Carpal tunnel care in Clarksville, starting with an exam of the wrist, arm and neck

Carpal tunnel syndrome is pressure on the median nerve where it runs through a narrow passage in the wrist, and it's one common reason fingers go numb at night or a grip starts to slip. At Source Chiropractic in Clarksville, our doctors of chiropractic, Dr. Jeff, Dr. Cindy and Dr. Ali, see people with tingling and numb fingers, a hand that falls asleep while driving or on the phone, and wrist and forearm pain from gripping, typing or tools. Other problems can make a hand ache or go numb too, so every plan starts with an exam of the wrist, the arm and the neck, and we'll tell you if the findings point to another kind of doctor.

What happens at your first visit for carpal tunnel?

Your first visit starts with a detailed history. You'll sit down with Dr. Jeff, Dr. Cindy or Dr. Ali and go over your health history, your symptoms, your concerns and your goals, such as sleeping through the night, holding a coffee cup, typing a full shift or getting back to a hobby. We'll ask which fingers tingle, when it started, if it wakes you, what sets it off and what eases it.

Then comes a full evaluation, with full-spine X-rays when they're clinically appropriate. Because hand symptoms can start at the wrist, the elbow or the neck, the exam may look at all three: how the joints move, where muscles are tight or swollen, and for signs of an irritated nerve, which can include feeling in your fingers, grip strength and reflexes in the arm. You'll hear what we found before we recommend anything, and the plan is built around your condition and those goals.

The new-patient chiropractic offer has its own terms. Book online or contact us.

What carpal tunnel treatment do we use in Clarksville?

Care depends on what the exam finds, because the nerve can be irritated at more than one point between the neck and the fingers. A plan may include:

• Chiropractic adjustments to joints the exam finds aren't moving well, in the neck and upper back. An adjustment is a controlled force applied to a specific joint, usually by hand.
• Soft-tissue work on tight muscles of the neck and shoulder, including dry needling for tight bands and trigger points the exam finds.
• Class IV laser therapy for temporary relief of muscle and joint pain and stiffness in the forearm and wrist area. It isn't used as a treatment for the nerve compression itself.
• Rehab exercises for the hand, wrist and neck, to build strength and movement back up, so the work carries on between visits.

A licensed massage therapist also works out of our office, and we'll put you in touch when soft-tissue work fits.

What the research shows about chiropractic and manual therapy for carpal tunnel

Two trials tested hands-on care for carpal tunnel, one against medical care and one against surgery:

• Chiropractic care compared with medical care. In a randomized trial of 91 people whose carpal tunnel syndrome was confirmed by exam and nerve conduction testing, chiropractic care (manipulation of the soft tissues and joints of the arm and spine, ultrasound over the wrist and night wrist supports) was compared with ibuprofen and night wrist supports over nine weeks. People in the trial improved overall in comfort, hand function, nerve conduction and finger sensation, and neither treatment did significantly better than the other.
• Manual therapy compared with surgery. In a hospital trial in Spain, women with carpal tunnel syndrome had either three sessions of physical therapy that included manual therapy or carpal tunnel release surgery, and both groups did tendon and nerve gliding exercises at home. At one year and at four years, pain, hand function and symptoms were similar in the two groups, and 15% of the manual therapy group went on to have surgery during the four years, with no significant difference in surgery rates between the groups.

These are small trials without an untreated comparison group, both groups in the chiropractic trial wore night wrist supports, and the four-year trial included only women, so they describe groups of people rather than predicting your own result.

Is chiropractic care for carpal tunnel safe?

NCCIH, the National Institutes of Health center for complementary health, says mild to moderate side effects such as increased pain or discomfort, stiffness or headache often follow spinal manipulation, and most go away within 24 hours. Serious side effects, including serious spinal or neurological problems and strokes involving arteries in the neck, have been reported. They are very rare, and there's no accurate estimate of how often they happen.

Your history and paperwork are part of how we check for any reason an adjustment, or another treatment, isn't right for you before we start.

Other options for carpal tunnel

A wrist splint worn at night keeps the wrist straight, which reduces pressure on the nerve. Changing the hand positions that set symptoms off, anti-inflammatory medicine, a steroid injection, which often relieves symptoms for a while, and exercises that help the median nerve move more freely are other nonsurgical options. Carpal tunnel release surgery cuts the ligament that forms the roof of the tunnel to make room for the nerve. AAOS says surgery may be recommended when nonsurgical treatment doesn't relieve symptoms or gives only temporary relief, and in long-standing cases with constant numbness and wasting of the thumb muscles, to prevent irreversible damage, and that for most patients surgery improves the symptoms. Hands-on care can be combined with a splint, and we'll go over the options that fit you at your exam.

What are the symptoms of carpal tunnel?

Symptoms often include numbness, tingling, burning or pain in the thumb, index and middle fingers, and part of the ring finger. Some people feel brief shock-like sensations into those fingers, or pain and tingling that travels up the forearm. Weakness and clumsiness can make buttons or gripping things difficult, and some people start dropping things.

Symptoms usually begin gradually, without a single injury, and often come and go at first. Night symptoms are very common, partly because many people sleep with their wrists bent, and in the day they tend to show up when the wrist is held bent for a long time: holding a phone, driving or reading. Many people find that moving or shaking the hand eases them for a while.

Get a prompt medical assessment if the numbness doesn't go away, your hand is getting weaker, you're dropping things, or you're losing muscle at the base of your thumb. Prolonged pressure can damage the nerve, which is why strength or feeling that's getting worse needs a medical assessment. Sudden arm weakness with a drooping face or trouble speaking can be a stroke, and the CDC lists these among its stroke warning signs: call 911. Hand numbness or clumsiness that comes with new trouble walking can start in the neck rather than the wrist, and on its page about cervical spondylosis, the age-related changes in the neck, the NHS lists new problems walking and a sudden lack of co-ordination, such as with buttoning a shirt, among the signs that need emergency help: call 911.

What causes carpal tunnel syndrome?

Pressure builds inside that narrow passage at the wrist when the tunnel narrows or the tissue around the tendons that run through it swells. Several things can contribute, and most cases come from more than one:

• Anatomy and family history. Some people have a naturally smaller tunnel, and the trait can run in families. Women and older people are more likely to develop it.
• Repetitive hand use. Repeating the same hand and wrist motions over a long period can aggravate the tendons and cause swelling. Our work injury page covers how repeated tasks build up.
• Wrist position. Long stretches with the wrist bent far forward or back raise the pressure on the nerve.
• Pregnancy. Hormonal changes can cause swelling that presses on the nerve. Our pregnancy page covers care during pregnancy.
• Health conditions. Diabetes, rheumatoid arthritis and thyroid imbalance are associated with carpal tunnel syndrome.

A nerve problem in the neck can cause similar hand symptoms, but that's a different diagnosis from median nerve compression at the wrist.

Could your hand symptoms be coming from your neck?

Sometimes. Pain and numbness are felt where a nerve ends, not always where it's being pressed on, so a nerve root irritated in the neck can produce tingling in the same fingers. Neck pain, symptoms that run from the neck or shoulder down the arm, or symptoms that change when you move your neck all point the exam toward the neck. Tingling in the little finger points away from the median nerve, which doesn't supply it, and toward another nerve. A tight muscle or an irritated tendon in the forearm or elbow can add its own pain to the picture. Sorting these out is what the exam is for, and our arm pain guide and wrist and hand guide go further.

Do you need a nerve test or X-ray for carpal tunnel?

Not always. According to AAOS, carpal tunnel syndrome can often be diagnosed from your history and a physical exam with no further testing. A nerve conduction study measures how well the median nerve is carrying its signal, which helps show how severe the compression is and if a nerve is being pressed somewhere else too. X-rays of the wrist are used to rule out other causes, such as arthritis or a fracture. If what we find calls for a nerve test or a specialist's opinion, we'll tell you and refer you.

Book a visit

If your fingers have been tingling, going numb at night or losing their grip, and none of the warning signs above fit, a first visit in Clarksville is where we start working out where it's coming from. We'll tell you what we find, including when what we find isn't something we treat. If we are not able to help you with your problem or are unable to reduce your pain levels, we will make sure to give you a recommendation to another experienced provider. Book online or contact us.