Carpal tunnel syndrome (CTS) is a common condition that occurs when the median nerve is compressed or restricted as it passes through the carpal tunnel located at the wrist, resulting in symptoms including pain, numbness, tingling, and/or weakness in the thumb, index finger, middle finger, and thumb-side of the ring finger. During their initial appointment, a patient will complete a health history to provide their chiropractor with information on how long they’ve had symptoms and what makes them worse/better, as well as information about any current health conditions they have and have had in the past. If carpal tunnel syndrome is indeed suspected, the next step is a physical examination.
During the physical examination, the doctor of chiropractic will examine the wrist to see if tapping, pressing on the median nerve, or flexing the wrist causes a numbing or tingling sensation. They will also conduct similar tests elsewhere along the course of the median nerve to determine if its mobility is hindered beyond the wrist, which is common in CTS patients. This is also known as double crush syndrome. The chiropractor will also test the fingers for sensation and assess the strength of the muscles at the base of the hand and look for signs of atrophy or weakening. These findings will help determine the severity of the patient’s CTS and if nerve damage has occurred.
In some cases, additional diagnostic tools may be employed. This can include laboratory tests to rule out conditions like diabetes that can damage nerves; X-rays to look for fractures, arthritis, or other abnormalities; a nerve conduction study to measure the speed at which signals are transmitted along a nerve to determine if they are slowed down at the carpal tunnel; electromyography (EMG) to assess the severity of muscle damage due to CTS; and ultrasound to see if the median nerve is swollen at the carpal tunnel.
If CTS is confirmed and the underlying cause is musculoskeletal in nature, then the doctor of chiropractic will adopt a multimodal approach that may include manual therapies, therapeutic exercises, nocturnal wrist splitting, anti-inflammatory measures, activity/work modifications, and physiotherapy modalities to restore the normal movement to the wrist and movement of the median nerve through the carpal tunnel. Should the median nerve be restricted elsewhere along its course, similar treatment measures will be employed. But if the chiropractor suspects conditions beyond their scope of practice (diabetes, hypothyroidism, rheumatoid arthritis, etc.), they may refer the patient to an allied healthcare provider so these disorders can be addressed.
