Carpal Tunnel Syndrome

Written by Dr. Jason Ngan, DC

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a peripheral nerve entrapment of the median nerve at the carpal tunnel. The median comes from a bundle of nerves at the shoulder called the brachial plexus. This nerve originates from C5-T1 nerve roots of the spinal cord, runs through the anterior part of the arm and ends at the fingers (thumb, index, middle, and half of ring finger). The median nerve control both motor and sensory functions. The carpal tunnel is a pathway in the anterior portion of the wrist that allows various tendons, ligaments, and the median nerve to pass through to the hand. The carpal tunnel is made up of a connective tissue structure called the flexor retinaculum anteriorly, and wrist bones (scaphoid, lunate, triquetrum, pisiform) posteriorly. The structures that run through the carpal tunnel include the median nerve, flexor pollicis longus, four flexor digitorum superficialisis, and four flexor digitorum profundus.

What Causes Carpal Tunnel Syndrome?

Carpal tunnel syndrome can be caused by a variety of factors:

  • Overuse (repetitive flexion and extension) especially excessive office work

  • Trauma causes inflammation

  • Pregnancy causes fluid retention

  • Arthritis causes bony changes

  • Diabetes causes high blood sugar. Sugar attaches to proteins of the tendons in the carpal tunnel causing inflammation and prevents the tendons from moving freely.

  • Connective tissue disease

What are the Signs and Symptoms?

  • Pain, numbness, tingling of the thumb, index, middle, and half of the ring finger at the palm side of the hand

  • Symptoms worse at night

  • Thenar atrophy (muscle loss at the base of the thumb to the wrist area)

  • Weak grip

How is Carpal Tunnel Syndrome Diagnosed?

Carpal tunnel syndrome is specifically compression of the median nerve at the wrist. The median nerve can be compressed at other locations and symptoms can present similar to carpal tunnel syndrome. Other median nerve conditions include cervical radiculopathy (injury to the nerve root where it exits the spine), and pronator teres syndrome (median nerve compression at the upper forearm muscle called the pronator teres). These compressions can be confused with carpal tunnel syndrome because it will affect the median nerve at the hand. To differentiate carpal tunnel syndrome and other conditions, thorough testing is required. Once carpal tunnel syndrome is properly diagnosed, we can treat the cause.

Carpal tunnel syndrome can be diagnosed with a thorough history, physical examination, and orthopedic testing.

  • Muscle weakness.

  • Abnormal sensation (pain, numbness, tingling).

  • EMG/NCV can be used to check for function of nerve and muscles.

What are the Treatment Options?

  • Splint wrist in slight extension

  • Chiropractic manipulation and mobilization

  • Vitamins C and B’s. Especially vitamin B6 to help drain fluids from the wrist.

  • Ergonomic counseling (mouse, keyboard, chair)

  • Gua-sha

  • E-stim

  • Ultrasound

  • Rehabilitative exercises and stretches

Other treatments that patients may seek (not provided at Ngan Chiropractic) include acupuncture, and surgery if severe.  

References

  1. Cranford, C. Sabin MD; Ho, Jason Y. MD; Kalainov, David M. MD; Hartigan, Brian J. MD. Carpal Tunnel Syndrome. Journal of the American Academy of Orthopaedic Surgeons 15(9):p 537-548, September 2007.

  2. de Leon RP, Auyong S. Chiropractic manipulative therapy of carpal tunnel syndrome. J Chiropr Med. 2002 Spring;1(2):75-8. doi: 10.1016/S0899-3467(07)60007-X. PMID: 19674565; PMCID: PMC2646925.

  3. Genova A, Dix O, Saefan A, Thakur M, Hassan A. Carpal Tunnel Syndrome: A Review of Literature. Cureus. 2020 Mar 19;12(3):e7333. doi: 10.7759/cureus.7333. PMID: 32313774; PMCID: PMC7164699.

  4. Sevy JO, Varacallo M. Carpal Tunnel Syndrome. [Updated 2022 Sep 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448179/

  5. Taylor, D. (2019). MANAGEMENT OF CARPAL TUNNEL SYNDROME WITH CONSERVATIVE MULTIMODAL THERAPY: A PROSPECTIVE CASE SERIES OF OUTCOMES WITH CONCURRENT WRIST AND CERVICAL MANIPULATION. Journal of Contemporary Chiropractic, 2(1), 123–130. Retrieved from https://journal.parker.edu/index.php/jcc/article/view/80

  6. Walter K. What Is Carpal Tunnel Syndrome? JAMA. 2022;328(6):593. doi:10.1001/jama.2022.10522