True carpal tunnel syndrome occurs when the median nerve, which runs from the arm to the hand, gets compressed or irritated at the wrist. The median nerve generally controls strength and sensation to the thumb and fingers (but not the little finger or the outside of the ring finger). Symptoms may include pain, numbness, tingling and weakness.

Treatment success for carpal tunnel syndrome varies. It is often misdiagnosed and frequently there are other factors contributing to the problem.

Symptoms usually start gradually, with pain, burning, tingling, and numbness. There may be a feeling of ‘heaviness’ or swelling in the fingers although usually no swelling is visible. Weakness may appear and in advanced cases atrophy or shrinking of the muscles of the palm may result. Symptoms are often worse in the morning due to sleeping with the wrists bent or flexed. Pain and numbness may extend up the arm.

Unfortunately, many people, and some health professionals, will call any pain or numbness in the hands carpal tunnel syndrome. Misdiagnosis occurs for a number of reasons. Many times the median nerve is actually being irritated in the forearm, upper arm or shoulder, producing identical symptoms to carpal tunnel syndrome. Similarly, irritations of the nerves in the neck or cervical spine are a common cause of arm and hand symptoms that are frequently missed on examination. Doctors of chiropractic specialize in functional spinal and nerve examinations and can help determine the true source of the hand symptoms. In many patients, there will be more than one cause of their problem and unless all sources of nerve irritation are addressed, the chances of successful treatment are lessened considerably.

1. A symptom pattern consistent with median nerve irritation.
2. Functional tests including Phalen’s, Tinel’s and other nerve compression tests.
3. Neurological examination for sensation and strength.
4. Proper evaluation of the cervical spine and arm.
5. Electrodiagnostic testing can help confirm a proper diagnosis.

1. Women are three times more likely to develop this condition than men.
2. It is common in pregnancy.
3. There are genetic factors relating to small wrists and narrow carpal tunnels.
4. People with diabetes and other metabolic disorders can be more susceptible.
5. Repetitive work, such as on assembly lines or constant computer use with poor workstations can contribute to carpal tunnel syndrome.
6. Arthritis, wrist fractures and dislocations can also narrow the tunnel.

Our approach is based on a proper diagnosis. While surgery is an option for advanced cases, it is generally recommended that patients initially try a conservative, non-surgical approach. Treatment may include the following:

1. Advice on how to reduce the factors that may be triggering or aggravating the problem.
2. Soft tissue therapy, including ART and Graston, to relieve nerve entrapments and shortened, tight musculature and tendons in the wrist, arm and neck.
3. Manipulation and mobilization of the carpal bones of the wrist.
4. Manipulation (adjustments) and mobilizations to relieve nerve irritation or compression in the cervical spine.
5. Therapies including ultrasound, TNS, and laser.
6. A home program of stretching and postural improvement exercises.
7. In some cases Vitamin B6 has been suggested to be of benefit.

1. Reduce prolonged wrist bending. Avoid prolonged bending your wrist, either all the way up or down. A relaxed middle position is best. Try changing your position or that of the object you are holding.
2. Relax your grip. Avoid gripping too hard when driving, writing or using tools. Frequently change your grip. Hold objects rather than pinching them.
3. Choose proper tools. When writing use a thick pen that is flows easily. Choose tools that have more of a pistol type grip as opposed to a straight handle. Avoid vibrating tools. Never use your hand as a tool.
4. Take breaks. When performing tasks that involve prolonged, repetitive or forceful wrist use, take rest breaks and exercise your wrists. If possible, try to vary your activities throughout the day.
5. Use proper posture. Poor posture causes your shoulders to roll forward, shortening your neck and shoulder muscles. This can compress the nerves and blood vessels in your neck and shoulder. Maintain proper posture when using computers and laptops. Refer to Office/Work Tips under Conditions.
6. Keep your hands warm. Pain and stiffness are much more likely if your hands are cold. Wear gloves and try to warm your fingers if there is prolonged cold exposure.
7. Wrist braces. For some patients, splints that help prevent extreme wrist motion are beneficial. Discuss this with your doctor of chiropractic.