When symptoms such as pain, tingling, numbness, and weakness affect the hand, the first condition that comes to mind for most people is carpal tunnel syndrome (CTS). While CTS is the most common nerve entrapment affecting the upper extremity, it is far from the only possible cause of these symptoms. So how does a chiropractor determine whether the problem is CTS or something else?

The process begins with the patient completing a detailed health history that addresses both current symptoms and relevant medical background. This information helps determine whether compression of the median nerve—central to a CTS diagnosis—is likely, or whether one of the other nerves supplying the hand should be considered. During the physical examination, the chiropractor performs specific provocative tests to help identify where the median nerve—or another nerve—may be restricted along its course. In some cases, though not routinely required, additional diagnostic tools such as nerve conduction studies or ultrasound may be used to help confirm the diagnosis.

If symptoms primarily involve the thumb, index finger, middle finger, and the thumb-side of the ring finger and are reproduced by wrist compression or sustained wrist positions, classic carpal tunnel syndrome is likely. However, compression of the median nerve at other locations along its pathway can produce a similar symptom pattern. Potential sites include the forearm, below or above the elbow, the shoulder, and even the neck. To further complicate matters, nerve compression can occur at multiple sites simultaneously. For example, a 2016 study found that approximately 1 in 16 patients with CTS also had median nerve compression in the forearm, a condition known as pronator teres syndrome.

The ulnar nerve, which supplies sensation to the pinky and the ulnar side of the ring finger, can also become compressed as it passes through a different anatomical structure at the wrist called Guyon’s canal. As with the median nerve, restriction of the ulnar nerve anywhere along its course from the neck to the hand can generate similar symptoms. The same principle applies to the radial nerve, which innervates the back of the hand and can become irritated as it passes through the radial tunnel near the wrist. This is why a thorough history and physical examination is so critical: the history helps identify which nerve is involved and the examination helps pinpoint where compression may be occurring.

In most cases, conditions involving median, ulnar, or radial nerve compression respond well to a multimodal conservative treatment approach. This may include manual therapies such as manipulation, mobilization, and soft tissue techniques; therapeutic exercises; nighttime bracing; activity modification; and anti-inflammatory strategies. Importantly, outcomes are typically faster and more favorable when patients seek care early, rather than waiting months or years before consulting with a chiropractor.