Carpal tunnel case file

Carpal tunnel case file yields pain and tingling in the thumb index and middle fingers and NEVER the pinkie.

Pain and tingling in the thumb, index and middle fingers is the order of the day; and sometimes part of the fourth digit. If the symptom pattern is different, for example in the first two only, then it's not carpal tunnel syndrome.

Inexperienced clinicians, are inclined to think that every case of tingling in the fingers must be an impingement in the wrist. This next graphic is not what we may think. Paresthesias in the thumb and forefinger comes from an irritated C6 nerve root in the neck. Turning the head and looking up will often provoke the symptoms in the hand, and the upper limb tension test would be positive but negative in a classic carpal tunnel syndrome.

What complicates things is that it's often a so called double crush syndrome. The median nerve is irritated in two or even three places. That means that both places of impingement must be addressed.

A recent case displays the difficulties of this condition. A woman with a very degenerative lower cervical spine was given a crude and vigorous manipulation of the neck. Within an hour she had severe pain and, on the opposite side, tingling and numbness in the median nerve distribution; in the first four fingers.

One would have expected it to follow a dermatomal pattern after a neck injury, and on the same side. But no, carpal tunnel case files don't follow the rules. She responded well, incidently; first we addressed the acute neck pain. That took about a month to settle down, and only then the tingling in the arm. I probably wouldn't have accepted her as a patient; she withheld vital information about the cause. But all's well that ends well.

This is NOT carpal tunnel syndrome

A frequent spoke in the wheel: PRONATOR TERES muscle

Notice how the Median nerve passes between the two bellies of the Pronator teres muscle, in the forearm, just below and in front of the elbow; it mimics the carpal tunnel syndrome.

If you have tingling in the arms and hands then it's vital you take note, because your chiropractor will ask you, and to make the correct diagnosis, and thence the correct treatment, you must know which fingers tingle.

So, which fingers?!

Carpal Tunnel case file

A carpal tunnel case file should never be treated as gospel, incidentally. They make interesting and useful reading but they are anecdotes, without any scientific validation. You could make up a case file for a Flat Earth Society. Or a world created about 8,000 years ago, with the dinosaurs being just a figment in Darwinists' imaginations.

The dinosaurs incidentally were wiped out when an enormous asteroid, six miles in diameter, crashed into the Yucatan peninsular some sixty million years ago. It turned the whole earth's axis. Coupled with a series of volcanic eruptions over India it meant a total change for the world's inhabitants; that would make for interesting reading of a dinosaur's case file too; I expect they also had a median nerve.

A 62 year old butcher consulted me three weeks ago with pain and tingling in his right arm and hand. He uses his hands continuously, and the work is often repetitive and difficult. He has no neck pain.

Fifteen years ago, tingling began in the left hand, for which he was operated. The procedure was successful, but he was quite disabled for some months, and the tingling never entirely stopped.

Five months ago paresthesias began in his right hand and forearm. The pain began to wake him in the early hours. Eventually, not wanting to go through with another medical case file, he consulted me.

Interestingly, he had pain in the forearm where the median nerve passes through a tunnel between the two heads of a pronator teres muscle, and a fixation of the first rib in his lower neck, but no signs of impingement in the wrist. This is what we call a classic double crush syndrome; each case file is different which is what makes chiropractic so interesting for the discerning mind.

Despite the fact that there is no strong research confirming that chiropractic can help a carpal tunnel case file, I told him confidently that I could assist him.

After three weeks of treatment, six in all, he says the pain and tingling in his hand is 70 percent less and no longer wakes him in the early hours. We are now into the rehabilitation phase to prevent a recurrence of his symptoms.

Updates are important; you must be wondering, did he get properly better? He is now 80 to 85 percent improved according to the Boston carpal tunnel syndrome questionaire that we are using to evaluate progress. Now it's maintenance of the condition; he needs to do his exercises faithfully, and come for the occasional, but regular treatment. Perhaps every 6 to 10 weeks. I doubt it will get 100 percent better.

Research shows incidentally that nothing will cure the condition; not surgery, not chiropractic and not pills; it will in most instances return and thus maintenance care is vital for each and every case file.

Occasional but regular chiropractic care is not a popular subject in some circles, yet we have no difficulty with the concept in the management of say diabetes, for example.


Carpal tunnel syndrome surgery is sometimes effective, but is not scientifically proven to cure this condition; nor is any other treatment including chiropractic.

See all the swelling in the fingers. Chiropractors are not anti-surgery but we do think you should try the conservative treatment first.

Mr S is very happy that he doesn't have to go through this again. "Cured"? Probably not. He will have to come in for treatment occasionally. His next consultation is in six weeks time.

  • Chiropractic Conditions is a central page at Chiropractic Help. It provides you simply and easily with the sorts of conditions that the average chiropractor would be treating.
  • Healthy Living Tips is another vital page at Chiropractic Help. Sparkling good health is not just about having your subluxations adjusted. Our healthy living tips page gives you some insights into different foods you could and perhaps should be eating.

Carpal Tunnel Exercises

Carpal tunnel exercises remind one of the importance of trying the simple things first.

I'm a greater believer in each and every one of us doing our best to help ourselves; before consulting a chiropractor or surgeon you may want to try these carpal tunnel exercises for a few weeks.

If they don't work, nothing is lost, and then you can become a case file!

Thoracic Outlet Syndrome

Thoracic outlet syndrome reminds us that a particular health problem may be secondary to some other condition. For example, a heart attack may be due to neglected diabetes. In every carpal tunnel case file there may well be an underlying thoracic outlet syndrome in which either the brachial plexus or the subclavian artery that supply the arm are being irritated.

Many arm conditions like carpal tunnel syndrome have a chronic underlying entrapment of the nerve and artery as they emerge from the chest, the so called Thoracic Outlet syndrome. Typically the arm aches especially when raised above the head, and may feel weak and go numb.

The nerve bundles passing to the arm, together with the only artery pass through a narrow gap known as the interscalene triangle. Muscle spasm of the scalene muscles, or a subluxated first rib, may affect them causing bizarre tingling in the arms and hands, and pain too, mimicking a carpal tunnel syndrome case file.

Never will I forget examining a retired judge in Holland with tingling in the arms and hands. I told I wasn't sure what was the cause, but it definitely wasn't carpal tunnel syndrome; the pain included the pinkie. Both the neurologist and orthopaedic surgeon who operated on him ended up being sued. In fact he was suffering from cervical stenosis.


An aside

My friendly butcher and I have had some interesting discussions over "hyaline cartilage", the very hard, slippery substance that lines the bones in a joint. He assures me that it is, in young animals, indeed extra-super-smooth. We need it so that your knee for example can bend smoothly whilst you walk.

In fact he brought me several samples from a pig, and you can see them at HYALINE CARTILAGE; there's plenty of it in the carpal tunnel too.

Preventing decay (arthritis) of the hyaline cartilage in your body is at the heart of chiropractic. How do we do that? Read all about it at the page above.


Any carpal tunnel case file often involves swelling, poor circulation in the arm, and inflammation. There's strong research that omega-3 fatty acids will help. No matter what disease is under discussion, poor nutrition will impede healing. Since they become very rapidly oxidised into toxic breakdown products, we recommend getting them from whole foods:

Tingling in arms and hands

Tingling in arms and hands is common, but probably less than fifty percent of the time is it a carpal tunnel case file.

Hopefully it's clear that there are many causes of what's known as paresthesias; tingling, prickling or burning in the fingers, in this instance. We could add the presence of a cervical rib, uncovertebral degeneration in the in the spine, and even vascular causes. 


Can chiropractic help every carpal tunnel case file? Obviously yes, but it remains a stubborn and unpredictable condition. I don't always win, so I expect my colleagues don't either; but usually we can get it to around the 80 percent better mark.

In all truth this isn't a classic carpal tunnel syndrome; the symptoms did follow the median nerve but the major problem concerned the first rib fixation and the impingement as the median nerve passed between the bellies of pronator teres; or under the tendon of the pec minor muscle. 

Boston carpal tunnel syndrome questionaire

It's difficult to grade symptoms objectively; just how bad are your symptoms? The Boston carpal tunnel syndrome questionaire is a useful tool.


» » Carpal tunnel case file

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.

Interesting letters from readers