Carpal tunnel is one of the most common workplace conditions. It commonly occurs after long term use of a computer with the most common symptoms being pain and numbness in the hands, wrists, and fingers. Up until a few years ago, the standard of care included pain relievers and surgery. However, with more research being done about the poor outcomes of surgery, Chiropractors have been able to offer a less invasive and more effective treatment option.
WHAT IS IT
True carpal tunnel is a wrist condition that affects the median nerve. Now, this nerve starts in your neck and travels down your arm, through your elbow, and down to your wrist and hand. Are there other conditions that affect this nerve and produce similar symptoms? Yes. But that aside, let’s talk about what carpal tunnel would look like in your textbook patient.
The carpal tunnel is an opening in your wrist that is formed between your hand bones, known as carpals, and the transverse carpal ligament. The tunnel allows the median nerve to pass through and provide sensory and motor function to the thumb, pointer, middle, and ring fingers.
The symptoms of carpal tunnel can vary from patient to patient. The most common include weakness when gripping objects, pain or numbness in the hand, a feeling of pins and needles in the fingers, swollen feeling in the fingers, burning sensation in the fingers, pain that is worse at night and can interrupt sleep. A big sign that your wrist pain could be from carpal tunnel is the timing around when you start to show symptoms. Typically, the symptoms start as mild, occasional, and sporadic. However, the longer you go without treatment, the symptoms tend to become much worse. Chronic carpal tunnel symptoms include dropping objects and trouble performing fine motor tasks.
WHAT CAUSES IT
Unfortunately, there is not one thing that causes carpal tunnel every time. The most common factors are:
Repetitive movements with the hands (typing, using a mouse)
Frequent grasping activities (tennis, golf)
Joint or bone diseases (arthritis)
Hormonal changes (pregnancy, menopause)
Injuries (sprain, strain, fracture)
Surgery used to be the treatment standard for carpal tunnel. There are two options for surgery: open surgery and endoscopic. In both cases, a piece of tissue that is pressing on the nerve is cut. Afterwards, the hand and wrist are wrapped and splinted to keep your hand from moving. What recent research has shown is that outcomes from surgery are either no improvement, or worse progression. There is a short time of relief, but over time scar tissue will build up that can put even more pressure on the nerve, causing the symptoms to come back even more severe. There is an association of poor surgical outcomes in people with strenuous or repetitive wrist movements jobs, which is the most common group of people to experience carpal tunnel pain in the first place.
There is a common misconception that chiropractors only treat the back. In reality, chiropractors treat every joint in the body, which includes the wrist, hand, and fingers.
Arm adjustments: if the carpal tunnel syndrome is the result of problems in the wrist or arm itself, an adjustment here will relieve pressure off the median nerve
Spinal adjustments: misalignments in the neck and upper back can put pressure on the nerve as well, so adjustments here will help reduce the symptoms
Soft tissue therapy: trigger points and tight muscles in the arm and neck can contribute to your symptoms, so using a tool (Graston) or a session with a licensed massage therapist will help to lengthen those muscles
Stretches and exercises: these can help improve the function of your wrist while supporting the health of the median nerve
al-Qattan, M. M., Bowen, V., & Manktelow, R. T. (1994). Factors associated with poor outcome following primary carpal tunnel release in non-diabetic patients. Journal of hand surgery (Edinburgh, Scotland), 19(5), 622–625. https://doi.org/10.1016/0266-7681(94)90130-9
Page, M. J., O'Connor, D., Pitt, V., & Massy-Westropp, N. (2012). Exercise and mobilisation interventions for carpal tunnel syndrome. The Cochrane database of systematic reviews, (6), CD009899. https://doi.org/10.1002/14651858.CD009899
Sault, J. D., Jayaseelan, D. J., Mischke, J. J., & Post, A. A. (2020). The Utilization of Joint Mobilization As Part of a Comprehensive Program to Manage Carpal Tunnel Syndrome: A Systematic Review. Journal of manipulative and physiological therapeutics, 43(4), 356–370. https://doi.org/10.1016/j.jmpt.2020.02.001