The carpal tunnel is a structure in the wrist that is primarily comprised of the carpal bones and the transverse carpal ligament. In addition to the median nerve, several tendons and other tissues pass through this region. If the shape of the carpal tunnel is altered or if any of the tissues within the tunnel are inflamed, pressure may be applied to the median nerve, which can reduce its mobility and function, stimulating the various hand and wrist symptoms typically associated with carpal tunnel syndrome.
Except in rare circumstances of major trauma, treatment guidelines advise patients to exhaust all conservative treatment options before considering surgery. In addition to the risks and prolonged recovery that come with undergoing a surgical procedure, the current research doesn’t indicate that surgery is any more effective over the long-term than non-surgical options. One study that included 120 women with carpal tunnel syndrome found that those who received non-surgical care had better results in the short term (at one and three months) and similar results with respect to pain relief and reduced disability after one year.
A study published in May 2021 that included 259 patients who underwent surgical care for carpal tunnel syndrome found that 76% had received some form of conservative care before their operation. This means nearly 1-in-4 of these patients proceeded directly to surgery as their initial form of treatment. Perhaps the most interesting finding from this study is that 2-in-3 patients received post-surgical conservative care, which suggests they did not find lasting relief from their procedure.
So why does surgery to reduce pressure in the carpal tunnel fail to produce lasting results for so many patients? There are several possible reasons but one worth considering is that pressure may be applied to the median nerve at any number of sites along its course from the neck to the hand. In fact, it’s common for median nerve entrapment to occur in two or more areas such as the wrist, forearm, elbow, shoulder, and neck. Pressure on the median nerve at any of these sites outside of the wrist can produce symptoms that can be mistaken for carpal tunnel syndrome. That’s why doctors of chiropractic examine the full course of the median nerve so that they can address all instances of potential median nerve entrapment.
For the carpal tunnel syndrome patient, chiropractors often utilize a multi-modal therapeutic approach that includes manual therapies such as joint manipulation and mobilization in addition to nocturnal splinting, specific exercises, workstation assessments/work modifications, and nutritional advice.