Carpal Tunnel Syndrome
Numbness, tingling, or weakness in the hand from median nerve irritation — often higher up the arm than you think.
Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy, with a prevalence of roughly 3–6% in the general adult population (Atroshi et al., JAMA 1999). It is traditionally attributed to compression of the median nerve as it passes beneath the transverse carpal ligament at the wrist. However, the median nerve can be entrapped anywhere along its course — at the scalenes, pectoralis minor, lacertus fibrosus, or pronator teres — and the cervical nerve roots (C6, C7) frequently contribute in a 'double crush' pattern that imitates pure wrist-based CTS.
Classic symptoms include numbness or tingling in the thumb, index, middle, and radial half of the ring finger, often worse at night or with sustained gripping. Many patients shake their hand out to relieve symptoms or wake repeatedly from sleep. In more advanced cases, grip weakness, dropping objects, and visible atrophy of the thenar eminence (base of the thumb) can develop. Forearm or upper-arm aching often signals a more proximal entrapment.
CTS is most common between ages 40 and 60 and roughly 3× more common in women. Higher-risk groups include desk workers and frequent keyboard users, manual trades with vibration exposure (carpenters, mechanics), strength athletes and rock climbers, pregnant women (due to fluid retention), and people with diabetes, hypothyroidism, or rheumatoid arthritis.
A combined, root-cause approach.
A 2017 randomized trial in the Journal of Orthopaedic & Sports Physical Therapy found that manual therapy was as effective as surgery for CTS at one year — and superior at one month. We screen the entire nerve pathway from the cervical spine to the wrist, release the actual sites of entrapment with ART and instrument-assisted soft-tissue mobilization, restore nerve glide with neurodynamic techniques, and address contributing posture and ergonomics so symptoms do not return.
- ART for forearm and pronator teres
- Nerve gliding for the median nerve
- Cervical adjustments
- McKenzie Method for the neck
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