Atlantic Coast Chiropractic

Carpal Tunnel Research On Effectiveness Of Conservative Treatment

So often we hear, “…well if it’s so good, show me the proof!”  Chiropractic case management of Carpal Tunnel Syndrome (CTS) has been well established for many years.  And yet, we still hear skepticism about the benefits of chiropractic management of CTS.  If we can show the data regarding the effectiveness of chiropractic for CTS patients, we will finally be able to help more people with this potentially disabling condition. 

So, let’s take a look at the evidence that supports the benefits of chiropractic for CTS:

1) Davis PT, Hulbert JR, Kassak KM, et al. “Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial”

J Manipulative Physiol Ther. 21.5 (June 1997): 317-326.

The most important finding reported in this 91 patient study was that chiropractic treatment was equally effective in reducing CTS symptoms as medical treatment.  The chiropractic care included ultrasound, nighttime wrist supports and manipulation of the wrist, arm and spine.  Medical care included ibuprofen (800 mg, 3x/day for 1 wk, 800 mg, 2x’day for 1 wk, & 800 mg as needed for 7 wks) plus a night wrist splint.  Both groups did equally well but given the side-effect potential of ibuprofen on the stomach, liver, and kidneys, a strong argument for the non-drug, chiropractic approach can be made.

2)  Bonebrake AR, Fernandez JE, Marley RJ et al. “A treatment for carpal tunnel syndrome: evaluation of objective and subjective measures” J Manipulative Physiol Ther. 13.9 (Nov-Dec 1990): 507-520

CTS sufferers (n=38) received chiropractic spinal manipulation and extremity adjusting.  Also,   soft tissue therapy, dietary modifications or supplements (B6) and daily exercises were prescribed. After treatment, results showed improvement in all strength and range of motion measures.  Also, a significant reduction in pain and distress ratings was reported.

3) Mariano KA, McDougle MA, Tanksley GW “Double crush syndrome: chiropractic care of an entrapment neuropathy” J Manipulative Physiol Ther. 14.4 (May 1991):262-5

In 1973, Upton and McComas first proposed the presence of the "double crush syndrome." Their hypothesis was that when a nerve is pinched anywhere along its route, it makes the rest of the nerve more sensitive to otherwise “normal” stimulation. A case report of a man with both cervical radiculopathy and carpal tunnel syndrome, i.e., "double crush syndrome" was presented. Chiropractic management consisted of chiropractic manipulative therapy as well as ultrasound, electrical nerve stimulation, traction and a wrist splint. The experimental basis, clinical evidence, etiology, symptomatology and findings of this condition are discussed.  The Double Crush Syndrome helps explain why cervical/neck manipulation helps many CTS patients.

Carpal tunnel syndrome occurs when the median nerve, which starts at the neck and runs from the forearm into the hand, becomes compressed or squeezed at the wrist. In some cases there may also be compression at the spine.

            The median nerve controls sensations to the palm side of the thumb and fingers (but not the little finger), as well as impulses to some small muscles in the hand that allows the thumb and fingers to move.

            A recent study in the Journal of Manipulative and Physiological Therapeutics compared two different conservative treatments for patients with mild to moderate carpal tunnel symptoms. One treatment was the Graston technique, which uses an instrument to rub the forearm, wrist and hand areas to breakdown scar tissue and adhesions. In the other treatment a chiropractor applied deep pressure by hand to the same areas. These treatments are thought to release tight muscles and myofascial restrictions.

            The patients got the treatments twice each week for four weeks followed by one treatment a week for two additional weeks. The patients also did at-home stretching exercises. They did not use common conservative treatments such as wrist splints and anti-inflammatory medications.

            After both interventions, there were objective improvements to nerve conduction latencies (nerve function), wrist strength, and wrist motion. The patient symptoms of pain also improved, and both groups reported high satisfaction with the care they received.

            Despite surgery being in widespread use in the US for carpal tunnel syndrome, it is important for conservative treatments to be tried prior to an invasive operation. The surgical complication rates are low but when they do occur, can be devastating. In addition to direct surgery costs, one has to also consider disability payments (not working), and rehabilitation that may take several weeks. These costs can be substantial. For this reason, many medical doctors recommend conservative treatments first.

            Of all the conservative options, manual therapy by a chiropractor is an excellent choice. It comes without the side effects associated with long-term use of medications