Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment neuropathy, meaning the compression of a nerve beyond the brain and spinal cord. In this case, the median nerve is compressed as it passes through the carpal tunnel of the wrist, which is comprised of eight small carpal bones that form the roof and walls of the tunnel and the transverse carpal ligament that acts as the floor of the tunnel. Let’s discuss the effect that compression of the median nerve has on an individual and how it can be managed without surgery.
The median nerve transmits motor instruction into the thumb, index, middle and thumb-side half of the ring finger, and parts of the palm. It also relays sensory information from those parts of the hand back to the brain. In addition to the median nerve, other soft tissues pass through the carpal tunnel, and if anything reduces the available space in the tunnel, it can compress or restrict the movement of the median nerve, negatively affecting its function. Initially, the patient may experience brief episodes of pain, numbness, tingling, and weakness. Over time, symptoms can become more frequent, intense, and longer lasting to the point that they transition from a minor annoyance to a real problem that interferes with normal activities.
Individuals born with a smaller carpal tunnel may be more prone to develop the condition. Likewise, hormonal conditions that may cause swelling or fluid retention can place added pressure in the carpal tunnel. But in most instances, the most common cause is inflammation caused by the repetitive work or leisure movements with insufficient rest combined with awkward wrist postures and/or excessive vibration exposure.
When a patient seeks care for CTS at a chiropractic clinic, their first step is to complete paperwork that can provide their chiropractor with information on the patient’s overall health history, as well as data specific to their hand and wrist symptoms. Based on this information, their doctor of chiropractic will conduct an examination to get a better idea as to possible pain generators. This will include a thorough look at the full course of the median nerve from the neck and through the shoulder, elbow, and forearm as compression in these areas can not only stimulate symptoms akin to CTS, but they can also increase the risk for compression at the wrist. In order to achieve a satisfactory outcome, each compression site will need to be addressed. If non-musculoskeletal causes are suspected, the doctor of chiropractic may co-manage the patient with a medical physician or specialist.
Treatment may focus on the application of manual therapies, modalities, specific exercises/stretches, work modifications, and nutritional recommendations aimed to either restore normal movement in the affected joint/s or reduce inflammation. The good news is that in cases of mild-to-moderate CTS, a conservative multimodal approach is likely to lead to a good outcome for the patient. In more severe cases, total resolution may not be possible, even if the patient elects for surgery. Hence, the common refrain among healthcare providers to opt for care early in the course of the disease and not to put off treatment until it’s unbearable.
