Carpal tunnel syndrome (CTS) is a condition that occurs following compression or restriction of the median nerve as it passes through the wrist and into the hand. Thus, the focus of treatment is to alleviate pressure on the median nerve, allowing it to transfer motor and sensory information to and from the hand. Clinical guidelines recommend exhausting conservative treatment options before considering surgery, of which chiropractic is an excellent choice. Let’s discuss the various tools at a chiropractor’s disposal for managing carpal tunnel syndrome.

• Manual Therapy: This includes manipulation, mobilization, massage therapy, and soft-tissue release techniques, including instrument-assisted approaches. Typically, these therapies are applied in proximity to the wrist, though they may be used elsewhere along the course of the median nerve if there is also compression/restriction in the neck, shoulder, elbow, or forearm.
• Wrist Splint: Because pressure in the wrist is greatest at the extreme ends of its range of motion, a wrist splint that helps maintain neutral posture can be especially effective during certain daytime activities, as well as during sleep.
• Exercise: Doctors of chiropractic may provide instruction for several exercises patients can perform throughout the day to facilitate the mobility of the median nerve, as well as relax the soft tissues in the hand and forearm.
• Modalities: Chiropractors often employ physical therapeutic modalities when treating patients with CTS such as cold laser, ultrasound, interferential electrical stimulation, and radial extracorporeal shockwave therapy.  
• Nutrition: Because inflammation can contribute to CTS, patients may receive dietary and supplement recommendations that provide anti-inflammatory benefits such as the Mediterranean diet, vitamin D, omega-3 fatty acids, alpha-lipoic acid, curcumin, and more.
• Ergonomic/Activity Modifications: For work or hobby activities that require repetitive movements, especially with vibration exposure or non-neutral wrist postures, patients may be instructed to take more frequent breaks, re-orient their workstation, temporarily change job functions, or use tools that require a more neutral or less forceful grip.
• Co-Management: Because infections, several types of arthritis, diabetes, thyroid disorders, and hormonal therapies and/or fluctuations can contribute to carpal tunnel syndrome, co-management with the patient’s medical physician or a specialist may be necessary.

While each of these tools can benefit the CTS patient, studies have shown a multimodal approach that utilizes two or more therapies often provides the best result.