When a person experiences pain, numbness, tingling, and/or weakness in the hand, they may assume it’s carpal tunnel syndrome (CTS) since it’s the most common and well-known peripheral neuropathy. Unfortunately, many healthcare providers may also jump to the same conclusion, and care may focus on the hand and wrist. One problem with this approach is that the patient may have several conditions that each contribute to their carpal tunnel symptoms and all need to be addressed for a satisfactory result.

The carpal tunnel itself is very small in diameter, and anything that causes swelling or inflammation can result in an even tighter space that the median nerve must pass through to innervate the thumb, index finger, middle finger, half the ring finger, and much of the palm. If the patient has a job or hobby that involves frequent, repetitive hand movements or the use of power tools, then they may be advised to take more breaks to allow the wrist to rest or to make changes to their tool or movements. For example, a 2022 study reported that using power tools with the wrist in a non-neutral position increases pressure in the carpal tunnel.

The patient’s history may also indicate non-musculoskeletal factors that may contribute to their symptoms, such as diabetes, birth control, hypothyroidism, vitamin D deficiency, etc. When this is the case, the doctor of chiropractic may co-manage the patient with their medical physician.

It’s also important to keep in mind that the median nerve doesn’t exist only in the wrist and hand.  The median nerve originates in the neck and is made up of branches from the C6 to T1 nerve roots and it passes through the shoulder, elbow, and forearm before reaching the carpal tunnel. If the mobility of the nerve is affected at any of these sites, the patient may report many of the same symptoms as CTS. Worse, there could be median nerve entrapment at the wrist and one or more of these other areas. This is why doctors of chiropractic will check the full course of the median nerve when examining a new patient for CTS. To complicate matters, the radial and ulnar nerves innervate other parts of the hand, and these may also be entrapped along their course. A survey of 1,001 individuals in a metropolitan area in 2017 found that nearly 6% experienced symptoms associated with ulnar nerve entrapment.

Once all the potential causes of the patient’s chief complaint are uncovered, treatment to reduce inflammation and improve joint mobility may include manual therapies, home exercises, activity/work modifications, nocturnal wrist splinting, vitamin/supplement recommendations, dietary modifications, and even co-managing the patient with an allied healthcare provider—all with the aim to return the patient to their normal work and life activities as soon as possible. However, it’s important to note that patients may experience faster improvement if their condition is addressed early in the course of the disease, so don’t wait until your hand and wrist symptoms become unbearable before seeking care.