Doctors of Chiropractic frequently see patients with carpal tunnel syndrome (CTS). It is a very common condition and usually responds well to the non-surgical chiropractic treatment approaches including hand, wrist, elbow, shoulder, and/or neck manipulation, myofascial release techniques, wrist splint use—especially at night, workstation evaluation and modifications, physiotherapy modality use (such as electrical stimulation, low level laser therapy, pulsed ultrasound), therapeutic exercises, and more.

So, what happens when CTS does not respond to these or other treatment approaches? Also, what can be done if problems still persist in patients who have already been operated on for CTS? The answer to these questions rests in obtaining a thorough evaluation of the condition including a detailed history and examination to identify different or concurrent conditions that may also need to be treated. For example, from an anatomical standpoint, a pinched nerve in the neck, thoracic outlet (shoulder), and/or elbow (pronator tunnel syndrome) may be the primary issue causing carpal tunnel syndrome-like symptoms without there being dysfunction in the carpal tunnel itself. In some cases, patients can have BOTH CTS and a pinched nerve above the wrist. This would be described as “double or multiple crush syndrome” and both areas must be addressed in order for a successful and satisfying outcome to occur.

Another nerve called the ulnar nerve can create numbness and weakness in the hand and can be confused with CTS. Because only about 50% of patients with hand numbness can accurately report the location of the symptoms, diagnosing compression of the ulnar nerve is essential as a CTS release will NOT help those with ulnar neuropathy. The most common location for pinching the ulnar nerve is at the inner or medial elbow near the “funny bone,” referred to as the cubital tunnel. The ulnar nerve can also be compressed at the wrist, neck, or combinations of these resulting in a double or multiple crush syndrome.

Therefore, when considering treatment options for CTS and/or other nerve compression syndromes affecting the upper limb, it is imperative that a thorough evaluation of the presenting patient be performed so treatment can address all probable causes of the patient’s symptoms in order to achieve a satisfying result.