Getting carpal tunnel from guitar playing is extremely common. In fact, a day doesn’t go by when a guitarist doesn’t ask us what to do about their numb or painful fingers and hand. Here's what’s going on.

Playing the guitar requires rapid movement of all fingers for an extended period of time. This produces one of the most common “overuse” musculoskeletal disorders today, called carpal tunnel syndrome. 

Anybody who uses their hand for rapid and repetitive activities is at high risk for getting this painful condition. So it's no wonder why getting carpal tunnel from guitar playing is so common.

And this disorder isn't something exclusive to musicians. Other professionals are also at high risk for getting carpal tunnel syndrome because they perform similar, repetitive hand activities. These professions are as diverse as graphic artists, video gamers, hairdressers, carpenters, transcriptionists, typists, and dental hygienists, just to name a few.

At its core, carpal tunnel syndrome is caused by overworked or stressed flexor tendons. These tendons run from your forearm to your fingertips. They're responsible for curling your fingers (creating a gripping or pinching action). 

When tendons are stressed, their coverings (sheaths) inflame and swell with fluid. Normally, that swelling isn’t such a problem anywhere else on the forearm. But if swelling and fluid builds up inside the wrist joint, things gets serious.

Inside the wrist joint the flexor tendons travel through a passageway called the carpal tunnel(hence the condition’s name). As shown in the picture above, they’re accompanied through the passageway by the median nerve. 

The median nerve is responsible for activating finger movements and also carries sensory information from the fingers all the way to the brain. In other words, it’s the main motor and sensory highway for the hand and fingers.

As the inflamed flexor tendons swell and expand with fluid, they push against the median nerve. With no extra room, the median nerve gets squeezed and compressed. This results in a “compression injury” to the nerve, causing neuropathy.

The reason you feel unpleasant symptoms  of carpal tunnel from guitar playing is the result of the median nerve’s compression. The compression produces neuropathy, which is when  the nerve’s signals between the fingers and brain are scrambled. 

This signal scrambling results in motor problems like weakness or limited hand movement. It also results in a variety of sensory problems. For example a feathery touch might feel like a stab or burn.

The most common neuropathy sensations caused by carpal tunnel syndrome usually include hand or finger:

• Pain
• Numbness
• Tingling
• Weakness
• Soreness
• Burning
• Shooting electric shocks

Symptoms of carpal tunnel from guitar playing can happen on either hand, and for different reasons. In the fretting hand , holding the guitar neck is particularly stressful to the hand’s anatomy. Curling and holding your thumb and fingers forces joints into awkward, stressed positions. 

The result is that tendons stay twisted and contracted more than normal. This also forces the median nerve backward, pressing it against the wall of the carpal tunnel passageway.

Usually, merely twisting and bending your hand isn’t harmful. But if you twist it in that particular position, hold it, and then produce rapid finger movements, you’ve created the perfect recipe for carpal tunnel syndrome.

In the picking/plucking hand , the fingers are rapidly moving (and sometimes pinching). While the wrist joint may be in a natural position, the fingers are in a constant, contracted or flexed position. Now combine that with rapid wrist and finger motions. Given the extreme picking speeds achieved by some guitarists, all of this creates huge stressful forces on these flexor tendons. 

Therefore, there's no mystery about how you acquire carpal tunnel from guitar playing. You can see why I tell my guitarist patients...

"If I designed the perfect device to CAUSE carpal tunnel, it would be a guitar!"

Carpal tunnel syndrome progresses through 3 general stages: 

• Mild stage
• Moderate stage
• Severe stage

The amount of time it takes to go from the mild to severe stage varies from person to person. It especially varies according to how many hours per day you play guitar. Generally speaking, the more hours spent on the guitar, the faster the condition’s progression. 

Without treatment, the majority of patients go from the mild stage to severe stage within 9 months.

Almost 80% of carpal tunnel sufferers will eventually see symptoms on the opposite hand as well. This is called bilateral carpal tunnel syndrome. Symptoms usually appear on the other hand within 6 months from when they first appeared on the initial hand.

Symptoms of carpal tunnel from guitar playing begin to show up in the mild stage. Unfortunately, this is when patients should do something about it, but they usually don't. 

When caught and treated in this stage, mild symptoms will resolve 50% of the time with simple rest and some night bracing. But in cases where mild symptoms are ignored, they will almost certainly worsen.

During the mild stage, pain, numbness, and tingling are only just beginning. They creep up extremely slowly. In fact, many people don’t even notice a problem unless they’re thinking about it. 

Also in the beginning, there's usually a "stress delay" when the symptoms show up. In other words, some people might feel the symptoms immediately after playing. Other times symptoms show up a few hours after playing, perhaps while holding a steering wheel or a phone. 

In almost every case, initial symptoms will occur at night while you're trying to sleep. Many say they have to wake up and shake out a numb hand or rub painful fingers.

When symptoms go from mild to moderate, the problems usually escalate fast. It’s also the stage when most people seek professional help. In the moderate stage:



• Numbness is ever-present, and your hand or fingers may feel like balloons. Hand clumsiness is an everyday problem.
• Pain gets more severe, especially in the thumb, and at night.
• Usually the hand and fingers lose 50% of their strength. Even opening a jar becomes impossible.
• Loss of finger speed and dexterity is a problem in everyday use, not just guitar playing.
• All of the above also coincides with losing the sensation of fine touch in your fingertips.

When these difficulties manifest, everyday life changes for the majority of carpal tunnel sufferers. If left untreated, most guitarists put their instruments down for good during this moderate stage of carpal tunnel syndrome.

In the severe stage  numbness or pain is constant, with no respite during the day or night. And it's almost intolerable. It can be so bad that patients often tell me, “I want to cut my hand off.” 

Some describe the numbness as “crushing” that’s ever-present and relentless, even at night. If the main symptom is pain, people describe it as "cruel" or "punishing" and it's always relentless. 

Eventually patients lose the feelings of hot and cold sensations in their fingers and hand. Also, the muscular bump at the base of the thumb noticeably flattens out, and the skin over the muscle wrinkles. That’s because the thumb muscle has degenerated. This begins the final, irreversible stage of carpal tunnel syndrome.

Guitar players are at very high risk for this condition. In fact, most doctors will tell you that a high proportion of their carpal tunnel patients are guitar players. 

Unfortunately, nobody has the exact statistic because good clinical surveys are still lacking. But overall musculoskeletal disorders occur in 26-93% of musicians.(1) That’s very high by any measure.

In one study of guitar players (2), the average rate of all "overuse disorders" ( including carpal tunnel syndrome) was 75%. That was further broken down as occurring in:

• 62.5% of classical guitarists
• 87.5% of flamenco guitarists

Moreover, among the guitarists affected by overuse disorders, the ability to play guitar declined dramatically in:

• 50.0% of classical guitarists 
• 82.1% of flamenco guitarists

By any standard, these statistics are astonishing. And since carpal tunnel syndrome is the predominant overuse disorder ,  we can extrapolate the following from the data: carpal tunnel syndrome from guitar playing is the primary cause of most of these hand  problems. 

From experience, I'm very familiar with this issue. So when guitar players ask me what to do, I always advise the same thing...

“If you treat early, you’ll probability beat it. 

But if you wait, it will almost certainly worsen. 

And that’s when it’s hardest to treat.”

Getting carpal tunnel from guitar playing is a major problem among musicians. Unfortunately, most guitarists don't take the mile warning signs very seriously, but only take action when the moderate stage hits.

At first, thinking their hands are just overworked, most people try inexpensive, half-hearted measures against the moderate stage. They might soak their hands in ice water. Or they buy a wrist splint from Walgreens or CVS for $16.00.

But it's unfortunate that even with the most sincere intentions, most  people don’t realize how serious carpal tunnel syndrome actually is. They don't understand that these insignificant measures are wasting valuable time as the disorder progresses towards the severe stage.

Simple treatments like rest and night bracing will normally work very well if symptoms are caught in the mild stage. But when I get patients – usually in the moderate or severe stages - simple bracing is too little, too late. The easy remedies are just not enough anymore.

If you have moderate or severe carpal tunnel from guitar playing, you have two options to treat it:

1. Carpal tunnel release surgery
2. Non-surgical remedies

The success of either option is proportional to how long you let symptoms go, and how severe they are. The American Academy of Orthopedic Surgeons (those who regulate hand surgery) and the National Institutes of Health both recommend that surgery should be your last and final option , when all non-surgical attempts failed. 

Surgical treatment involves a procedure called carpal tunnel release. After back surgery, it’s the most common surgical procedure performed in the United States today. It can be performed in one of two ways:

• In open carpal tunnel release surgery the surgeon makes a 2-3 inch long incision on the palm and cuts the carpal ligament over the wrist joint. The operation is performed using general or local anesthesia, on an outpatient basis.
  
  
• In endoscopic carpal tunnel release surgery the surgeon makes smaller incisions in the hand. Then the ligament is cut via the tiny holes in the palm. The operation is usually performed with local anesthesia and on an outpatient basis.

With both ways of doing the surgery, the end result is the same. The carpal ligament is cut, thereby giving more “breathing room” to the median nerve. This also lets excess fluid pressure drain away. The resultant release of pressure on the nerve “decompresses” it, thereby relieving the neuropathy.

After surgery  most patients require several months of hand physical therapy and rehabilitation to restore strength and function. Guitar players who had surgery usually must make some type of playing adjustment. About 50% of patients never recover full hand function after surgery.

Most musicians who acquire carpal tunnel from guitar playing seek non-surgical remedies. Understandably, few of them feel comfortable with having their hand cut open.

Happily, for most patients in the moderate and even severe stages, non-surgical treatment of carpal tunnel syndrome is effective and lasting. Usually two or more of these must be used concurrently. The most often used non-surgical treatments are categorized as:

1. Drugs
2. Bracing
3. Exercise
4. Massage

Again, each treatment alone can work to relieve mild stage symptoms. But for moderate to severe stage symptoms, it’s best to use a combination of the above treatments concurrently.

Drug therapy for carpal tunnel syndrome is by far the most widely used. It focuses on reducing pain and swelling. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) are the most common. These include Advil, Aleve, Motrin, and Tylenol. They’re particularly effective in the mild stage of carpal tunnel syndrome.

Be mindful that simply relieving pain with drugs doesn’t solve the problem of why you have carpal tunnel syndrome to begin with. In other words, drugs don't stop carpal tunnel at the source, but merely mask the pain .

Also, these drugs don't help drain excess fluid from the wrist joint. That fluid build-up causes pressure on the median nerve, and it must be drained.

Therefore, when symptoms are beyond mild (i.e., they have elevated to the moderate or severe stage), using NSAID drugs is almost pointless.

Corticosteroids (steroids) are commonly used to reduce swelling by injecting them directly into the carpal tunnel passageway. This temporarily relieves pressure on the median nerve. 

The steroid shots provide temporary pain relief in about 45% of sufferers. However, like NSAIDs, they only relieve pain for a short while (3-5 months). They don’t drain excess fluid nor do they attack the root cause of why you have carpal tunnel in the first place.

Steroid shots are helpful with moderate (and is some cases, severe) symptoms. However, you cannot have more than a few steroid shots per lifetime. That’s because of the  risks and dangers associated with too many steroid shots.

For mild or moderate stage carpal tunnel syndrome, stretching exercises, when maintained, can provide long-term relief. That’s because they force tendons to glide, lubricate, and drain excess fluid. 

However, these exercises alone are usually not sufficient for moderate or severe symptoms. Additional therapies in combination with the stretching exercises, like night bracing and massage (see below) help the most.

There are literally hundreds of videos and self-help tutorials about which exercises are best. In my experience, a few core  stretching exercises are vital; most others are not nearly as important. The core exercises focus on stretching the flexor tendons inside the carpal tunnel passageway.

These stretches must be performed several times a day. Again, they’re best to use in combination with night bracing and massage to effectively alleviate symptoms.

If you have symptoms of carpal tunnel from guitar playing, then bracing your hand and wrist while you sleep is essential. 

When we sleep, we unconsciously bend our hand backward (in extension). Holding that position for long periods of time increases pressure inside the carpal tunnel space, further compressing the median nerve. 

But a night brace will keep the hand in the “neutral position” - which is essential y straight. That position maintains the carpal tunnel passageway in the widest anatomical shape. And that shape gives the median nerve a bit more “breathing room”.

When choosing a night brace, never use one that has a metal spine on the palmar surface (see picture above). If it has one, it’s not a certified carpal tunnel brace.

A certified carpal tunnel brace is designed to specifically treat carpal tunnel syndrome. There currently are 9 companies manufacturing such braces (listed at this link).

A metal spine will push into your wrist joint if you bend your hand backward. That will multiply the pressure inside the carpal tunnel, further damaging the median nerve. You may be like many patients who told me they slept with such braces, only to wake up with worse symptoms. Now you know why.

Most importantly, never wear a wrist brace during the day while your hand is working or playing. There are two reasons for this:

1. First, wearing a wrist brace will force your hand to fight it subconsciously. This makes the situation worse. It’s like doing numerous mini isometric exercises, which will further stress your tendons.
   
   
2. Second, the only way the body can pump away excess fluid from a joint is by joint movement. Restricting that movement during the day will hamper fluid drainage. The result is more fluid buildup and more pressure on the median nerve.

Perhaps the strongest remedy for relieving carpal tunnel symptoms is myofascial release massage. The technique produces 3 crucial results which are necessary for healing. This therapy:

1. Breaks up painful adhesions and restrictions
   
2. Drains excess fluid around the median nerve
   
3. Encourages blood flow, restoring the injured nerve and damaged tendons

Myofascial release massage physically stretches and forces the flexor tendons in multiple directions simultaneously. Essentially, it “kneads” the skin and underlying tissues.

There are many videos and articles about performing myofascial release massage. But the basics are as follows: imagine kneading a bundle of sticky ropes as they bend and push against each other.  With enough kneading, eventually they un-stick. 

The same happens with tendons. The “release” means that adhesions (also called “restrictions”) that make tendons sticky are broken apart. 

• The adhesions cause tendons to swell & expand, ultimately crushing the median nerve. 
• This massage loosens & breaks up the adhesions.
• Therefore, this massage is crucial to alleviate carpal tunnel syndrome.

Myofascial release massage therapy is effective even in the severe stage of carpal tunnel syndrome. However, it must applied twice daily for at least one month.

Crucially, you cannot perform myofascial release massage on yourself. That’s because you need two hands (actually, two thumbs) to effectively knead the tissues below the skin. It also requires a bit of skill, and many people simply do not have the time to learn it in order to help treat their partner.

Massage therapists, chiropractors, and physical therapists are skilled in this technique. It’s usually a huge part of each professional’s practice. But that’s the big downside to myofascial release massage therapy. 



While it’s highly effective (for even severe stage carpal tunnel syndrome) it must be performed twice daily for at least a month. Visiting a therapist that often can be very expensive.