Carpal Tunnel Syndrome:
Neurodynamic Techniques for Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is a condition that results from pressure applied to the median nerve on the palm side of the wrist. The disorder is associated with both motor and sensory signs and symptoms such as numbness, pain, and paresthesia that radiates from the wrist first to the first three digits and can include muscle weakness, including grip weakness and hand dexterity loss. For mild-to-moderate CTS, treatment guidelines recommend pursuing non-surgical approaches before consulting with a surgeon, with chiropractic care offering patients an excellent option. Among the tools at a doctor of chiropractic’s disposal are neurodynamic techniques.
Neurodynamic techniques encompass a group of hands-on manual therapies that promote the lengthening and mobility of nerves. In the case of CTS, neurodynamic techniques are focused on the median nerve both at the wrist and elsewhere along the course of the nerve from its origin in the neck and through the shoulder, elbow, and forearm. This is especially important as restriction of the median nerve before the wrist can both stimulate similar symptoms as CTS and increase the risk for entrapment at the wrist. Regardless, failure to examine the full course of the median nerve can lead to a suboptimal outcome for the patient.
In a July 2023 systematic review and meta-analysis of twelve randomized controlled trials that included 1,000 patients with mild-to-moderate CTS, researchers found evidence that neurodynamic techniques are effective for improving CTS-related symptoms and wrist/hand function. Their findings also showed that such techniques improve function of the median nerve itself, by way of nerve conduction diagnostic testing. This echoes findings from a systematic review published in 2022 that included six randomized controlled trials and 401 CTS patients that found that neurodynamic techniques led to immediate improvements in pain, function, and nerve conduction.
Emphasizing the importance of looking at the whole patient versus just focusing on the wrist, a 2022 randomized controlled trial divided 62 CTS patients into two groups, one with treatment on just the wrist alone and the other received treatment at the wrist and elsewhere on the course of the median nerve. While both groups reported improvements in pain, grip strength, and functional status, the patients in the more comprehensive treatment group experienced greater benefits.
In addition to neurodynamic techniques, conservative chiropractic care for managing CTS may include other manual therapies, nocturnal splinting, exercise training, nutritional consulting, and physiotherapy modalities like electrical stimulation, ultrasound, laser, and pulsed magnetic field. If necessary, the patient’s chiropractor will co-manage the case with an allied healthcare professional for treatments beyond their scope of care.