Carpal Tunnel Syndrome

In today’s technology centered world, one condition that seems to be rising in prevalence as a result of this lifestyle change is carpal tunnel syndrome (CTS) (1). The carpal tunnel is one of several “tunnels” throughout the human body. The characteristics of this syndrome are numbness, weakness, paresthesia (loss of feeling/sensation) and sometimes pain throughout the distribution of the median nerve, which travels through the carpal tunnel (1). As seen in Figure 1, the carpal tunnel is a relatively small area with lots of traffic running through it. With all of the contents, there is little room left for things to act out of line. When this happens, inflammation builds and compresses the tunnel and along with it, the median nerve and causing carpal tunnel syndrome.

Surgery is often recommended to those who are displaying CTS symptoms. However, a more conservative approach initially “could benefit a substantial portion of the population” (2). In our office, this would take the form of adjusting the carpal bones, cold laser therapy, as well as extension based wrist exercises and stretches. According to a systematic review and meta-analysis based on the benefits of conservative treatment and minimal risks associated with the therapy, it should be the front line of treatment (2). Another study found patients who received manual therapy for CTS showed a significantly larger decrease in pain sensitivity and increase in functionality at one month and three months compared to patients who underwent surgical treatment (3). Even more encouraging, a systematic review looking at the efficacy of joint mobilization in CTS found when adjusting the cervical spine combined with the carpals, there can be an improvement in a patient’s range of motion, sensory function, motor function and pain management (4).

Cross Section of the Carpal Tunnel

Sources

1. Taylor, D. . (2019). Management of Carpal Tunnel Syndrome With Conservative Multimodal Therapy: A Prospective Case Series of Outcomes With Concurrent Wrist and Cervical Manipulation. Journal of Contemporary Chiropractic, 2(1), 123–130. Retrieved from https://journal.parker.edu/index.php/jcc/article/view/80

2. Shi, Q., Bobos, P., Lalone, E. A., Warren, L., & MacDermid, J. C. (2020). Comparison of the Short-Term and Long-Term Effects of Surgery and Nonsurgical Intervention in Treating Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis. Hand (New York, N.Y.), 15(1), 13–22. https://doi.org/10.1177/1558944718787892

3. Tang, M. & Seffinger, M. (2017). Evidence Supporting the Benefits of Manual Therapy for Carpal Tunnel Syndrome. Journal of Osteopathic Medicine, 117(1), 56-57. https://doi.org/10.7556/jaoa.2017.008

4. Sault, J. D., Jayaseelan, D. J., Mischke, J. J., & Post, A. A. (2020). The Utilization of Joint Mobilization As Part of a Comprehensive Program to Manage Carpal Tunnel Syndrome: A Systematic Review. Journal of manipulative and physiological therapeutics, 43(4), 356–370. https://doi.org/10.1016/j.jmpt.2020.02.001