Carpal Tunnel Syndrome:
Traction for Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy that affects roughly 4-5% of the general population and about 10% of working adults. The chiropractic treatment approach for the CTS patient typically involves many of the same therapies as those used for conditions like neck and back pain, such as joint manipulation, mobilization, specific exercises, and nutritional recommendations to reduce inflammation. In some cases, patients with neck and back pain can benefit from traction. Could the CTS patient also benefit from traction applied to the wrist?
Back in 2004, the Journal of the Canadian Chiropractic Association reported on a case series concerning four patients with confirmed CTS who underwent a mechanical traction treatment protocol that involved between five and twelve five-minute treatment sessions over a three-month time frame. The results showed an improvement on nerve conductive tests that persisted up to one year following the conclusion of treatment.
In a study published in October 2017, researchers assigned 181 CTS patients to receive either mechanical traction (two treatments a week for six weeks) or usual medical care. The criterion used by the investigators for a successful outcome was whether or not the participants had elected to undergo carpal tunnel release surgery within the following six months.
According to the research team, 43% of the participants in the usual care group had undergone surgical carpal tunnel release in the allotted timeframe compared to just 25% of the patients in the mechanical traction group. The authors concluded that mechanical traction appeared to be an effective conservative treatment option for the CTS patient. Treatment guidelines recommend that patients exhaust all non-surgical treatment options before considering surgery, unless warranted otherwise.
However, as with any musculoskeletal condition, it’s important to identify all contributing factors of a patient’s chief complaint. In the case of a patient with suspected CTS, there may or may not be median nerve compression at the wrist. Similarly, median nerve compression can occur elsewhere along the course of the nerve from the neck into the hand. There may also be non-musculoskeletal causes for inflammation in the carpal tunnel that would need to be addressed in conjunction with other healthcare providers in order for the patient to achieve a satisfactory outcome.