Carpal tunnel syndrome (CTS) is a fairly common condition that occurs when the median nerve is compressed or its movement is restricted as it passes through the wrist. There can be many potential causes median nerve entrapment in the carpal tunnel from inflammation caused by overuse or chronic health conditions to mechanical injury. Treatment guidelines typically recommend the use of non-surgical therapies prior to surgical intervention, at least outside of emergency circumstances like a wrist fracture. But what non-surgical approaches offer the best chance for successful resolution?

A systematic review that included 461 published studies on the non-surgical management of CTS found that manual therapies offer the same long-term results as surgery with respect to reducing pain and improving function. Best of all, conservative approaches tend to carry fewer risks than surgery, and patients may experience significant improvement within weeks with nonsurgical care instead of months if they go under the knife. In the context of this review, non-surgical treatment options included mobilization techniques, massage therapy techniques, kinesiotaping, and yoga; however, among these options, which is the best bet for the CTS sufferer? In another systematic review with meta-analysis, researchers looked at 422 CTS cases and split them into two groups: those treated with manual therapies and those treated with other non-surgical options. In the context of symptom severity and functional capacity, manual therapies outperformed the other available treatments.

For patients whose CTS can be traced back to mechanical issues, it makes sense that manual therapies  applied to the wrist can be a great choice. But what if a contributing or primary cause of the patient’s symptoms is due to systemic diseases like rheumatoid arthritis, hypothyroid, or diabetes mellitus? In a systematic review that included 29 randomized clinical trials that included data on whether or not the participants had a history of systemic diseases, the researchers found that manual therapies can benefit CTS patients with systemic diseases, even in patients with severe CTS symptoms, though more research needs to be done with this more challenging patient population.

Doctors of chiropractic offer an excellent treatment option for the CTS patient, often using a multimodal treatment approach that induces manual therapies, specific exercises, physiotherapy modalities, and nutrition recommendations with the aim of reducing inflammation to allow the median nerve to function properly and free of restriction. This includes checking the full course of the median nerve from the neck to the hand as compression in the neck, shoulder, elbow, or forearm is common in CTS patients and would need to be addressed to achieve a satisfactory result. If a patient has systemic health conditions, they may require co-management with the patient’s medical physician or a specialist.