Pain Relief Chiropractic

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

Tags: carpal tunnel syndrome, mechanicsburg pa chiropractor

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

Tags: carpal tunnel syndrome, mechanicsburg pa chiropractor