Carpal Tunnel Syndrome

Understanding Carpal Tunnel Syndrome

Also known as: CTS, Median Nerve Entrapment at the Wrist Most people know carpal tunnel syndrome as a wrist problem. What's less appreciated is that it's often a whole-pathway problem — where irritation of the median nerve can originate or be amplified anywhere from the neck down to the wrist, a pattern called "double crush. " This distinction matters because treating only the wrist often produces incomplete results, while addressing the entire nerve pathway produces much better outcomes. The median nerve becomes compressed as it passes through the carpal tunnel — a narrow channel at the base of your palm bordered by wrist bones and the transverse carpal ligament — and it supplies sensation to the thumb, index, middle, and half of the ring finger.

The classic story is waking at night shaking out your hand to relieve numbness and tingling, with symptoms centered in the thumb, index, and middle fingers. Dropping objects, difficulty with fine motor tasks, and weakness in thumb grip develop as compression progresses. Prolonged driving, holding a phone, or typing often provokes symptoms. Women are affected roughly three times more often than men, and many patients first notice symptoms during pregnancy.

Repetitive wrist flexion, gripping, and keyboarding lead the list. Pregnancy, hypothyroidism, diabetes, rheumatoid arthritis, and obesity all increase risk. The double-crush phenomenon — where nerve irritation in the neck compounds wrist compression — is common and explains why cervical treatment helps patients who might otherwise seem like "just a wrist problem. " We treat the whole pathway.

Wrist mobilization frees the carpal bones. Cervical and thoracic adjustments address the double-crush component. ART and Graston/IASTM release the flexor retinaculum, pronator teres, and tight forearm tendons. Median nerve glides restore neural mobility.

A neutral-wrist night splint to prevent prolonged flexion during sleep is often the single highest-yield intervention in mild to moderate cases. Ergonomic coaching on keyboard height, mouse placement, and micro-breaks prevents recurrence. Class IV laser has good evidence for symptom reduction in carpal tunnel. Most patients improve within six to ten weeks.

We refer for nerve conduction studies and surgical consultation for severe cases or visible thenar wasting. We may recommend: diversified adjustments, ART, Graston/IASTM, Class IV laser, low-level laser, corrective exercise, ergonomic coaching Seek immediate care if: You develop rapid loss of thumb strength, visible muscle wasting at the base of the thumb, or constant numbness that no longer fluctuates — these signal advanced compression and often benefit from surgical consultation.