When symptoms such as pain, tingling, numbness, and weakness affect the hand, the first
condition that comes to mind for most people is carpal tunnel syndrome (CTS). While CTS is the
most common nerve entrapment affecting the upper extremity, it is far from the only possible cause
of these symptoms. So how does a chiropractor determine whether the problem is CTS or something
else?
The process begins with the patient completing a detailed health history that addresses both
current symptoms and relevant medical background. This information helps determine whether
compression of the median nerve—central to a CTS diagnosis—is likely, or whether one of the other
nerves supplying the hand should be considered. During the physical examination, the chiropractor
performs specific provocative tests to help identify where the median nerve—or another nerve—may
be restricted along its course. In some cases, though not routinely required, additional diagnostic
tools such as nerve conduction studies or ultrasound may be used to help confirm the diagnosis.
If symptoms primarily involve the thumb, index finger, middle finger, and the thumb-side of
the ring finger and are reproduced by wrist compression or sustained wrist positions, classic carpal
tunnel syndrome is likely. However, compression of the median nerve at other locations along its
pathway can produce a similar symptom pattern. Potential sites include the forearm, below or above
the elbow, the shoulder, and even the neck. To further complicate matters, nerve compression can
occur at multiple sites simultaneously. For example, a 2016 study found that approximately 1 in 16
patients with CTS also had median nerve compression in the forearm, a condition known as pronator
teres syndrome.
The ulnar nerve, which supplies sensation to the pinky and the ulnar side of the ring finger,
can also become compressed as it passes through a different anatomical structure at the wrist called
Guyon’s canal. As with the median nerve, restriction of the ulnar nerve anywhere along its course
from the neck to the hand can generate similar symptoms. The same principle applies to the radial
nerve, which innervates the back of the hand and can become irritated as it passes through the radial
tunnel near the wrist. This is why a thorough history and physical examination is so critical: the
history helps identify which nerve is involved and the examination helps pinpoint where compression
may be occurring.
In most cases, conditions involving median, ulnar, or radial nerve compression respond well
to a multimodal conservative treatment approach. This may include manual therapies such as
manipulation, mobilization, and soft tissue techniques; therapeutic exercises; nighttime bracing;
activity modification; and anti-inflammatory strategies. Importantly, outcomes are typically faster
and more favorable when patients seek care early, rather than waiting months or years before
consulting with a chiropractor.
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.
Brent Binder, D.C. 4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888
It Isn’t Always Carpal Tunnel Syndrome
11 FebNocturnal Wrist Bracing for Carpal Tunnel Syndrome
8 JanCarpal tunnel syndrome occurs when pressure within the wrist restricts the function of the median nerve, leading to numbness, tingling, pain, and eventually weakness in the parts of the palm, thumb, index, middle and thumb-side of the ring finger. Management focuses on reducing pressure inside the carpal tunnel, which may include manual therapies, exercises, and activity modifications designed to decrease inflammation and help the tendons passing through the wrist glide more freely. In some cases, addressing hormonal or metabolic factors that contribute to inflammation, water retention, or impaired nerve health may also be necessary. One of the simplest and most effective strategies is using a wrist brace at night. But why is this so commonly recommended in clinical guidelines?
A key point is that the shape of the carpal tunnel is not fixed. The carpal bones form a concave arch, and the transverse carpal ligament forms the roof of the tunnel. When the wrist bends out of neutral alignment, the arch narrows and compresses the structures inside. These pressure increases are not subtle. A wrist positioned just 30 degrees into flexion or extension can triple pressure inside the carpal tunnel. At the extremes of flexion or extension, pressures can increase ten-fold. Even side-to-side wrist deviation can double or triple pressure on the median nerve and surrounding tendons. Not only does this directly stress the median nerve, but using the fingers while the wrist is bent causes the flexor tendons to generate heat and friction in a crowded space, which can promote inflammation and worsen symptoms.
During waking hours, we can consciously monitor our hand positions and adjust our activities to avoid these high-pressure postures. Overnight, however, this is impossible. Many patients with carpal tunnel syndrome experience sleep disturbances because their wrists naturally drift into prolonged flexion or extension while they sleep. A nocturnal wrist brace prevents this by keeping the wrist in a neutral, nerve-friendly position. Most braces look like a soft short arm cast that supports the wrist from the palm to the mid-forearm and prevents bending.
Wearing such a brace during the day would be impractical and could interfere with manual tasks—and continuous daytime bracing may even cause irritation where the ends of the brace contact the skin. For daily activity, other types of bracing and non-bracing options are more appropriate, such as ergonomic modifications for work tasks and using a soft, beanbag or memory-foam wrist support during computer use to reduce carpal tunnel pressure. However—and your chiropractor will likely emphasize this—over-reliance on bracing can hinder long-term recovery, as the muscles controlling the hand and fingers can weaken without regular use. That’s why it’s important to pair nighttime bracing with prescribed wrist exercises, frequent breaks, avoidance of extreme wrist postures, and healthy lifestyle habits that reduce systemic inflammation.
Pain Relief Chiropractic
4909 Louise Drive Suite 102
Mechanicsburg, PA, 17055
Midlife Carpal Tunnel Syndrome
11 DecCarpal 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
Work Activities Linked to Carpal Tunnel Syndrome
6 NovCarpal 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
The Course of the Median Nerve and Carpal Tunnel Syndrome
6 OctCarpal 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
Decision-Making Factors for Carpal Tunnel Syndrome Care
17 AprWhile 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.
Pain Relief Chiropractic 