Tag Archives: carpal tunnel syndrome

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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How Do Manual Therapies Help Carpal Tunnel Syndrome?

10 Sep

Carpal tunnel syndrome (CTS) is a condition characterized by the slow onset of pain, tingling, or numbness (paresthesia) in the thumb, index, and middle and thumb-half of the ring finger. Over time, symptoms can increase in both frequency and severity to the point that the individual cannot comfortably carry out their regular work or leisure activities. Initially, a sufferer may manage the condition by shaking their hand or flicking their fingers, but as the symptoms worsen, they may try home and over-the-counter remedies to find temporary relief, at best. It’s at this point when they may seek treatment with a doctor of chiropractic. 

But why would a chiropractor be useful for managing CTS? It starts by understanding the anatomy of the carpal tunnel itself. This structure is made up of eight small bones that form the arch of the tunnel with the transverse carpal ligament serving as the floor. Several tendons as well as the median nerve pass through this tunnel. The median nerve emerges from the neck and travels through the shoulder, elbow, and forearm before entering the carpal tunnel. It then supplies motor instructions to part of the hand and relays sensory information back to the brain. Anything within the carpal tunnel that reduces the available space—tendon inflammation, water retention, or compression of the shape of the tunnel—will apply force on the median nerve that can affect its normal movement and function. When this occurs, symptoms will begin to manifest. 

The goal of treatment is to reduce pressure on the median nerve and improve its mobility as it passes through the carpal tunnel. Primarily, doctors of chiropractic accomplish this with the use of manual therapies—manual and instrumental soft tissue mobilizations, massage therapy, bone and joint mobilizations or manipulations, and neurodynamic techniques—to restore normal movement to the affected joints and associated soft tissues. A 2022 systematic review and meta-analysis (considered the most respected form of research) concluded that manual therapies provide statistically significant improvement in symptom severity, physical function, and sensory and motor nerve conduction in mild-to-moderate CTS cases. 

To achieve a satisfactory outcome for the patient, chiropractic care may also include addressing musculoskeletal issues along the course of the median nerve as dysfunction in the neck, shoulder/arm, and forearm/elbow often co-occur with CTS and can produce CTS-like symptoms. If non-musculoskeletal conditions are present, the case may need to be co-managed with the patient’s medical physician or a specialist. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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Carpal Tunnel Syndrome and Hand Positions

5 Jun

The wrist is very flexible, and the reason the wrist is so supple is because it’s made up of eight small carpal bones that are lined up in two rows of four bones each. Along with the transverse carpal ligament, these rows of carpal bones form an actual tunnel in which nine muscle tendons (and their sheaths) and the median nerve pass. If inflammation or swelling occurs that reduces the space in the carpal tunnel, then the median nerve can become compressed and restricted, which stimulates the various symptoms commonly linked to carpal tunnel syndrome (CTS). Another factor that can limit space in the carpal tunnel has to do with hand positions.

In a 2023 study, researcher utilized high-frequency, diagnostic ultrasound (HFDU) to specifically look at median nerve position changes and cross-sectional area of the nerve when the wrist is bent upward (dorsiflexion) and downward (palmar flexion) in 85 patients (110 affected hands) diagnosed with mild (n=38), moderate (n=30) and severe (n=42) CTS as well as 25 healthy control subjects (50 hands). Compared with the control wrists, the CTS-affected wrists exhibited much greater median nerve compression against the floor of the tunnel (the transverse carpal ligament) in both bent wrist positions. The researchers also used a diagnostic technology called nerve conduction velocity to confirm that this compression at the end-ranges of wrist flexion and extension are associated with dysfunction of the median nerve.

While this finding is interesting, it just reinforces what many healthcare providers already know about CTS: symptoms worsen at the end ranges of motion, and prolonged, awkward wrist postures should be avoided. That’s why one of the most common tools used to manage CTS is a nocturnal wrist splint to prevent the wrist from bending during sleep. However, it’s generally not recommended to wear a wrist splint at all times as immobilization could lead to deconditioning of the muscles in the region and worsen the patient’s situation.

In addition to avoiding prolonged bending of the wrists, CTS patients are also instructed to try to keep the wrist in a neutral position, take frequent breaks, and avoid high vibration exposure when performing hands-on work or hobby-related tasks because it can increase inflammation in the carpal tunnel and exacerbate symptoms and slow recovery. 

Successful management of CTS may also involve addressing non-musculoskeletal factors that can promote inflammation or swelling in the wrist, such as diabetes. Patients may also receive advice on inflammation-promoting foods to avoid or supplements to take to reduce inflammation in the body. Your chiropractor will also assess the full course of the median nerve starting at the neck to make sure there are no other areas in which the nerve’s motion is restricted since it’s not uncommon for this to occur in multiple sites.  

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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