Carpal Tunnel Syndrome (CTS) – What Else Could It Be?

In our clinic, we see patients frequently with CTS.  If is a very common condition and usually responds well to the non-surgical chiropractic treatment approaches including hand, wrist, elbow, shoulder and/or neck manipulation, Myofascial release techniques, wrist splint use – especially at night, work station evaluation and modifications, physiotherapy modality use, such as electrical stimulation, low level laser therapy, pulsed ultrasound, therapeutic exercises, as well as other treatment approaches

CTS symptoms include numbness, tingling, or half asleep sensations in the hand involving the palm and 2nd, 3rd, and thumb side of the 4th fingers.  Sometimes, there is weakness in the grip strength with frequent dropping of objects or difficulty unscrewing jars commonly reported.  Waking at night and needing to shake or flick the fingers to “…wake them up” is common.  Driving due to holding onto the steering wheel with the wrist bent, holding a book or newspaper, buttoning a shirt, and threading a needle, can all become challenging when the median nerve which goes through the carpal tunnel is pinched.  Because there are 9 tendons along with the median nerve that travel through the tunnel, fast repetitive movements of the hands and fingers is frequently associated with the onset of CTS.  What makes treatment of CTS challenging is that most patients wait WAY TOO LONG before they go for help and nerve damage can occur as a result.

So, what happens when CTS does not respond to these or other treatment approaches?  Also, what can be done if, after CTS surgery, problems still persist?  The answer to these questions rests in obtaining a thorough evaluation of the condition including a detailed history and examination and, consideration of a different or concurrent condition.  For example, from an anatomy standpoint, a pinched nerve in the neck, thoracic outlet (shoulder) and/or elbow (pronator tunnel syndrome), may be the primary issue, not CTS alone or, sometimes at all.  If BOTH CTS and a pinched nerve above the wrist are present, the “double or multiple crush syndrome” must be addressed in order for a successful and satisfying outcome to occur.

Another nerve called the ulnar nerve can create numbness and weakness in the hand and can be confused with CTS.  Because only about 50% of patients with hand numbness can accurately report the location of the symptoms, diagnosing compression of the ulnar nerve is essential as a CTS release will NOT help those with ulnar neuropathy.  The most common location for pinching the ulnar nerve is at the inner or medial elbow near the “funny bone,” referred to as the cubital tunnel.  It can also be compressed at the wrist, neck, or combinations of these resulting in a double or multiple crush syndrome.  We’ve had many patients present with “carpal tunnel” that were not CTS at all but rather, ulnar nerve compression conditions.

Therefore, when considering treatment options for CTS and/or other nerve compression syndromes affecting the upper limb, it is imperative that a thorough evaluation of the presenting patient be performed so time is not wasted treating an unrelated condition and to obtain a satisfying outcome.