CARPAL TUNNEL SYNDROME
Carpal tunnel syndrome patients can be extremely frustrating to care for in a conservative medical setting. Many patients will move too quickly to the surgical option, without fully considering conservative approaches, for which there is some evidence of efficacy and a good safety record.
The rational for providing chiropractic care in patients with mild to moderate carpal tunnel syndrome is four-fold:
- wrist mobilization/manipulation may allow the nerves to move more freely through the wrist and adjuncts such as stretching and exercises to increase forearm and hand strength, may be important additions to care;
- patient may have a coexisting neck disorder which could benefit from manipulation and/or the nerves coursing through the wrist may be compromised by a "double crush lesion" at the cervical joints;
- your patient's simple preference to try a non-drug and non-surgical potential solution; and
- failure to respond to conservative medical care such as bracing or medications, and surgery is being weighed.
As far as the "double crush" theory, the jury is still out on its validity (Russel BS. Chiropr & Osteopat 2008;16(1):2). In patients with only sensory disturbances, as opposed to motor weakness, the validity is more uncertain.
Nevertheless, if your CTS patient also has neck pain, it does provide an additional indication for adjustments. I have been trained in specific techniques where displaced/sprained carpal bones are adjusted.
There are case reports, case series/comparison trials, and at least one full-scale randomized clinical trial demonstrating efficacy for chiropractic care in patients with carpal tunnel syndrome (Vernon R. J Manipulative Physiol Ther 1994;17:246; Burke J, et. al. J Manipulative Physiol Ther 2007;30;50; Davis PT, et. al. J Manipulative Physiol Ther 1998;21:317). Cochrane reviews on carpal tunnel syndrome and arm complaints, have reported modest evidence of efficacy for manipulation/mobilization.
The safety of chiropractic care based on a review of the evidence, is good. There have been no reported adverse reactions in trials of CTS patients. Cervical adverse reactions are also very rare.
A reasonable trial of care would be six to eight visits. Your patient should show improvement in this time period. If there were a favorable response to care, it would justify continued treatment with a gradual decrease in frequency.