Neck pain is the second most common reason that patients seek out chiropractic care. While the initial paperwork patients complete will ask about pain and disability in other areas of the body, many might overlook issues like mild or infrequent numbness in the hand because they think that it’s unrelated and not something to be concerned about—at least at the moment. But once care begins, a patient might notice those “carpal tunnel syndrome” symptoms seem to resolve. Why’s that?

First, it’s important to understand that carpal tunnel syndrome is caused by pressure placed on the median nerve and restricting its mobility as it passes through the wrist. This can be the result of inflamed tissues due to rapid, repetitive hand movements or from swelling cause by hormonal issues, like pregnancy.

However, the median nerve doesn’t just appear out of nowhere and travel into the wrist to innervate the hand and fingers. It runs from the cervical spine, through the shoulder, and down the arm, passing through a variety of tissues that are all capable of placing pressure on the nerve. When this occurs, symptoms like pain, numbness, tingling, and weakness in the hand and wrist—the textbook symptoms of carpal tunnel syndrome—can manifest, even if there is no issue in the wrist.

Additionally, problems affecting the median nerve as it exits the neck can also make it more susceptible to problems elsewhere. An example of this can be seen in a 2021 study that found that patients with a cervical spinal cord injury have a two-times increased risk for carpal tunnel syndrome. Another study, also published in 2021, found that patients with double crush syndrome—compression of the median nerve at two locations along its course, which may include the wrist—are more likely to have reduced spinal mobility and abnormal alignment in the cervical and thoracic spine.

Because musculoskeletal disorders that affect the neck can produce or contribute to symptoms in other regions of the body, a doctor of chiropractic will examine the whole patient when they come in for complaints like hand and wrist pain. This will also include an examination of the shoulder and arm to look for other causes of median nerve interference. A study published in 2016 found that about 6% of carpal tunnel syndrome patients also have a condition called pronator teres syndrome, which is restriction of the median nerve as it passes through the forearm.

Treatment will aim to address all potential causes of median nerve entrapment observed during the initial examination using a multimodal approach that can include spinal manipulation, joint mobilization, soft tissue work, nutritional recommendations, nocturnal splinting, activity modifications, and specific exercises. If non-musculoskeletal issues are suspected, the doctor of chiropractic may co-manage the condition with an allied healthcare professional such as the patient’s medical physician or a specialist.