Conditions
Carpal tunnel syndrome
Reviewed by Dr Voula Roumel, Chiropractor , registered since 1987, AHPRA CHI0000942872
Last updated
Carpal tunnel syndrome is compression of the median nerve where it passes through a narrow channel at the wrist. The symptoms follow that nerve: tingling or numbness in the thumb, index and middle fingers, often worst at night or first thing in the morning, and a grip that quietly stops being reliable.
Where it gets missed is that the median nerve does not start at the wrist. It runs from the neck, through the shoulder and down the forearm before it reaches the tunnel, and it can be irritated anywhere along that route. A wrist assessed on its own may explain only part of the problem, which is why relief from wrist-only treatment often does not last.
What it feels like
- Pins and needles in the thumb, index and middle fingers, the little finger is usually spared, which is a useful distinguishing sign
- Numbness that wakes you, or that is at its worst on waking
- A burning ache travelling up the forearm from the wrist
- Grip strength dropping off, dropping cups, fumbling buttons and jar lids
- Symptoms provoked by driving, typing, or holding a phone
Early symptoms are easy to write off, and they tend not to resolve on their own. Getting assessed while the picture is still intermittent gives the most options.
What the assessment covers
- A history, which fingers, what time of day, how long, and what your hands do at work
- Testing along the whole nerve path, wrist, elbow, shoulder and cervical spine, because compression can occur at more than one level
- An orthopaedic and neurological screen, sensation, grip and reflexes, and the specific provocation tests for the median nerve
- A check for the causes that sit outside the wrist, thyroid conditions, diabetes, pregnancy and rheumatoid arthritis all raise the risk, and any of them changes the advice
- An explanation of what was found, before any treatment
What treatment involves
Treatment is aimed at reducing load on the nerve and restoring movement to the structures around it. Depending on what the assessment finds, it may include:
- Mobilisation of the wrist and carpal bones, and of the forearm joints
- Soft tissue and massage therapy through the forearm flexors, which are frequently tight and contributing
- Chiropractic adjustment of the neck and upper back where the assessment points there
- Dry needling, where trigger points in the forearm are part of the picture
- Nerve gliding and stretching work you do at home between appointments
- Practical changes to desk height, wrist position and tool use
What helps between appointments
- Wrist and forearm stretches, shown to you rather than guessed at
- A neutral wrist position overnight: a night splint is often the single most useful thing for sleep-disrupting numbness
- Workstation changes, keyboard height, mouse position, and how long you go before changing posture
- Ice on the inside of the wrist during a flare, ten to fifteen minutes
When to be referred on
Persistent numbness, weakness, or visible wasting of the muscle at the base of the thumb are signs the compression has progressed, and they warrant further investigation rather than more conservative care. If that is what the assessment finds, you will be told plainly and referred.
Related
Symptoms that travel into the elbow are covered on elbow pain, and where the neck is the driver, neck pain goes into more detail. Joint pain covers the broader picture where more than one joint is involved. Fees and every item code are on the fees page.
Frequently asked questions
How do I know if it is carpal tunnel and not something else?
The pattern is the useful clue. Carpal tunnel affects the thumb, index and middle fingers, the median nerve's territory, and characteristically wakes people at night or bites first thing in the morning. Numbness in the little finger points somewhere else entirely, usually the ulnar nerve at the elbow. Symptoms in the whole hand, or in both hands, are worth assessing properly rather than self-diagnosing, because the neck can produce a very similar picture.
Why would the chiropractor look at my neck for a wrist problem?
Because the median nerve starts there. It runs from the cervical spine, through the shoulder and forearm, and into the wrist, and it can be irritated at any point along that path. If part of the problem sits higher up, work confined to the wrist tends to give short-lived relief. Checking the whole path is how the assessment establishes where the compression actually is.
Will I need surgery?
That is a question for a surgeon, and it depends on how far the compression has progressed. Conservative care is generally the first approach for mild to moderate symptoms. Where there is persistent numbness, muscle wasting at the base of the thumb, or symptoms that are not responding, the appropriate step is referral for further investigation, and your chiropractor will say so directly rather than continuing with treatment that is not working.
Does a night splint help?
For many people it does, and it is one of the more useful things to try. A splint holds the wrist in a neutral position overnight, which is when the tunnel is most often compressed by a curled sleeping posture. It is a management tool rather than a fix, and it works best alongside the rest of the plan rather than on its own.
It started during pregnancy, is that different?
Fluid retention during pregnancy commonly raises pressure inside the carpal tunnel, and symptoms that begin then frequently settle after the birth. That does not mean putting up with it in the meantime. Tell your chiropractor you are pregnant so the assessment and any treatment account for it.
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