Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy, affecting upward of 6% of adults in their lifetime. In some occupational groups, the prevalence jumps to nearly 20%! While carpal tunnel syndrome can be simply described as the symptoms that result from compression or restriction of the median nerve as it passes through the wrist, the condition can be anything but easy to diagnose and manage. This is due, in part, to three key factors:
Myriad Causes: There are multiple ways the median nerve can become compressed or restricted as it passes through the carpal tunnel. For example, non-neutral wrist postures can reduce the size of the tunnel and increase the pressure within, repetitive movements involving the hands can stimulate inflammation as the tendons in the wrist slide back and forth, and excessive vibrations can also trigger inflammation in the wrist. If the tissues don’t have the opportunity to recover, scarring can develop and lead to more frequent and worsening symptoms. Hence, CTS is much more common among workers whose job activities involve using heavy equipment repeatedly throughout the day in awkward wrist postures. Unfortunately, biomechanical factors aren’t the only potential cause of CTS. Any health condition that induces inflammation or swelling in the wrist or directly affects the health of the median nerve can play a role in CTS development.
Gradual Onset: The symptoms associated with carpal tunnel syndrome include pain, numbness, tingling, and weakness along the course of the median nerve from the wrist to the thumb, index, middle, and thumb-side of the ring finger. Because CTS tends to be the result of repetitive stressors, these symptoms tend to come on gradually. For a time, most people can ignore or self-manage their symptoms. It’s only once the condition has progressed and when the pain, numbness, tingling, and weakness becomes too much to carry out daily activities that the CTS sufferer makes an appointment to get checked out.
Other Nerve Compression Sites: When median nerve compression occurs elsewhere on its course from the neck to the wrist, the patient may experience the same symptoms as CTS. In many cases, there may be restriction of the median nerve both at the wrist and in another location like the neck, shoulder, elbow, or forearm. Additionally, some CTS patients may experience symptoms radiating up the arm, which can lead a healthcare provider to ignore the wrist and focus on compression at the forearm or elbow.
The good news is that doctors of chiropractic are trained to look at a patient’s health history and to evaluate the full course of the median nerve to identify each contributing factor for the patient’s carpal tunnel symptoms. Then, they will employ a multimodal approach to restore normal motion to the affected joints and relieve pressure at the wrist using manual therapies, specific exercises, nocturnal wrist splinting, activity modifications, and more. If health conditions beyond their scope of practice are present, they’ll work with an allied healthcare provider with the goal of symptom resolution so the patient can return to their normal daily activities.
