When an individual experiences symptoms like pain, numbness, tingling, and weakness in the thumb, index finger, middle finger, thumb-side of the ring finger, and part of the palm, the first thought may be carpal tunnel syndrome. While it’s the most common peripheral neuropathy, other conditions with overlapping symptoms must be ruled out during the initial physical examination. One potential contributing cause of carpal tunnel-like symptoms is cervical radiculopathy.

Five nerve roots exit the lower cervical spine and combine into a structure called the brachial plexus, from which the median nerve emerges and continues down the arm to supply sensation and muscle function to part of the hand. Compression or irritation of several of these nerve roots—most commonly C6, C7, and C8—can result in downstream symptoms in the arm and hand that closely resemble carpal tunnel syndrome.

In one study that included 866 patients with either suspected cervical radiculopathy or carpal tunnel syndrome, researchers found that roughly one-in-four had both conditions. Another study examining patients on a surgical waiting list for carpal tunnel release reported that a significant percentage also showed degenerative changes in the cervical spine near the level where the C6 nerve root exits, suggesting that coexisting neck pathology may contribute to hand symptoms in some cases.

If a patient presents with suspected carpal tunnel syndrome, how might their chiropractor determine if cervical radiculopathy may be an underlying cause or contributing factor? First, the chiropractor will review the patient’s intake history for clues such as whether hand symptoms flare during episodes of neck discomfort; symptoms are felt anywhere between the neck and hand; numbness extends into the pinky or outer side of the hand; certain neck positions worsen symptoms; if there’s coexisting neck pain or stiffness; if there is the presence of headaches or shoulder blade pain; and if there is any history of neck trauma.

During the physical examination, several orthopedic and neurologic tests may be performed to evaluate for possible cervical radiculopathy. These may include cervical distraction (gentle upward traction is applied to the head to determine whether arm symptoms improve); the upper limb tension test (specific arm and neck movements are used to reproduce or alter symptoms); and cervical range-of-motion testing to assess whether certain neck movements, particularly at end range, provoke arm or hand symptoms. The chiropractor may also assess deep tendon reflexes to identify asymmetries between sides; perform upper extremity strength testing to evaluate for myotomal weakness; and conduct dermatomal sensory testing of the thumb (C6), middle finger (C7), and pinky (C8) to determine whether sensory changes follow a cervical nerve root pattern rather than an isolated median nerve distribution.

If cervical radiculopathy is identified as a contributing factor, treatment will focus on restoring normal movement and function to the affected joints and surrounding tissues to relieve pressure on the involved nerve roots. This may include manual therapies, therapeutic modalities, traction, nighttime bracing (when appropriate), and specific exercises or stretches to perform between visits. Many patients experience significant improvement with conservative care. However, if findings suggest a condition outside the chiropractor’s scope of care or if more invasive treatment is required, referral to an appropriate medical specialist will be recommended.