What exactly is the carpal tunnel?
Your carpal tunnel is formed by 8 small bones in your wrist and a strong, thick ligament called the flexor retinaculum.
These structures form a “tunnel” through which many tendons pass, as well as your median nerve coming down from your arm.
What causes carpal tunnel syndrome?
- Most commonly, repetitive use of the forearms, wrists, and hands will cause irritation of the tendons in the tunnel, causing inflammation to build up, eventually compressing the median nerve and leading to symptoms of carpal tunnel syndrome.
- Since the carpal tunnel is an enclosed structure, the inflammation stays and builds within the tunnel, leading to direct compression of the median nerve.
- Anyone who uses their arms and hands repetitively is at risk, such as computer workers, musicians, factory workers and trades people.
- Falls or fractures to the wrist can also result in the development of CTS.
- Other more rare causes of CTS include arthritis, bone disorders such as Paget’s disease and certain medication use.
Issues that mimic carpal tunnel syndrome
- Since the nerves that pass through your wrist begin in your neck, it’s important to have these areas examined for any nerve pressure.
- “Double Crush Syndrome” is a term used to describe irritation of the nerves in both the carpal tunnel and higher up along the nerve pathways, resulting in the need for both entrapment sites to be addressed if resolution is to be achieved.
- “Thoracic Outlet Syndrome” is a term used to describe various nerve entrapments around the brachial plexus (nerve bundle) in the neck. Since the nerves eventually feed into the wrist and hand, patients may experience symptoms similar to CTS, even though the nerve pressure is actually happening near the neck.
The traditional medical approach
- The traditional medical approach for CTS includes splinting the wrist in a neutral position (to avoid excessive stress on the carpal tunnel), as well as drug therapy, steroid injections, and eventually surgical release of the carpal tunnel.
- Complications with surgery are rare, however when they do happen they can result in significant limitations for patients with CTS. Combined with the high costs associated with surgery, it makes sense to exhaust all conservative methods of care (including chiropractic) before considering surgical procedures.
The chiropractic approach
- Your chiropractor is ideally trained to examine your entire body, including your wrist, for the source of your CTS symptoms. It is important that all sites be examined for nerve compression if you are to receive relief from care.
- Studies have shown improvements in wrist strength, range of motion and nerve symptoms following chiropractic care.
- Follow-up studies also indicate that CTS patients are often able to achieve a significant recovery to within comparative levels of non-CTS patients in most measures of progress.
- Your chiropractor can also advise you on ergonomic strategies for work and home to help minimise the original source of your CTS issues.
Atroshi, I., Gummesson, C., Johnsson, R., Ornstein, E., Ranstam, J., & Rosén, I. (1999). Prevalence of carpal tunnel syndrome in a general population.JAMA: the journal of the American Medical Association, 282(2), 153-158.
Bonebrake, A. R., Fernandez, J. E., Marley, R. J., Dahalan, J. B., & Kilmer, K. J. (1990). A treatment for carpal tunnel syndrome: evaluation of objective and subjective measures. Journal of manipulative and physiological therapeutics,13(9), 507.
Bonebrake, A. R., Fernandez, J. E., Dahalan, J. B., & Marley, R. J. (1993). A treatment for carpal tunnel syndrome: results of a follow-up study. Journal of manipulative and physiological therapeutics, 16(3), 125-139.
Burke, J., Buchberger, D. J., Carey-Loghmani, M. T., Dougherty, P. E., Greco, D. S., & Dishman, J. D. (2007). A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. Journal of manipulative and physiological therapeutics, 30(1), 50-61.
Davis, P. T., Hulbert, J. R., Kassak, K. M., & Meyer, J. J. (1998). Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trail. Journal of manipulative and physiological therapeutics, 21(5), 317.
Hui, A. C. F., Wong, S., Leung, C. H., Tong, P., Mok, V., Poon, D., … & Boet, R. (2005). A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology, 64(12), 2074-2078.
Hurst, L. C., Weissberg, D., & Carroll, R. E. (1985). The relationship of the double crush to carpal tunnel syndrome (an analysis of 1,000 cases of carpal tunnel syndrome). The Journal of Hand Surgery: British & European Volume,10(2), 202-204.
Luckhaupt, S. E., Dahlhamer, J. M., Ward, B. W., Sweeney, M. H., Sestito, J. P., & Calvert, G. M. (2012). Prevalence and work‐relatedness of carpal tunnel syndrome in the working population, United States, 2010 national health interview survey. American Journal of Industrial Medicine.
Ly‐Pen, D., Andréu, J. L., de Blas, G., Sánchez‐Olaso, A., & Millán, I. (2005). Surgical decompression versus local steroid injection in carpal tunnel syndrome: A one‐year, prospective, randomized, open, controlled clinical trial.Arthritis & Rheumatism, 52(2), 612-619.
Mariano, K. A., McDougle, M. A., & Tanksley, G. W. (1991). Double crush syndrome: chiropractic care of an entrapment neuropathy. Journal of manipulative and physiological therapeutics, 14(4), 262.
O’Connor, D., Marshall, S., & Massy-Westropp, N. (2003). Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev, 1.
Oskay, D., Meriç, A., Kirdi, N., Firat, T., Ayhan, Ç., & Leblebicioğlu, G. (2010). Neurodynamic mobilization in the conservative treatment of cubital tunnel syndrome: long-term follow-up of 7 cases. Journal of manipulative and physiological therapeutics, 33(2), 156-163.
Russell, B. S. (2008). Carpal tunnel syndrome and the “double crush” hypothesis: a review and implications for chiropractic. Chiropractic & Osteopathy, 16(1), 2.
Tal-Akabi, A., & Rushton, A. (2000). An investigation to compare the effectiveness of carpal bone mobilisation and neurodynamic mobilisation as methods of treatment for carpal tunnel syndrome. Manual therapy, 5(4), 214-222.
Valente, R., & Gibson, H. (1994). Chiropractic manipulation in carpal tunnel syndrome. Journal of manipulative and physiological therapeutics, 17(4), 246.
Verghese, J., Galanopoulou, A. S., & Herskovitz, S. (2000). Autonomic dysfunction in idiopathic carpal tunnel syndrome. Muscle & nerve, 23(8), 1209-1213.