Carpal Tunnel Syndrome 101

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, or pinched nerve, in the extremities. The condition is estimated to affect 3-6% of the population, often in both hands. Let’s discuss what causes CTS, its symptoms, how it’s diagnosed, and how it’s treated…

Causation: Carpal tunnel syndrome occurs when pressure is placed on the median nerve as it travels through the wrist. This can be due to inflammation caused by obesity, repetitive movements, pregnancy, arthritis, hypothyroidism, diabetes mellitus, trauma, mass lesions, amyloidosis, sarcoidosis, multiple myeloma, leukemia, and more. Women are at a greater risk for CTS than men, due to having a smaller wrist and possibly hormonal reasons.

Symptoms: Pain, numbness, and tingling are common CTS symptoms that affect the thumb, index finger, middle finger, and the thumb-side of the ring finger. Symptoms can radiate up into the forearm and even into the shoulder and neck. Weakness in grip strength and nighttime/sleep interruptions are also common symptoms.

Diagnosis: The patient history is very important for diagnosing CTS, as it provides the doctor information to help determine if CTS is likely or if another condition is causing the patient’s symptoms, such as ulnar tunnel syndrome or dysfunction elsewhere along the course of the median nerve. The “flick sign” (flicking the fingers to “wake them up”) predicts electrodiagnostic abnormalities 93% of the time with a false-positive rate of <5%. Other in-office tests include provocative tests (reproducing symptoms), neurological tests for sensation (sharp vs. dull), and strength-muscle tests. More advanced electrodiagnostic tests (EMG/NCV or electromyogram/nerve conduction velocity) can quantify the severity of CTS and verify the diagnosis.

Treatment: All treatment guidelines recommend conservative, non-surgical care prior to surgery unless there is a unique, unusual case like trauma (fracture), or some other unusual situation. THIS IS WHERE CHIROPRACTIC SHINES! Besides “usual” non-surgical care (night splinting, anti-inflammatory measures, exercises, and ergonomic modifications), chiropractic treatment includes manual therapies such as soft tissue release techniques and joint manipulation. A 2018 study reported that following manipulative therapy, patients experienced an increase in the front-to-back diameter and roundness of their carpal tunnel, which reduced pressure on the tunnel’s contents. Chiropractors also perform manual therapy based on neurodynamic techniques, which a 2019 study concluded were highly effective in a group of patients with mild-to-moderate CTS.

It’s important to note that patients are more likely to achieve a successful outcome if they seek treatment earlier in the course of the disease than if they wait months or even years. If you experience the symptoms associated with CTS, seek care sooner rather than later!