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Midlife Carpal Tunnel Syndrome

11 Dec

Carpal tunnel syndrome (CTS) occurs when the median nerve becomes compressed or restricted
as it passes through the wrist. Early on, this may cause mild, intermittent tingling, numbness, or pain in
parts of the hand, but over time, symptoms can become more frequent and activity-limiting. While CTS
can develop at any age, it’s most common during midlife due to the convergence of three key factors:
occupational stress, hormonal and metabolic changes, and age-related anatomy.
When we perform frequent, repetitive hand movements, the tendons that run through the carpal
tunnel glide back and forth against one another. Over time, the lubricating sheaths surrounding these
tendons can become inflamed and sustain micro-injuries that need time to recover. However, occupations
or hobbies that involve non-neutral wrist positions, high gripping forces, or vibration exposure often
provide little opportunity for rest. After years—or decades—of repetitive stress, minor irritation can
progress into chronic inflammation that’s difficult to ignore or manage with over-the-counter remedies.
In addition to repetitive movement, hormonal changes and worsening metabolic health during
midlife increase CTS risk. Chronically elevated blood sugar can thicken connective tissue (including the
transverse carpal ligament) and increase fluid retention, both of which reduce space inside the carpal
tunnel and place pressure on the median nerve. Poor metabolic health also damages the microvessels that
supply the nerve and fuel systemic inflammation that can narrow the tunnel even further. Women face an
added risk during this stage of life, as changes in estrogen and thyroid hormones can make tissues less
elastic and more vulnerable to shear forces.
Age-related changes compound the problem. As we grow older, damaged tissues heal and
regenerate more slowly. Tendons thicken, ligaments stiffen, and the myelin sheath that insulates nerves
can begin to thin, leaving the median nerve more susceptible to compression at the carpal tunnel. Muscle
mass naturally declines as well, reducing the stabilizing forces around the wrist. These changes affect not
only the carpal tunnel itself but the entire course of the median nerve—from the neck and shoulder down
through the elbow and forearm—meaning that restriction anywhere along its path can heighten sensitivity
to compression at the wrist.
Fortunately, all is not lost. Although we can’t stop the aging process, we can control occupational
and metabolic risk factors. Adjusting tools to maintain a neutral wrist position, scheduling regular microbreaks, and performing nerve-gliding or wrist-mobility exercises can help reduce pressure in the tunnel.
Supporting overall metabolic health is equally important: limit sugary drinks and ultra-processed foods,
increase fruit and vegetable intake, take daily walks, and aim for 150 minutes of moderate activity plus
two resistance-training sessions per week.
Finally, chiropractic care can help restore normal motion to the wrist and surrounding joints,
reducing strain on the median nerve along its entire pathway. Your chiropractor can also teach you the
most effective exercises for symptom management and guide you on ergonomic adjustments to keep your
wrists healthy long-term.
Brent Binder, D.C.

4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

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Work Activities Linked to Carpal Tunnel Syndrome

6 Nov

Carpal tunnel syndrome (CTS) occurs when the median nerve is compressed or entrapped as it passes through the wrist. This often leads to numbness or tingling in the thumb, index, middle, and part of the ring finger, along with muscle weakness that makes pinching and gripping difficult. Certain types of jobs carry a higher risk of developing CTS, including agriculture, trucking, factory work, construction, food service, and office work. But it is not the occupation itself that causes the problem so much as the specific tasks involved.

Repetitive hand movements are one of the most common contributors. The tendons that allow the fingers to flex and extend travel through the narrow carpal tunnel, each wrapped in a lubricating sheath to help them glide smoothly. When these tendons are worked too often without rest, friction builds, the sheaths swell, and pressure inside the tunnel rises, affecting the function of the median nerve. Over time, microtraumas accumulate and inflammation becomes more frequent, producing even more severe symptoms. Forceful gripping adds another layer of stress, since tightening down on a tool or object makes the tendons thicken and further crowd the tunnel, creating more opportunities for irritation.

Vibration is another key factor. The use of jackhammers, chainsaws, grinders, or other vibrating tools not only increases tendon friction but also places mechanical stress directly on the median nerve. Vibration reduces blood flow by constricting small vessels, further depriving the tissues of oxygen and nutrients. Likewise, working in non-neutral wrist positions—whether bending the wrist up, down, or to the side—changes the shape of the carpal tunnel and raises internal pressure. Cold temperatures, while not a direct cause, intensify the problem by stiffening tissues and restricting blood flow, making symptoms more severe.

In real-world work, most tasks involve a combination of these stressors. A meatpacker gripping an electric knife in a cold warehouse, a carpenter operating a vibrating power tool, or an office worker typing for hours with poor ergonomics all face multiple overlapping risks. Because people are motivated to keep working, CTS symptoms are often ignored or self-managed until they become too limiting to continue daily tasks. The good news is that the sooner care is sought, the better the chance of recovery. Chiropractic care can be an effective option, helping patients restore comfortable movement and strength so they can return to normal activities without lingering pain or limitation.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

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The Course of the Median Nerve and Carpal Tunnel Syndrome

6 Oct

Carpal tunnel syndrome (CTS) is a condition characterized by numbness, tingling, pain, and weakness in the thumb, index finger, middle finger, and the radial half of the ring finger, as well as the portion of the hand between these digits and the wrist. The condition results from compression of the median nerve as it passes through the wrist; however, if care is only directed toward alleviating pressure on the nerve within the carpal tunnel, lasting relief may not occur. This is because of the course of the median nerve itself.

Five nerves exit the cervical spine and join to form the brachial plexus at the base of the neck. Segments of the lateral and medial cords then combine to form the median nerve. From there, the nerve travels through the shoulder, down the upper arm, past the elbow, along the forearm, and finally through the carpal tunnel to terminate in the hand. The median nerve functions much like a two-lane road, carrying commands for movement and other body functions to muscles and tissues while relaying sensory information back to the brain. When this process is impeded by narrowing in the carpal tunnel, sensory nerves may misfire and motor nerves may be slow to activate—leading to the symptoms of CTS.

Compression, however, can occur at any point along the nerve’s path and may create the same symptoms as CTS. In some cases, compression exists in multiple locations simultaneously. For this reason, chiropractors examine the entire length of the median nerve to identify all potential points of entrapment. By applying pressure with the thumb over the most common compression sites and noting how quickly symptoms are reproduced, chiropractors can identify inflamed areas requiring treatment.

Once the points of compression are identified, chiropractors typically employ a combination of methods such as manual and soft tissue therapies, exercise training, splinting (particularly at night to maintain a neutral wrist position), and anti-inflammatory physiologic or nutritional approaches. They will also inquire about work and recreational activities, since highly repetitive hand movements—especially those involving forceful gripping or pinching—can worsen symptoms and may impede recovery.

Perhaps even more important than how chiropractors treat CTS is when they treat it. Because the condition typically develops from repetitive microtrauma, symptoms often begin subtly and intermittently then gradually increase in frequency and severity. Many individuals ignore or self-manage until the condition interferes too much with their daily life and work tasks. Unfortunately, delaying care can allow permanent nerve damage to occur, making complete resolution unlikely. The key takeaway is to seek chiropractic care for carpal tunnel symptoms sooner rather than later.

Pain Relief Chiropractic

4909 Louise Drive. Mechanicsburg, PA 17055

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Decision-Making Factors for Carpal Tunnel Syndrome Care

17 Apr

While carpal tunnel syndrome (CTS) is a very common condition, controversy still exists among researchers and healthcare professionals regarding best practices for managing the condition. Most studies on musculoskeletal disorders, including CTS, focus on identifying treatments that provide symptom relief rather than exploring the factors influencing patients’ decisions, particularly when choosing between surgical and non-surgical options.

A December 2024 meta-analysis reviewed six studies that examined CTS treatment from the patient’s perspective, revealing four key decision-making themes:

  • Return to Normalcy – Does this treatment effectively relieve symptoms and restore quality of life, allowing for uninterrupted sleep and daily activities?
  • Patient-Centered Care – Is treatment information clear, specific, and accessible? Are patients given options, or are they simply told what their treatment will be?
  • Work Considerations – Will treatment require time off work or job modifications? Will the doctor provide necessary documentation for the employer? Will the patient be able to return to their usual job, or must they consider a career change?
  • Expectations – How quickly will relief occur? What is the likelihood of full recovery? If this treatment fails, what are the next steps?

The authors emphasized the importance of healthcare providers considering multiple decision-making factors and prioritizing clear communication and shared decision-making in CTS care. This approach enhances patient satisfaction and may lead to better treatment outcomes.

Chiropractic care provides CTS patients with a non-surgical treatment option that incorporates manual therapies to restore mobility to the median nerve, not only at the wrist but along its entire course from the neck to the hands. In addition, chiropractors may use complementary approaches such as night splinting, exercise training, physical therapy modalities, ergonomic assessment and modifications, and anti-inflammatory strategies. If necessary, care may be co-managed with other healthcare professionals who provide services beyond a doctor of chiropractic’s scope of practice.

Pain Relief Chiropractic

Painreliefcare.net

Mechanicsburg, PA

 (717) 697-1888

Member of Chiro-Trust.org

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

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Treating the Neck of the Carpal Tunnel Syndrome Patient

6 Mar

Carpal tunnel syndrome (CTS) is the most frequently diagnosed peripheral neuropathy and one of the most common conditions affecting the hand. The disorder typically results from compression of the median nerve on the palm side of the wrist, leading to numbness, tingling, and sometimes weakness in the thumb and fingers—except for the pinky and the pinky-side of the ring finger, which are innervated by the ulnar nerve. To avoid surgery, many CTS patients seek chiropractic care, which often includes manual therapies applied beyond the wrist and even to the neck due to the nature of the median nerve.

The median nerve originates from the C6-T1 spinal nerve roots in the neck and provides sensory and motor functions to the palm-side forearm and hand. It enables gripping, forming a fist, and detecting temperature and texture. If the mobility of the median nerve is restricted along its course, the resulting symptoms may mimic or overlap with traditional CTS. To complicate matters further, compression can occur at multiple sites, all of which need to be addressed for effective treatment.

In an October 2024 study, researchers divided 48 CTS patients into two groups. Both groups received wrist-focused treatment, including ten sessions of wrist mobilization, electrotherapy, and the use of a nocturnal wrist splint to maintain a neutral wrist posture overnight. However, one group also received manual therapies targeting the cervical spine. Patients underwent motor and sensory nerve conduction testing and completed questionnaires on CTS-related disability at baseline, immediately after treatment, and at six-month follow-ups.

Initially, both groups reported similar improvements in all outcome measures. However, at the six-month follow-up, the group that received cervical spine care showed greater improvements, suggesting that long-term benefits favor incorporating cervical spine treatment into CTS care.

Doctors of chiropractic are well-equipped to assess the entire course of the median nerve—from the neck to the hand—and identify all potential areas of restriction. They can provide conservative treatments to restore normal nerve function and help patients return to their daily activities. In more complex cases, chiropractors may coordinate care with specialists or medical physicians as needed.

Pain Relief Chiropractic

4909 Louise Drive, Suite 102

Mechanicsburg, PA 17055

Painreliefcare.net

Member of Chiro-Trust.org

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

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Carpal Tunnel Syndrome and Regional Interdependence

10 Oct

Carpal tunnel syndrome (CTS) is the most common compression neuropathy of the upper extremity, which is caused by increased pressure on the median nerve as it passes through the wrist with resulting symptoms of pain, numbness, and tingling in the thumb through third finger and thumb half of the fourth finger (palm-side). Traditionally, treatment guidelines for CTS have focused on therapies applied to the wrist. However, there is a growing understanding in the research community that CTS may be best viewed as a complex pain syndrome that requires a comprehensive sensory nervous system approach to achieve a satisfactory outcome for the patient. 

Current literature suggests that 45% of CTS patients may also experience pain in the forearm, elbow, and shoulder and 14% have concurrent neck pain. Patients with CTS have also been observed to have myofascial trigger points in upper trapezius and infraspinatus muscles, as well as osteoarthritis in the cervical spine. Carpal tunnel syndrome sufferers may also have reduced cervical range of motion to the side opposite the affected wrist in addition to forward head posture—which occurs when the head rests forward of the sagittal plane, placing added stress on the soft tissues at the back of the neck and upper back to keep the head upright. Because these issues can occur along the course of the median nerve or affect anatomical regions that the median nerve passes through, treatment to address these disorders can reduce a patient’s CTS symptoms. The term “regional interdependence” is used when interventions applied to one anatomical region can influence the outcome and function of other body regions that may be seemingly unrelated.

In a June 2023 pilot study that included 15 CTS patients, researchers observed that a treatment plan consisting of ten sessions of manual traction, lateral glide mobilization, and posterior to anterior pressure applied to the neck, along with self-stretching of the upper fibers of the trapezius, scalenes, and levator scapulae muscles led to improvements in CTS pain intensity, symptoms severity, disability, and functional capacity, as well as improved function of the median nerve based on electrodiagnostic studies of median nerve motor distal latency and medial sensory nerve conduction velocity. Best of all, these improvements persisted when researchers examined the patents six months after the conclusion of care.

For decades, doctors of chiropractic have focused on the full course of the median nerve when assessing a patient with carpal tunnel syndrome symptoms based on their experience that compression of the median nerve beyond the wrist can contribute to CTS. It’s great to see that the scientific community is starting catch up and look at CTS as not just an issue of the wrist itself but more of a disorder that can include multiple body sites that all need treatment to get a patient out of pain and back to their normal activities.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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