Carpal tunnel syndrome (CTS) is a condition that occurs when the median nerve is compressed or restricted as it passes through the wrist, resulting in sensory and motor symptoms, which include numbness, pain, paresthesia and sometimes weakness that can radiate from the wrist into the thumb and index, middle, and half of the ring finger. Additionally, symptoms can travel proximally into the forearm and for some, into the shoulder and neck. Unfortunately, carpal tunnel symptoms tend to come on gradually and increase in intensity slowly over time, which leads many individuals to only seek care after the condition has progressed to the point in which it has a serious impact on their ability to work and carry out other activities of daily living.
When a patient does present for care, the first order of business in evaluating the case history and conducting an examination is to determine if the symptoms are the result of median nerve compression (there are two additional nerves that travel into the hand and result in similar, yet different symptoms) and to identify if it is limited to the wrist or is there restriction elsewhere on the course of the never from the neck to the hand. The doctor of chiropractic will also attempt to establish the cause of these points of compression, which helps guide the course of treatment. If the patient frequently engages in activities that require fast and repetitive hand movements or the use of awkward wrist postures or vibratory forces, then they may be advised to take regular breaks, change their tools, or make ergonomic modifications. In some instances, health conditions that cause inflammation or water retention may play a role, and the patient may receive lifestyle advice or treatment with an allied healthcare provider to properly manage the condition.
To help restore normal motion to the affected joints and to take pressure off the median nerve, a doctor of chiropractic will perform manual therapies in the office, which may include manipulation, mobilization, soft tissue work, etc. They may also utilize modalities like cold laser, ultrasound, and e-stim, depending on the patient’s unique case, as well as the chiropractor’s training and clinical experience.
Between visits, the patient may be advised to wear a nocturnal wrist splint to keep the wrist from resting at the extreme ends of its range of motion during sleep, which can increase pressure in the carpal tunnel and exacerbate symptoms. The patient may also receive instruction on at-home neurodynamic exercises to help stretch the tissues in the wrist and reduce friction so that the median nerve can travel through the carpal tunnel more easily. Patients may also be encouraged to switch to an anti-inflammatory diet, consume supplements that reduce inflammation, reduce sedentary time, and increase the time spent exercising, even if it means taking a daily walk in the evening.
With the combination of in-office treatment and self-help care, many cases of mild-to-moderate carpal tunnel syndrome can be successfully managed without the need to consider more invasive treatment options like injections or surgery. Of course, the earlier in the disease process that treatment is started, the better the patient’s chances for not only a satisfactory outcome but also a shorter course of care.
