Carpal tunnel syndrome (CTS) is the most common compression neuropathy of the upper extremity, which is caused by increased pressure on the median nerve as it passes through the wrist with resulting symptoms of pain, numbness, and tingling in the thumb through third finger and thumb half of the fourth finger (palm-side). Traditionally, treatment guidelines for CTS have focused on therapies applied to the wrist. However, there is a growing understanding in the research community that CTS may be best viewed as a complex pain syndrome that requires a comprehensive sensory nervous system approach to achieve a satisfactory outcome for the patient.
Current literature suggests that 45% of CTS patients may also experience pain in the forearm, elbow, and shoulder and 14% have concurrent neck pain. Patients with CTS have also been observed to have myofascial trigger points in upper trapezius and infraspinatus muscles, as well as osteoarthritis in the cervical spine. Carpal tunnel syndrome sufferers may also have reduced cervical range of motion to the side opposite the affected wrist in addition to forward head posture—which occurs when the head rests forward of the sagittal plane, placing added stress on the soft tissues at the back of the neck and upper back to keep the head upright. Because these issues can occur along the course of the median nerve or affect anatomical regions that the median nerve passes through, treatment to address these disorders can reduce a patient’s CTS symptoms. The term “regional interdependence” is used when interventions applied to one anatomical region can influence the outcome and function of other body regions that may be seemingly unrelated.
In a June 2023 pilot study that included 15 CTS patients, researchers observed that a treatment plan consisting of ten sessions of manual traction, lateral glide mobilization, and posterior to anterior pressure applied to the neck, along with self-stretching of the upper fibers of the trapezius, scalenes, and levator scapulae muscles led to improvements in CTS pain intensity, symptoms severity, disability, and functional capacity, as well as improved function of the median nerve based on electrodiagnostic studies of median nerve motor distal latency and medial sensory nerve conduction velocity. Best of all, these improvements persisted when researchers examined the patents six months after the conclusion of care.
For decades, doctors of chiropractic have focused on the full course of the median nerve when assessing a patient with carpal tunnel syndrome symptoms based on their experience that compression of the median nerve beyond the wrist can contribute to CTS. It’s great to see that the scientific community is starting catch up and look at CTS as not just an issue of the wrist itself but more of a disorder that can include multiple body sites that all need treatment to get a patient out of pain and back to their normal activities.
