Carpal tunnel syndrome (CTS) is the most common neuropathy, or a pinched nerve, in the extremities. CTS is estimated to affect 3-6% of the population, often seen in both hands. What causes CTS, its symptoms, how it’s diagnosed, and how is it treated?
Carpal Tunnel Causation
Carpal tunnel syndrome occurs when pressure placed on the median nerve travels through the wrist. This occurs due to inflammation caused by obesity, repetitive movements, pregnancy, and arthritis. It can also occur from hypothyroidism, diabetes mellitus, trauma, mass lesions, amyloidosis, sarcoidosis, multiple myeloma, leukemia, and more. Women are at greater risk for CTS than men, due to having a smaller wrist and possibly hormonal reasons.
Symptoms
Pain, numbness, and tingling are common CTS symptoms. It affects the thumb, index finger, middle finger, and the thumb-side of the ring finger. Symptoms can radiate up into the forearm, shoulder, and neck. Weakness in a person’s grip strength and nighttime/sleep interruptions are also common symptoms.
Carpal Tunnel Diagnosis
Patient history is very important in terms of diagnosing CTS. It provides the doctor information to help determine if CTS is likely to occur. It also shows if another condition is causing the patient’s symptoms, such as ulnar tunnel syndrome or dysfunction elsewhere along the course of the median nerve. The “flick sign” predicts electrodiagnostic abnormalities 93% of the time with a false-positive rate of <5%. Other in-office tests include provocative tests (reproducing symptoms), neurological tests for sensation (sharp vs. dull), and strength-muscle tests. More advanced electrodiagnostic tests (EMG/NCV or electromyogram/nerve conduction velocity) can quantify the severity of CTS and verify the diagnosis.
Treatment
All treatment guidelines recommend conservative, non-surgical care prior to surgery. That’s unless there is a unique, unusual case like trauma (fracture), or some other unusual situation. Chiropractors are golden for non-surgical care. Typical non-surgical care can include night splinting, anti-inflammatory measures, exercises, and ergonomic modifications. Chiropractic treatment includes manual therapies such as soft tissue release techniques and joint manipulation. A 2018 study reported that following manipulative therapy, patients experienced an increase in the front-to-back diameter and roundness of their carpal tunnel which reduced pressure on the tunnel’s contents. Chiropractors perform manual therapy based on neurodynamic techniques. A 2019 study concluded were highly effective in a group of patients with mild-to-moderate CTS.
Patients are more likely to achieve a successful outcome if they seek treatment earlier in the course of the disease than if they wait for months or years. If you experience the symptoms associated with CTS, seek care sooner rather than later!
