When an individual experiences symptoms like pain, numbness, tingling, and weakness in the thumb,
index finger, middle finger, thumb-side of the ring finger, and part of the palm, the first thought may be carpal
tunnel syndrome. While it’s the most common peripheral neuropathy, other conditions with overlapping
symptoms must be ruled out during the initial physical examination. One potential contributing cause of carpal
tunnel-like symptoms is cervical radiculopathy.
Five nerve roots exit the lower cervical spine and combine into a structure called the brachial plexus,
from which the median nerve emerges and continues down the arm to supply sensation and muscle function to
part of the hand. Compression or irritation of several of these nerve roots—most commonly C6, C7, and C8—
can result in downstream symptoms in the arm and hand that closely resemble carpal tunnel syndrome.
In one study that included 866 patients with either suspected cervical radiculopathy or carpal tunnel
syndrome, researchers found that roughly one-in-four had both conditions. Another study examining patients
on a surgical waiting list for carpal tunnel release reported that a significant percentage also showed
degenerative changes in the cervical spine near the level where the C6 nerve root exits, suggesting that
coexisting neck pathology may contribute to hand symptoms in some cases.
If a patient presents with suspected carpal tunnel syndrome, how might their chiropractor determine if
cervical radiculopathy may be an underlying cause or contributing factor? First, the chiropractor will review
the patient’s intake history for clues such as whether hand symptoms flare during episodes of neck discomfort;
symptoms are felt anywhere between the neck and hand; numbness extends into the pinky or outer side of the
hand; certain neck positions worsen symptoms; if there’s coexisting neck pain or stiffness; if there is the
presence of headaches or shoulder blade pain; and if there is any history of neck trauma.
During the physical examination, several orthopedic and neurologic tests may be performed to
evaluate for possible cervical radiculopathy. These may include cervical distraction (gentle upward traction is
applied to the head to determine whether arm symptoms improve); the upper limb tension test (specific arm
and neck movements are used to reproduce or alter symptoms); and cervical range-of-motion testing to assess
whether certain neck movements, particularly at end range, provoke arm or hand symptoms. The chiropractor
may also assess deep tendon reflexes to identify asymmetries between sides; perform upper extremity strength
testing to evaluate for myotomal weakness; and conduct dermatomal sensory testing of the thumb (C6), middle
finger (C7), and pinky (C8) to determine whether sensory changes follow a cervical nerve root pattern rather
than an isolated median nerve distribution.
If cervical radiculopathy is identified as a contributing factor, treatment will focus on restoring normal
movement and function to the affected joints and surrounding tissues to relieve pressure on the involved nerve
roots. This may include manual therapies, therapeutic modalities, traction, nighttime bracing (when
appropriate), and specific exercises or stretches to perform between visits. Many patients experience
significant improvement with conservative care. However, if findings suggest a condition outside the
chiropractor’s scope of care or if more invasive treatment is required, referral to an appropriate medical
specialist will be recommended.
Brent Binder, D.C.
4909 Louise Dr. Suite 102
Mechanicsburg, PA 17055 (717) 697-1888
Pain Relief Chiropractic 
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