Carpal tunnel syndrome (CTS) is a condition that occurs when the median nerve is compressed as it passes through the wrist. The carpal tunnel is a narrow passage in the wrist that also contains several tendons and blood vessels. Any factor that reduces the cross-sectional area of the tunnel or increases the volume of its contents—such as inflammation, swelling, or structural changes—can compress the median nerve and trigger the hallmark symptoms of CTS, including pain, numbness, tingling, and weakness in the hand and fingers. Clinical guidelines generally recommend conservative care as the first line of treatment for CTS. Chiropractic care, which may include manual therapy, nerve gliding techniques, exercise, and ergonomic advice, is a well-supported conservative approach. However, in some cases, more invasive interventions such as surgery may be necessary.

The clearest indication for surgical intervention is in an emergency situation. While CTS is most often caused by repetitive microtrauma over time (such assembly line work), it can also result from acute trauma. In cases involving a distal radius fracture, crush injury, or rapid-onset swelling from hematoma, abscess, or infection, urgent surgical decompression may be needed to prevent permanent nerve damage.

Surgery may also be necessary in non-emergency cases when conservative care fails. Most patients with mild-to-moderate CTS respond well to conservative management. However, in more advanced or prolonged cases, scar tissue, chronic inflammation, or direct nerve damage may make recovery slower—or unlikely—without surgical intervention. Unfortunately, many patients wait until symptoms significantly impair daily function before seeking care, which can reduce the effectiveness of conservative treatments.

Unfortunately, research shows that best-practice guidelines are not consistently followed. For example, a study of 782,717 patient records found that only 88 patients received all recommended conservative treatments within the first year after diagnosis. Similarly, a 2021 Finnish study reported that 17% of patients who underwent carpal tunnel release surgery had received no conservative care beforehand.

The good news is that chiropractic care is not only a highly effective conservative treatment for CTS, but chiropractors are also trained to assess the entire course of the median nerve, not just the wrist. This is crucial, as nerve compression can occur anywhere along the nerve’s path—from the neck and shoulder to the elbow and forearm. In fact, many patients with carpal tunnel syndrome also have multiple sites of nerve entrapment, a condition known as double crush syndrome. For long-term success, all contributing factors must be identified and addressed.