua et al CTS study at Lancet Neural 2023; 22:255-67. https://doi.org/10.1016/S1474-4422(22)00432-X

I sent this message to my hand doctors, the one who's been treating me for the severe pinky sprain I suffered about 1.5 years ago and the one who's going to operate on me for CTS this coming Monday:
- - - -
On pg. 256 (of the study mentioned above) mention is made of indications for tenosynovial biopsy during CTS surgery if amyloidosis is suspected, e.g. for males w/ bilateral CTS. It indicates bicep tendon rupture a warning sign, also spinal stenosis. I don't know if I have the latter, however I underwent left shoulder arthroscopic surgical Type 4 SLAP lesion repair on 10/15/2002, being bicep tendon reattachment of "bucket handle." I had been an aggressive swimmer & weight lifter, daily, for 10 years leading up to the injury. Part of attempts to diagnose my shoulder pain prior to the surgery was a neurological test. The doctor said as an aside that he saw indications of some CTS. I have this week talked to family members of both my parents & there appears to be no known incidence of amyloidosis. Should we biopsy for it during our procedure?
- - - -
I talked to my P.T. sister this morning and she assures me that if I had amyloidosis it would be obvious at this point and that I shouldn't be concerned. The operating doctor messaged me that there is no indication for a biopsy. I figure this is correct.

I figure ultrasound would be a good diagnostic tool at this point but figure ETCR on my right hand Monday is likely a good idea anyway. Otherwise I'd have to reschedule and lose time. I figure waiting could be costly in terms of my outcome given the results of the testing. I don't know what my clinical workup indicated.

Several documents are readily accessible online, 2 pagers, on what to expect after ETCR.

 

[Muse]

Had dominant hand endoscopic carpal tunnel release surgery (ECTR) Dec. 11 (i.e. almost 11 weeks ago), same on other hand Jan. 23 (i.e. 4 1/2 weeks ago). Have sensitivity at the single incision sites (not bad), some pillar pain (soreness at base of palm, again not bad). Those are likely to continue to improve and disappear by May.

Dominant hand symptoms improving, may not totally resolve, I was severe. Other hand, the symptoms are so far pretty much gone, will see. I'm now able to bicycle without hand numbness developing, hope that continues!!!

Very glad I had these done ASAP.

 

[William Gaatjes]

Had dominant hand endoscopic carpal tunnel release surgery (ECTR) Dec. 11 (i.e. almost 11 weeks ago), same on other hand Jan. 23 (i.e. 4 1/2 weeks ago). Have sensitivity at the single incision sites (not bad), some pillar pain (soreness at base of palm, again not bad). Those are likely to continue to improve and disappear by May.

Dominant hand symptoms improving, may not totally resolve, I was severe. Other hand, the symptoms are so far pretty much gone, will see. I'm now able to bicycle without hand numbness developing, hope that continues!!!

Very glad I had these done ASAP.

I am gald to hear you did surgery.
How is it going now ?

I have to read up on what CTS really is to understand your posts but i understand that the tendon sheaths get irritated and that the median nerve is affected because the inflammation of the tendon sheaths is also affecting the mendian nerve ?

I know from the skeletal joints, that there is synovial fluid , is there also this kind of fluid or something similar in the tendon sheaths ? To lubricate and lower friction ?

 

[Muse]

I am gald to hear you did surgery.
How is it going now ?

I have to read up on what CTS really is to understand your posts but i understand that the tendon sheaths get irritated and that the median nerve is affected because the inflammation of the tendon sheaths is also affecting the mendian nerve ?

I know from the skeletal joints, that there is synovial fluid , is there also this kind of fluid or something similar in the tendon sheaths ? To lubricate and lower friction ?

All I know is the surgeon, after each of my endoscopic CT release surgeries said I was "really tight in there." Just more evidence that my problems were really due to compression of the median nerves in the carpal tunnel space. Tendon inflammation within the carpal tunnel of some kind must have been causing that.

 

[highland145]

I have to read up on what CTS really is to understand your posts but i understand that the tendon sheaths get irritated and that the median nerve is affected because the inflammation of the tendon sheaths is also affecting the mendian nerve ?

Yep, scar tissue forms and encapsulates the nerve...in my case. 30 years of biking so both hands. During the day, some numbness/tingling. Night, up 5 or 6 times because of the pain. Sucked. Wrist braces worked early on but had surgery last year. Nighttime pain vanished.

 

[William Gaatjes]

All I know is the surgeon, after each of my endoscopic CT release surgeries said I was "really tight in there." Just more evidence that my problems were really due to compression of the median nerves in the carpal tunnel space. Tendon inflammation within the carpal tunnel of some kind must have been causing that.

I read about it , and indeed, the tendon sheath also has synovial fluid.
This is an lubrication fluid, to lower friction, and therefore damage, and therefore irritation and inflammation.
What i vaguely know about it, the sack containing the fluid surrounding the tendon can have inflammation. But the reason can be various. Some suggest infection by bacteria or virea , combine that with the physical stress.
It is either the large amount of fluid that causes the compression of the nerve, or the outside of the nerve also gets inflamed when the tendon sheath gets inflamed.
Think as example , MS (Multiple sclerose). With that awful disease the isolating sheat of the nerves becomes damaged and the nerve conduction is reduced until no conduction is left.

I also had to think about the artritis you mentioned :

As a sidenote :
I know from people who have gout, that they often have a way too high levels of purines in their blood and the kidneys have problems getting rid of the uric acid. Uric acid is the same as urate.
These purines get broken down to uric acid. Uric acid has the tendency to grow in crystal form. Creating tiny needles.
When the uric acid in the blood is too high, it seems that the uric acid is deposited in the joints in the synovial fluid. Creating tiny needles there. So our biological lubrication oil is in such a situation contaminated with these tiny rough sharp shards of uric acid crystals.
This happens especially in the joints, like the joints in the hands and fingers, the shoulders, the knees, the little bones in the feet.
And this synovial fluid is as we know the "oil " that keeps the joints move by keeping the cartilage smooth and polished like a ball bearing. As a bad analog : Cartilage is a bit like polyamide sort of, a flexible but hygroscopic plastic compound.
But not when it is contaminated. And then our little immune cell soldiers and technicians come to the rescue but sometimes this goes wrong, because also the cartilage can get broken down and it is not replaced.

These little uric acid needles cause inflammation because the uric acid is not supposed to be in the joints but removed from the blood, stored in the kidneys to be flushed out to the bladder and will then leave the body when urinating.
Gout is often seen with people with overweight, or people who consume large amounts of purine rich food and also consume alcohol. But for some people only the high levels of purines can be enough . And as a fun fact, we see this often a lot more during the heat of the summer.
Because with the same amount of water intake, during the heat people will sweat more and urinate less.
Exacerbating the uric acid levels in the blood.
The best solution to lower the amount of uric acid in the blood , is drink a lot of water. Not soda, but just plain water. Perhaps with a little bit of freshly cut lemon in it. But that is it. No sugar additions needed. Keep the sugar away here. Your pancreas will love you for it.

When you have high levels of uric acid, you get gout. When you get gout, you have inflammation of the joints, often fingers and toes. When you have gout for a prolonged period of time, the damage because of the inflammation is irreversible because of the damage that is done to the cartilage. Then you have artritis which can end up in reumatic artritis.
A diet with way too much levels of purines, often much alcohol and not enough water to urinate is often the start to end up with reumatic artritis.
Add infectious diseases we all get where the pathogen can also end up in the synovial fluid. So, that is the problem.

Lot of people do sports , sweat a lot and then drink afterwards a lot of alcoholic beverages in the canteen and do not drink enough water afterwards and days after.
But do consume purine rich food.
And days later, complain about their sore and sometimes swollen : Knees, hands, wrists, feet, ankles, shoulders... You get the idea.
As an example we see here in the Netherlands often because soccer is very popular : Soccer players who love doing soccer for the hobby, some of them have this often. Not all of course.
And then some dude or dudette comes by with some miracle cure of massage and some diet tips. And all of a sudden all the problems are gone.
Think that medical medium style nonsense.

This can also happen to people with a non sportive, sitting lifestyle and a lot of purine rich food, and a lot of alcohol and being overweight.

Perhaps with some people , the uric acid is also stored in the synovial fluid filling the tendon sheath.
This together with physical overloading can cause the inflammation.
But your doctor should be able to explain this all to you.

Short story :
Drink lot of water, urinate often to lower the uric acid levels in the body and watch the amount of purines in the weekly diet.





See image :



For more information about gout :

Gout

What is gout? It is a kind of arthritis that causes painful and stiff joints. Gout is caused by the build-up of crystals of uric acid in your joints.

www.niams.nih.gov

For more information about synovial fluid :

Synovial (Joint) Fluid Analysis

Learn why your doctor might order a synovial fluid test and what it can reveal about your joints.

www.webmd.com

For more information about tendons and tendon sheaths (This is the same for all mammals):

AEC Client Education - PD Tenosynovitis

General information about tenosynovitis :

Tendon Sheath: Anatomy, Function, and Treatment

Learn about the anatomy, function, and conditions associated with the tendon sheath, which surrounds and protects each tendon of the body.

www.verywellhealth.com

edit: added another weblink about tenosynovitis.

 

[William Gaatjes]

Yep, scar tissue forms and encapsulates the nerve...in my case. 30 years of biking so both hands. During the day, some numbness/tingling. Night, up 5 or 6 times because of the pain. Sucked. Wrist braces worked early on but had surgery last year. Nighttime pain vanished.

Perhaps this will help :

I did boxing training on the boxing sack, and the first thing i learned is to always keep my wrist straight no matter what. The hand is inline with the forearm. When you keep bending the wrist , the impact will damage the wrist. Even with wrist wraps and even with wrist wraps and boxing gloves.
I have a technique to lock up my wrist. So i can go hit the boxing sack full impact even without boxing gloves or wrist wraps. But i rather not do that, even with wrist wraps only i rip holes in the boxing sack, and also with gloves i see the dust come blown out from the sowing ends and sometimes rip a hole. The harder the boxing sack is, the more i love to hit it but not constantly hard. But that was when i had energy and i focus my energy and get the technique good.
But for biking it is the same as with boxing. Try to keep the wrist straight and squeeze with a moderate amount of power the handles when not having to break. This will ask a lot from the muscles in the forearm. But your wrists will love you for it. And you end up with muscular forearms. I have a mountain bike myself and i noticed that when i used to ride the bike after a boxing training, that my wrist would not hurt when i kept them straight during biking. Even while being on the concrete road. And while keeping the wrist straight, i feel the strain in my muscles from my forearms, but my wrists are fine. THen next day, sour muscles and growth but no wrist problems.

I also move my entire arm when moving the mouse and not just my hand through wrist movement only. This help against CTS.
This is also good for the shoulders and elbow.

 

[highland145]

Perhaps this will help :

I did boxing training on the boxing sack, and the first thing i learned is to always keep my wrist straight no matter what. The hand is inline with the forearm. When you keep bending the wrist , the impact will damage the wrist. Even with wrist wraps and even with wrist wraps and boxing gloves.
I have a technique to lock up my wrist. So i can go hit the boxing sack full impact even without boxing gloves or wrist wraps. But i rather not do that, even with wrist wraps only i rip holes in the boxing sack, and also with gloves i see the dust come blown out from the sowing ends and sometimes rip a hole. The harder the boxing sack is, the more i love to hit it but not constantly hard. But that was when i had energy and i focus my energy and get the technique good.
But for biking it is the same as with boxing. Try to keep the wrist straight and squeeze with a moderate amount of power the handles when not having to break. This will ask a lot from the muscles in the forearm. But your wrists will love you for it. And you end up with muscular forearms. I have a mountain bike myself and i noticed that when i used to ride the bike after a boxing training, that my wrist would not hurt when i kept them straight during biking. Even while being on the concrete road. And while keeping the wrist straight, i feel the strain in my muscles from my forearms, but my wrists are fine. THen next day, sour muscles and growth but no wrist problems.

I also move my entire arm when moving the mouse and not just my hand through wrist movement only. This help against CTS.
This is also good for the shoulders and elbow.

Thanks. I'll try that. I've heard that CT comes back for some people and I don't want that. Mine was from the pressure on the palms, year after year, causing inflammation. Paid the shop to set up my new bike to a better position, got better padded gloves...we shall see.