When individuals experience symptoms like pain, tingling, numbness, or weakness in their hand, carpal tunnel syndrome (CTS) is often the first condition considered. CTS is indeed the most prevalent nerve entrapment issue in the upper limb, but it is not the sole explanation for these symptoms. So, how does a chiropractor distinguish between CTS and other possible causes?
The diagnostic process begins with the patient providing a comprehensive health history, detailing their current symptoms as well as any relevant medical conditions. This information assists in evaluating whether compression of the median nerve—a hallmark of CTS—is probable, or if involvement of other hand nerves might be responsible. During the physical examination, the chiropractor will use targeted provocative tests to assess where the median nerve or another nerve might be experiencing pressure along its pathway. In some situations, although not always needed, supplementary diagnostic methods such as nerve conduction studies or ultrasound may help substantiate the diagnosis.
Symptoms that chiefly affect the thumb, index finger, middle finger, and the thumb side of the ring finger—which worsen with wrist compression or maintaining the wrist in certain positions—are characteristic of classic carpal tunnel syndrome. Nevertheless, the median nerve can also be compressed at other points along its route, including the forearm, near or above the elbow, the shoulder, or even the neck, leading to similar symptoms. Sometimes, nerve compression may occur simultaneously at more than one location. For instance, a study from 2016 determined that about 1 in 16 people with CTS also experienced median nerve compression in the forearm, a situation known as pronator teres syndrome.
The ulnar nerve is another nerve that can be compressed, particularly as it travels through Guyon’s canal at the wrist, providing sensation to the pinky and the adjacent side of the ring finger. Restriction of the ulnar nerve can occur anywhere from the neck down to the hand, and can manifest symptoms similar to those of median nerve compression. Similarly, the radial nerve, which serves the back of the hand, is susceptible to irritation as it passes through the radial tunnel near the wrist. Therefore, a careful medical history and thorough examination are essential. The history narrows down which nerve is involved, while the examination identifies the site of compression.
Most cases involving compression of the median, ulnar, or radial nerves are effectively managed with a conservative, multimodal treatment plan. This can include manual therapies such as joint manipulation, mobilization, and soft tissue work; prescribed therapeutic exercises; the use of night splints; adjustments in activity; and anti-inflammatory measures. Notably, individuals tend to achieve better and faster outcomes when they seek professional care early, instead of postponing evaluation and treatment for extended periods.
