Fast and repetitive hand and finger movements with little rest time can cause the sheaths that cover the
tendons passing through the carpal tunnel to become inflamed, placing increased pressure within the tunnel,
compressing the median nerve, and stimulating the symptoms associated with carpal tunnel syndrome. Injury
or overuse of the tendons themselves can also cause symptoms that may be thought of as carpal tunnel
syndrome. How does a doctor of chiropractic determine which condition a patient has, carpal tunnel syndrome
or wrist tendonitis?
The first step involves the patient’s history and initial consultation. In addition to providing
information on their past and current health issues, the patient may be asked specific questions about their
presenting complaint, such as whether they recall what caused their symptoms, when the symptoms first
became noticeable, what makes the symptoms feel better or worse, what their exact symptoms are, and what
time of day the symptoms are best or worst, for example.
Based on the information provided, the chiropractor will conduct a physical examination. The exam
will include observation; palpation (touching and pressing); range of motion assessments of the arm, wrist,
hand, and fingers; and neurological tests of the upper extremity, including reflexes, muscle strength (such as
grip and/or pinch), and sensation testing (for example, light touch or distinguishing between sharp and dull).
To rule out red-flag issues—such as fracture or advanced joint disease—an X-ray may be ordered. Other
diagnostic studies, such as ultrasound or nerve conduction velocity testing, may be of use to help confirm a
suspected diagnosis.
If carpal tunnel syndrome is suspected, symptoms such as pain, numbness, tingling, and reduced
sensation will follow the course of the median nerve into the thumb, index finger, middle finger, and the
thumb-side of the ring finger, though symptoms may also travel up the forearm. Symptoms may worsen at
night and during the day when the wrist is bent up or down or held in one position for prolonged periods.
Orthopedic tests that involve flexing the wrists for 60–90 seconds, tapping over the carpal tunnel, and
manually compressing the carpal tunnel will also be positive in carpal tunnel syndrome. When performed, a
nerve conduction study will typically show slowed median nerve function across the wrist.
In cases of wrist tendonitis, pain will be localized to a specific tendon with tenderness at one precise
point, and symptoms will mostly be felt in the wrist or forearm rather than the fingers. Symptoms may be
described as achy, sharp, or pulling pain, without numbness or tingling, that worsens with gripping, lifting,
twisting, or resisted motion. With rest, symptoms will usually improve. Diagnostic imaging may show tendon
thickening or inflammatory changes.
Treatment will depend on examination findings, but in general, with carpal tunnel syndrome, the
approach used will be intended to reduce compression on the median nerve, potentially with activity
modifications and ergonomic changes to reduce inflammation while tissues heal. With wrist tendonitis, heavier
activity will be reduced initially to allow the tendon to recover, followed by specific exercises to increase
tendon strength and load tolerance. The good news is that doctors of chiropractic are well-equipped to
distinguish between these conditions and manage them using an effective, non-surgical, conservative approach.
Brent Binder M.S., D.C.
4909 Louise Dr. Suite 102
Mechanicsburg, PA 17055
(717) 697-1888
Pain Relief Chiropractic 
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