Carpal Tunnel Syndrome (CTS) is a very common problem. The American Association of Orthopedic Surgeons (AAOS) reported that in 2007, there were 330,000 carpal tunnel release surgeries performed. The main reason to have the surgery is to “open up” the tunnel. That is, the transverse carpal ligament or “floor” of the tunnel is released so the contents inside the tunnel are able to move more freely, reducing the pressure inside the tunnel. Essentially, this is the goal of any treatment (surgical or not): improving the depth of the tunnel, thus reducing the pressure from inside the tunnel allowing the tendons to slide better as the muscles on the palm-side forearm contract to move the nine tendons that pass through the tunnel and attach to the fingers and thumb. However, there are non-surgical methods for reducing the pressure within the tunnel that should be attempted first as surgery is always reported to be the “…last resort” for good reason. There can be surgical complications, the effects may be only partial, and there is an average of 30% grip strength loss following the transverse ligament surgical release. So, the question is, how can chiropractic approaches reduce the pressure inside the carpal tunnel without somehow changing the length of the transverse carpal ligament?
The roof of the tunnel is made up of two rows of four bones for a total of eight carpal bones that arch over the nine tendons that pass through the tunnel. The height of the tunnel is dependent on the position of those eight bones, especially three of the eight bones that make up the proximal row at the top of the cave. These are technically the lunate (located at the peak of the roof which tends to drop down lowering the roof of the tunnel), the scaphoid (located on the thumb side of the roof), and the triquetrum (located on the pinky side of the roof). The latter two bones tend to shift up and out and when the middle bone drops down, the tunnel flattens making the space tighter or smaller. This is how chiropractic adjustments of the wrist help. There are specific techniques doctors of chiropractic use to reposition the lunate and outer two bones that shift up and out. In addition, chiropractors can either tape or use an elastic wristband to hold the tunnel “open” after the adjustment.
The use of a night splint to keep the wrist in a straight or slightly “cocked-up” position is also highly beneficial as the pressure inside the tunnel goes up as much as 6-8x when CTS is present when the wrist bends to the end points of upward or downward bending. Also, your doctor of chiropractic will treat all the possible points of possible compression including the neck, shoulder, elbow, forearm, and wrist which ALWAYS gets better results than treating only the carpal tunnel.