Fast and repetitive hand and finger movements with little rest time can cause the sheaths that cover the tendons passing through the carpal tunnel to become inflamed, placing increased pressure within the tunnel, compressing the median nerve, and stimulating the symptoms associated with carpal tunnel syndrome. Injury or overuse of the tendons themselves can also cause symptoms that may be thought of as carpal tunnel syndrome. How does a doctor of chiropractic determine which condition a patient has, carpal tunnel syndrome or wrist tendonitis?

The first step involves the patient’s history and initial consultation. In addition to providing information on their past and current health issues, the patient may be asked specific questions about their presenting complaint, such as whether they recall what caused their symptoms, when the symptoms first became noticeable, what makes the symptoms feel better or worse, what their exact symptoms are, and what time of day the symptoms are best or worst, for example.

Based on the information provided, the chiropractor will conduct a physical examination. The exam will include observation; palpation (touching and pressing); range of motion assessments of the arm, wrist, hand, and fingers; and neurological tests of the upper extremity, including reflexes, muscle strength (such as grip and/or pinch), and sensation testing (for example, light touch or distinguishing between sharp and dull). To rule out red-flag issues—such as fracture or advanced joint disease—an X-ray may be ordered. Other diagnostic studies, such as ultrasound or nerve conduction velocity testing, may be of use to help confirm a suspected diagnosis.

If carpal tunnel syndrome is suspected, symptoms such as pain, numbness, tingling, and reduced sensation will follow the course of the median nerve into the thumb, index finger, middle finger, and the thumb-side of the ring finger, though symptoms may also travel up the forearm. Symptoms may worsen at night and during the day when the wrist is bent up or down or held in one position for prolonged periods. Orthopedic tests that involve flexing the wrists for 60–90 seconds, tapping over the carpal tunnel, and manually compressing the carpal tunnel will also be positive in carpal tunnel syndrome. When performed, a nerve conduction study will typically show slowed median nerve function across the wrist.

In cases of wrist tendonitis, pain will be localized to a specific tendon with tenderness at one precise point, and symptoms will mostly be felt in the wrist or forearm rather than the fingers. Symptoms may be described as achy, sharp, or pulling pain, without numbness or tingling, that worsens with gripping, lifting, twisting, or resisted motion. With rest, symptoms will usually improve. Diagnostic imaging may show tendon thickening or inflammatory changes.

Treatment will depend on examination findings, but in general, with carpal tunnel syndrome, the approach used will be intended to reduce compression on the median nerve, potentially with activity modifications and ergonomic changes to reduce inflammation while tissues heal. With wrist tendonitis, heavier activity will be reduced initially to allow the tendon to recover, followed by specific exercises to increase tendon strength and load tolerance. The good news is that doctors of chiropractic are well-equipped to distinguish between these conditions and manage them using an effective, non-surgical, conservative approach.