The carpal tunnel is formed by eight small bones that comprise the top of the tunnel with the transverse carpal ligament serving as the floor. The median nerve, blood vessels, and nine tendons and their sheaths pass through the tunnel. In a healthy individual, there is a constant fluid pressure within the carpal tunnel that ranges between 2.5 and 13 mmHg. If the cross-sectional size of the tunnel is reduced or if one or more of the contents swell or become inflamed, then the pressure within the carpal tunnel will increase. This increased pressure can restrict the movement of the median nerve and stimulate the symptoms we commonly associate with carpal tunnel syndrome in the thumb through thumb-side half of the ring finger such as numbness, tingling, pain, and weakness. However, there are many potential causes for increased pressure in the carpal tunnel, and they must be identified and addressed for the patient to experience a resolution of their symptoms.
The most common cause of pressure build-up in the carpal tunnel is frequent, repetitive hand movements that inflame the tendons sliding against each other in the tunnel. As inflammation increases, the median nerve is pressed against the transverse carpal ligament and symptoms arise. Working with awkward hand postures, forceful grips, and high vibration exposure, along with infrequent breaks, can exacerbate symptoms.
In mild-to-moderate cases of carpal tunnel syndrome, treatment will focus on restoring normal movement to the median nerve and reducing inflammation in the wrist. This may include manual therapies, nerve gliding exercises, diet/supplement recommendations, ice therapy, physiotherapy modalities, nocturnal wrist splinting, and job/activity modifications such as more frequent breaks and more ergonomic tools. If rheumatoid arthritis or hormonal fluctuations are present (pregnancy, menstruation, menopause, birth control pills, hormone replacement therapy, diabetes, hypothyroid, kidney disease, lymphedema, and some medications), then co-management with an allied healthcare provider may be necessary.
Unfortunately, most patients who develop carpal tunnel syndrome often delay seeking treatment because the symptoms come one gradually and can be easily ignored. By the time they contact their doctor of chiropractic, it may be months (or even years) down the line and the condition has progressed and will take longer to manage. If the symptoms are too severe, conservative care may not be sufficient and a surgical consultation may be the next logical step.
