Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. It is estimated to affect up to 4.9% of the population. The condition includes symptoms like pain, numbness, tingling, and weakness in parts of one or both hands. It’s easy to understand why CTS can have such a negative impact on one’s quality of life and ability to carry out everyday activities. In past articles, we’ve discussed how chiropractic care can benefit patients with mild-to-moderate CTS. What about more severe cases, especially those in which a systemic condition—like diabetes—is also present?
Carpal Tunnel Study
In 2021, a group of researchers reviewed data from twenty-nine studies published in the preceding decade on the management of carpal tunnel syndrome. Particularly, for severe cases or those attributable to a secondary condition such as diabetes, hypothyroidism, obesity, etc. They found evidence that pharmacology, electrotherapy, and manual therapy are beneficial for severe and/or systemically caused CTS. However, studies with larger sample sizes are needed.
The paper reported that manual therapies, commonly used by chiropractors, provided benefits with respect to symptom and function improvement. Manual therapies include carpal bone mobilization, neurodynamic techniques, and other soft tissue techniques. Improvement is great when combined with nocturnal splinting. Researchers also found the use of a neutral wrist position splint rather than the 20-degree wrist extension splint is beneficial.
The review also noted evidence that various forms of “electrotherapy” may be beneficial, especially as part of a multimodal approach. Electrotherapy includes pulsed and continuous ultrasound, diathermy, high-intensity laser therapy (HILT), and low-level laser therapy (LLLT). It also includes pulsed electromagnetic field (PEMF), extracorporeal shockwave therapy (ESWT), pulsed radiofrequency, and electro-acupuncture. Additionally, the review found that corticosteroids may not provide a benefit when used alone. When combined with nocturnal splinting, corticosteroids work best.
Conclusion
Ultimately, the authors concluded that for these types of CTS cases, a multimodal treatment plan that combines pharmacology, electrotherapy, and manual therapy may be the best approach. Although, more research is necessary to determine which specific therapies may work best for a particular CTS case type. Chiropractors are trained in the use of several forms of manual therapies and may offer some electrotherapy options. If there are secondary conditions that require management in conjunction with a medical physician, your chiropractor can team up with your family doctor or a specialist.
