Carpal tunnel syndrome (CTS) is caused by compression of the median nerve as it passes through the wrist, leading to pain, numbness, tingling, and even weakness in the palm and the thumb, index, middle, and radial (thumb-side) half of the ring finger. Because the symptoms often develop slowly and intermittently, individuals frequently ignore them or attempt self-care measures until the condition begins to interfere with work and leisure activities. At that point, many patients seek out chiropractic care in an effort to find a non-surgical, non-invasive solution to their problem. So, what’s the first visit like for a new patient with suspected carpal tunnel syndrome?

The first step is for the patient to complete intake paperwork detailing their medical history, current health concerns, daily activities, and specifics about the symptoms that brought them into the office. This includes when and how the symptoms began, what aggravates or relieves them, the quality and location of the sensations, severity, and whether the condition appears to be improving or worsening over time.

Many chiropractors use the well-validated Boston Carpal Tunnel Questionnaire, which has two sections: the Symptom Severity Scale (SSS), where patients rate the intensity of 11 different symptoms on a 1-5 scale, and the Functional Status Scale (FSS), which contains eight questions that assess how CTS affects daily function. This questionnaire may be repeated throughout the course of care to track improvement. Patients might also be asked to complete a pain diagram to mark areas of pain and describe associated sensations like tingling, numbness, or burning.

The physical examination typically includes orthopedic and neurological tests of the neck, shoulder, elbow, wrist, and hand, as compression of the median nerve can occur at multiple sites along its path from the cervical spine to the wrist. If warranted, diagnostic tests such as X-rays or nerve conduction studies may be recommended to confirm the diagnosis or rule out other conditions.

With all of this information gathered, the chiropractor can develop a treatment plan to restore normal joint function and enhance mobility of the median nerve at the wrist and any other sites where entrapment may be occurring. Treatment may include manual therapies (such as spinal or extremity manipulation and soft tissue mobilization), therapeutic exercises, ergonomic advice or activity modification, nighttime wrist splinting, and nutritional guidance. If additional contributing factors are suspected—especially those beyond the chiropractor’s scope—the case may be co-managed with a medical physician or referred to a specialist for further evaluation.