Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy, and it is estimated to affect up to 4.9% of the population. Because the condition is characterized by symptoms like pain, numbness, tingling, and weakness in parts of one or both hands, it’s easy to understand why CTS can have such a negative impact on one’s quality of life and ability to carry out everyday activities. In past articles, we’ve discussed how chiropractic care can benefit patients with mild-to-moderate CTS, but what about more severe cases, especially those in which a systemic condition—like diabetes—is also present?

In 2021, a group of researchers reviewed data from twenty-nine studies published in the preceding decade on the management of carpal tunnel syndrome, particularly for severe cases or those attributable to a secondary condition such as diabetes, hypothyroidism, obesity, etc. They found evidence that pharmacology, electrotherapy, and manual therapy are beneficial for severe and/or systemically caused CTS. However, studies with larger sample sizes are needed.

The paper reported that manual therapies—which are commonly used by chiropractors—like carpal bone mobilization, neurodynamic techniques, and other soft tissue techniques provided benefits with respect to symptom and function improvement, especially when combined with nocturnal splinting.  The researchers also found that studies support the use of a neutral wrist position (or even slight flexion) splint rather than the commonly recommended 20 degree wrist extension splint.

The review also noted evidence that various forms of “electrotherapy”—pulsed and continuous ultrasound, diathermy, high intensity laser therapy (HILT), low level laser therapy (LLLT), pulsed electromagnetic field (PEMF), extracorporeal shockwave therapy (ESWT), pulsed radiofrequency, and electro-acupuncture—may be beneficial, especially as part of a multimodal approach. Additionally, the review found that corticosteroids may not provide a benefit when used alone but did when combined with nocturnal splinting.

Ultimately, the authors concluded that for these types of CTS cases, a multimodal treatment plan that combines pharmacology, electrotherapy, and manual therapy may be the best approach, though more research is necessary to determine which specific therapies may work best for a particular CTS case type. Doctors of chiropractic are trained in the use of several forms of manual therapies and may also offer some of the electrotherapy options noted above. If there are secondary conditions that require management in conjunction with a medical physician, your chiropractor can team up with your family doctor or a specialist.