Carpal Tunnel and Chiropractic

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:   Frankp@chiro.org
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Chiropractic Research Results for Carpal Tunnel Syndrome

	The Repetitive Stress Disorder Page A Chiro.Org article collection There is a huge difference between chiropractic and medical management of disorders like Carpal Tunnel. There are pictures below of typical medical management. A chiropractor knows that if your hands have pain and tingling, that the first place to look is your neck, specifically in the mid to lower cervical spine. That is where the nerve roots which make up the brachial plexus originate. Then the brachial plexus divides into named nerves like the median and ulnar nerve. You will see the brachial plexus forming from the nerve roots on the right side of this picture.
	Chiropractic Management of Work-related Upper Limb Disorder Complicated By Intraosseous Ganglion Cysts: A Case Report J Chiropractic Medicine 2011 (Sep); 10 (3): 166–172 The patient was diagnosed previously with bilateral CTS and presented with common CTS symptoms that were nonresponsive to several previous courses of care. Magnetic resonance imaging revealed bilateral ganglion cysts, and electrodiagnostic studies found left CTS and bilateral radial neuralgia. Right limb findings appeared more consistent with nonspecific arm pain. Chiropractic manipulative therapy, soft-tissue approaches, and physiotherapy modalities were applied to the arms and wrists over a 3-month period. Home care included exercises using elastic tubing and a gyroscopic handheld device. Chiropractic manipulative therapy and other conservative approaches resulted in subjective improvements of decreased hand paresthesias and muscle weakness and objective improvements in range of motion and neurologic deficits. Although the patient's symptoms and function improved, she remained with a level of permanent impairment.
	Neurodynamic Mobilization in the Conservative Treatment of Cubital Tunnel Syndrome: Long-Term Follow-Up of 7 Cases J Manipulative Physiol Ther. 2010 (Feb); 33 (2): 156–163 ~ FULL TEXT This case series demonstrated that conservative treatment of CTS may be beneficial for selected patients with mild to moderate symptoms. The treatment included neurodynamic mobilizations, including sliding techniques and tensioning techniques, which are thought to enhance ulnar nerve gliding and restore neural tissue mobility. Conservative treatment using neurodynamic mobilization with patient education and activity modification demonstrated some long-term positive results.
	Occupational Injuries Suffered by Classical Musicians Through Overuse Clinical Chiropractic 2004 (Jun); 7 (2): 55–66 There is a high rate of injury to professional classical musicians and teachers that can be disruptive to practice and potentially threatening top careers. Females and string players were discovered to be of particular risk. The majority of injuries were to the shoulder and proximal thoracic spine and the absence of injuries in amateur players suggests a relationship to overuse. The author suggests that the incorporation of postural and ergonomic into musical education and chiropractic treatment programmes for classical musicians and teachers could be of benefit.
	Clinical Surveillance of Carpal Tunnel Syndrome in Two Areas of the United Kingdom, 1991-2001 J Neurol Neurosurg Psychiatry 2003 (Dec); 74 (12): 1674–1679 The age distributions of unselected cases of carpal tunnel syndrome in both clinics differ markedly from that usually portrayed in surgical series. There was a significant increase in cases diagnosed between 1992 and 2001 in Canterbury, probably the result of increased ascertainment of milder cases. Median nerve impairment is more severe in the elderly and in men at all ages.
	The Symptomatic Upper Extremity: An Algorithmic Approach to Diagnosis, Part 1 J American Chiropractic Assoc 1999 (Apr): 36 (4): 32–58 ~ FULL TEXT Numbness in an arm or hand is a common presenting or secondary patient complaint. Carpal tunnel syndrome poses a familiar mechanism and is frequently cited as the cause of the patient's symptoms. While it may be the most common upper-extremity peripheral nerve entrapment neuropathy, a myriad of other nerve entrapment sites and pathologies are capable of producing upper-limb symptoms. In this article, an algorithmic approach by topographical region is utilized to narrow or expand the diagnostic focus.
	The Symptomatic Upper Extremity: An Algorithmic Approach to Diagnosis, Part 2 J American Chiropractic Assoc 1999 (May): 36 (5): 30–41 ~ FULL TEXT Numerous condtions, notably nerve entrapment syndromes, account for symptoms in the upper extremities. Some are quite common and familiar, while others are remote. In this article, an algorithmic approach has been utilized to describe a broad variety of neurological and non-neurological conditions and to provide readers with an overview of each. The algorithm is intended to be used by the non-specialist who is interested in expanding his list of differential diagnoses for a patient's complaint. It is a reference tool, not a cookbook for diagnosis. Likewise, a planar diagram cannot provide a definitive diagnosis. Common sense and experience will do that.
	Comparative Efficacy of Conservative Medical and Chiropractic Treatments for Carpal Tunnel Syndrome: A Randomized Clinical Trial J Manipulative Physiol Ther 1998 (Jun); 21 (5): 317–326 Interventions included ibuprofen (800 mg 3 times a day for 1 wk, 800 mg twice a day for 1 wk and 800 mg as needed to a maximum daily dose of 2400 mg for 7 wk) and nocturnal wrist supports for medical treatment. Chiropractic treatment included manipulation of the soft tissues and bony joints of the upper extremities and spine (three treatments/week for 2 wk, two treatments/week for 3 wk and one treatment/week for 4 wk), ultrasound over the carpal tunnel and nocturnal wrist supports. There was significant improvement in perceived comfort and function, nerve conduction and finger sensation overall, but no significant differences between groups in the efficacy of either treatment.
	Chiropractic Manipulation in Carpal Tunnel Syndrome J Manipulative Physiol Ther 1994 (May); 17 (4): 246–249 Chiropractic manipulations were rendered 3 times per week for 4 wk, to the subject's cervical spine, right elbow and wrist using a low amplitude, short lever, low force, high velocity thrust. Significant increase in grip strength and normalization of motor and sensory latencies were noted. Orthopedic tests were negative. Symptoms dissipated. In this case study, chiropractic made a demonstrable difference through objective and subjective outcomes.

Other Management Approaches for Carpal Tunnel Syndrome

Vitamin B6 (pyridoxine and pyridoxal 5'-phosphate) - Monograph   (PDF) Alternative Medicine Review 2001 (Feb); 6 (1): 87–92 ~ FULL TEXT Researchers have found a direct correlation between carpal tunnel syndrome (CTS) and a deficiency in P5P, and that treatment with 100–200 mg pyridoxine daily for at least 12 weeks was highly beneficial in reducing both the symptomology and a P5P deficiency associated with CTS. [14–16] A few studies have shown no clinical benefit from pyridoxine HCl supplementation, [17–19] with most of the reports of beneficial effects coming from Ellis et al. [15, 20–23] A 1996 literature review of clinical trials using pyridoxine to treat CTS concluded that the evidence for the use of pyridoxine as the sole treatment for CTS is weak, but that it may be valuable as an adjunctive treatment through its effect on altered perception of pain and increased pain threshold. [24]

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