Carpal tunnel syndrome is a condition of multiple causes. Up until recently, reports solely attributed it to such factors as injury, trauma or even genetic predisposition. Some new research suggests cervical spine involvement may be another reason this ailment affects such a wide array of age groups.
A debilitating condition of the upper limb, carpal tunnel syndrome affects the medial nerve, a portion of the forearm, hand and wrist. When the medial nerve becomes compressed at the wrist, for example, patients may experience numbness in the hands and fingers.
The most common treatment involves rest, reducing activities that aggravate the condition, ice, and immobility of the affected hand with a brace or splint.
Double crush syndrome?
The central nervous system is comprised of a group of interrelated nerve systems that all work together. The medial nerve is part of the peripheral nerve system that essentially connects spine and limbs nerves together. Some research shows when cervical spinal nerve roots are compressed, it leads to double-crush
syndrome. This may mean chiropractors need to adjust both the cervical spine and the affected hand and arm to alleviate symptoms of carpal tunnel.
Researchers argue double-crush syndrome cannot just be explained by pain in the hand and in the cervical spine. Rather, pain in the hand makes the patient more
susceptible to pain in the cervical spine, upper arm, elbow, and forearm. This theory may explain why surgical intervention often fails, because it is only treating the
compression at the carpal tunnel and fails to recognize the cervical spine involvement.
There is a great deal of controversy over whether or not patients with carpal tunnel syndrome and neck pain are in fact suffering from one condition (thus, supporting the double crush theory) or two separate conditions. Failure to treat pain in both locations can lead to further nerve damage.
Although several studies have proposed that the two conditions are indeed related, patients may not have been properly examined to determine the source of pain at both the forearm/wrist and the neck. One such study found that 80 percent of patients with carpal tunnel syndrome also showed “symptoms and/or signs of cervical spine disease,” including pain in the neck, shoulder, and upper arm. However, electrodiagnostic findings were not reported for the wrist. This leaves open the question of a link between cervical pain and carpal tunnel syndrome.
Overall, it is recommended that chiropractors proceed with caution in terms of justifying the necessity of a cervical manipulation in cases of carpal tunnel syndrome. Although there are a number of individual, anecdotal cases where the double crush syndrome exists, it has not been extensively proven in the literature.
