Tag Archives: carpal tunnel syndrome

Carpal Tunnel Syndrome Symptom Mapping

18 Jun

Carpal tunnel syndrome (CTS) is a condition characterized by symptoms in parts of the hand
supplied by the median nerve, typically caused by compression of the nerve as it passes through the
wrist. However, the constellation of symptoms associated with CTS is not unique to this peripheral
neuropathy, and without a thorough history and examination, it’s possible for a healthcare provider to
make an incorrect or incomplete diagnosis. In such cases, patients may achieve only temporary relief
at best.
Let’s look at how a doctor of chiropractic may map a patient’s symptoms to develop a clearer
picture of the chief complaint:

  • Location: The chiropractor will work with the patient to identify the precise areas in the hand
    where symptoms are experienced. In CTS, symptoms are most often reported in the thumb,
    index finger, middle finger, and the thumb-side of the ring finger as well as the
    corresponding portion of the palm. Symptoms affecting the pinky, the pinky-side of the ring
    finger, or the back of the hand may suggest involvement of a different nerve.
  • Timing and movement: Uncovering when symptoms occur can provide important clues. In
    CTS, symptoms may worsen at night, during repetitive or forceful hand activity, or at the
    extremes of wrist motion. If symptoms are provoked by changes in neck position or certain
    arm movements, this may indicate involvement beyond the wrist.
  • Path: If symptoms travel from the hand up the arm—or from the neck or shoulder down into
    the hand—this may suggest nerve irritation somewhere along its course.
  • Associated symptoms: While hand symptoms often drive patients to seek care, it’s important
    to check for additional complaints such as neck pain or stiffness, shoulder discomfort,
    headaches, or weakness in the arm or hand. These findings may be related and can influence
    the diagnosis.
    Assessing symptoms in this way helps determine whether the patient likely has CTS, whether
    there is median nerve involvement at other points along its path, whether a different nerve is
    involved, or some combination of these factors. It’s not uncommon for median nerve compression at
    the wrist to coexist with irritation at other sites (often referred to as double crush syndrome), or for
    the ulnar or radial nerves to also be involved—especially in cases that do not respond as expected to
    typical CTS care.
    With a more complete clinical picture, the chiropractor can develop a treatment plan aimed at
    reducing pressure on the affected nerves. This may include manual therapies, targeted exercises,
    physiotherapy modalities, nighttime wrist splinting, and nutritional recommendations to help manage
    inflammation. If underlying health conditions are suspected to contribute to nerve irritation, care may
    also involve collaboration with other healthcare providers, such as a medical physician or specialist.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055 (717) 697-1888

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Potential Causes of Wrist Pain

18 May

After shoulder pain, wrist complaints are among the most common reasons patients seek
chiropractic care for upper limb issues. Before treatment begins, the likely cause of the patient’s
wrist symptoms must be identified. Let’s review the most common causes of wrist pain and the
key features that help differentiate them:

  • If a patient presents with fever (suggesting possible septic arthritis), severe pain out of
    proportion to the injury or sudden neurologic changes (raising concern for acute
    compartment syndrome), or significant trauma (like a suspected scaphoid fracture),
    immediate referral to the emergency room is warranted.
  • Carpal tunnel syndrome is the most common peripheral neuropathy and is
    characterized by numbness and tingling in the median nerve distribution (thumb,
    index, middle, and radial half of the ring finger). Positive findings on physical
    examinations that involve compression of the wrist strongly support this diagnosis.
  • De Quervain’s tenosynovitis causes pain on the thumb side of the wrist and most
    commonly affects women ages 30–50, especially postpartum. A positive Finkelstein
    test (thumb in fist, bend wrist toward pinky—pain on thumb side is positive) supports
    this diagnosis.
  • Osteoarthritis of the wrist or carpometacarpal joint can cause pain and stiffness during
    gripping, pinching, and other hand-intensive activities. It may lead to visible
    deformity and is typically confirmed with X-ray imaging.
  • A fall on an outstretched hand can result in a wrist sprain or ligament injury. Pain is
    typically localized and reproduced with palpation and range-of-motion testing. Mildto-moderate swelling, no visible deformity, no neurovascular deficits, and preserved
    (though painful) range of motion help differentiate this from more serious trauma.
  • Triangular fibrocartilage complex injury presents with pain on the ulnar (pinky) side
    of the wrist, often following trauma or repetitive axial loading (motions like pushing
    up off a chair or performing a push-up that direct force through the wrist into the
    forearm). Tenderness over the ulnar fovea and pain or clicking with forceful wrist
    rotation are suggestive findings.
  • Flexor or extensor tendinopathy results from overuse of the forearm and wrist
    musculature, presenting as localized pain along the affected tendon(s), often
    aggravated by resisted movement.
    Once the likely source of wrist pain is identified, treatment typically involves a
    combination of manual therapy and targeted exercises to reduce stress on affected tissues and
    restore normal joint function. Patients who do not respond as expected may be referred for
    further evaluation or advanced imaging.

Brent Binder,

D.C. 4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055 (717) 697-1888

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Wrist Tendonitis vs. Carpal Tunnel Syndrome

16 Apr

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

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Wrist Tendonitis vs. Carpal Tunnel Syndrome

23 Mar

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

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It Isn’t Always Carpal Tunnel Syndrome

11 Feb

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

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Nocturnal Wrist Bracing for Carpal Tunnel Syndrome

8 Jan

Carpal 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

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