Dr. David Kulla, DC provides individualized evaluation and conservative care for patients with carpal tunnel syndrome and other causes of hand, wrist, and arm symptoms at Synergy Wellness Chiropractic & Physical Therapy in New York City.
With more than 26 years of clinical experience, Dr. Kulla evaluates numbness, tingling, hand weakness, wrist pain, and other symptoms to determine whether the median nerve is being compressed at the wrist or whether another condition may be contributing.
Our Manhattan office is located at 237 First Avenue near East 14th Street, convenient to Union Square, the East Village, and Gramercy.
What Is Carpal Tunnel Syndrome?
Carpal tunnel syndrome, commonly called CTS, occurs when the median nerve becomes compressed as it passes through the carpal tunnel at the wrist.
The carpal tunnel is a narrow passageway formed by wrist bones and the transverse carpal ligament. The median nerve and several flexor tendons pass through this confined space.
The median nerve provides sensation to the thumb, index finger, middle finger, and part of the ring finger. It also supplies muscles involved in thumb movement. The little finger is generally not supplied by the median nerve.
Common Symptoms of Carpal Tunnel Syndrome
CTS symptoms often develop gradually and may initially be most noticeable at night.
Common symptoms include:
- Numbness or tingling in the thumb, index, middle, or part of the ring finger
- Nighttime hand numbness or tingling
- Symptoms while gripping a steering wheel, phone, book, or other object
- Burning or aching discomfort in the wrist or hand
- Symptoms extending into the forearm
- Difficulty with fine hand movements
- Reduced grip or pinch strength
- Dropping objects
- Weakness or wasting of the muscles at the base of the thumb in more advanced cases
Symptoms involving the little finger, the entire arm, or a pattern that does not fit the median nerve distribution may suggest another diagnosis.
What Causes Carpal Tunnel Syndrome?
Anything that reduces available space within the carpal tunnel or increases pressure on the median nerve can contribute to CTS.
Risk factors and associated conditions may include:
- Repetitive or forceful hand activity
- Prolonged wrist flexion or extension
- Use of vibrating tools
- Previous wrist fracture or trauma
- Arthritis
- Diabetes
- Thyroid disorders
- Pregnancy-related fluid retention
- Other conditions that produce swelling around the wrist
Computer and keyboard use may aggravate symptoms in some people, but carpal tunnel syndrome should not automatically be attributed to typing alone.
Carpal Tunnel Syndrome or a Neck Problem?
Not all hand numbness comes from the wrist.
A cervical nerve problem, peripheral nerve disorder, or another upper-extremity condition can sometimes produce symptoms that resemble CTS. This is one reason a broader examination of the neck, shoulder, arm, elbow, wrist, and hand may be useful.
Patients with neck pain together with arm or hand symptoms may also require evaluation for a cervical condition such as a neck problem or cervical disc condition.
How Is Carpal Tunnel Syndrome Diagnosed?
Dr. David Kulla, DC begins with the patient’s symptom history and physical examination.
The evaluation may include:
- Location and pattern of numbness or tingling
- Hand and thumb strength
- Sensation testing
- Assessment for muscle wasting
- Wrist movement and tenderness
- Phalen and Tinel testing
- Evaluation of the neck, shoulder, elbow, and other possible sources of nerve symptoms
Current clinical guidelines support diagnosing many typical cases from the history and examination without automatically requiring additional testing.
Do You Need EMG or Nerve-Conduction Testing?
Not every person with suspected CTS requires electrodiagnostic testing.
Nerve-conduction studies and electromyography may be useful when the diagnosis is uncertain, symptoms are severe, nerve damage is suspected, another neurological condition needs to be excluded, or surgical treatment is being considered.
Ultrasound can sometimes visualize enlargement or compression of the median nerve. MRI is generally not routinely required to diagnose uncomplicated carpal tunnel syndrome.
Conservative Treatment for Carpal Tunnel Syndrome
Treatment depends on symptom severity, duration, neurological findings, underlying medical conditions, and how much the condition is affecting hand function.
Conservative treatment for mild to moderate CTS may include:
- Nighttime wrist splinting in a neutral position
- Modification of activities that repeatedly aggravate symptoms
- Ergonomic changes
- Hand and wrist rehabilitation
- Nerve or tendon mobility exercises when appropriate
- Physical therapy or hand therapy
- Medical management of contributing conditions such as diabetes or inflammatory disease
Corticosteroid injection may provide temporary symptom relief for some patients, although current evidence does not show durable long-term improvement from injections.
Cold Laser Therapy for Carpal Tunnel Syndrome
Cold laser therapy, also called low-level laser therapy or photobiomodulation, is available at Synergy Wellness and may be considered as an adjunctive treatment for selected patients.
Research on laser therapy for CTS has produced mixed results. Some studies report short-term improvements while others show little difference compared with splinting or placebo treatment. Current evidence does not establish laser therapy as a reliably superior or long-term cure for CTS.
For that reason, Dr. Kulla uses treatment decisions based on the individual patient’s symptoms, examination findings, and response rather than presenting laser therapy as appropriate for every case.
Can Chiropractic Care Help Carpal Tunnel Symptoms?
Because hand symptoms can sometimes coexist with mechanical problems involving the wrist, elbow, shoulder, or cervical spine, a broader musculoskeletal evaluation may identify contributing factors that can be addressed conservatively.
Depending on the patient’s findings, treatment may include joint mobilization, soft-tissue techniques, exercise, ergonomic recommendations, or other conservative approaches.
Chiropractic treatment should not replace appropriate evaluation of significant median nerve compression or progressive neurological loss.
When Is Carpal Tunnel Surgery Considered?
Carpal tunnel release surgery reduces pressure on the median nerve by dividing the transverse carpal ligament and creating more space within the tunnel.
Surgical consultation may be appropriate when:
- Symptoms are severe or persistent
- Conservative treatment has not provided adequate improvement
- There is significant weakness
- Thenar muscle wasting is developing
- Testing indicates substantial median nerve damage
Carpal tunnel release can be an effective treatment for appropriately selected patients. The goal of conservative care is not simply to “avoid surgery” at all costs, but to determine which approach is appropriate for the individual patient.
When Hand Numbness Requires Prompt Evaluation
Seek prompt medical evaluation for rapidly worsening hand weakness, significant loss of sensation, major trauma, severe swelling, progressive muscle wasting, or symptoms affecting multiple parts of the nervous system.
Carpal Tunnel Syndrome Videos
These videos from Dr. David Kulla and Synergy Wellness discuss carpal tunnel syndrome and conservative approaches to wrist and nerve symptoms.
Schedule a Carpal Tunnel Evaluation in New York City
If you are experiencing hand numbness, tingling, wrist pain, nighttime symptoms, weakness, or difficulty gripping objects, Dr. David Kulla, DC can evaluate whether your symptoms are consistent with carpal tunnel syndrome or another musculoskeletal or nerve condition.
Synergy Wellness Chiropractic & Physical Therapy
237 First Avenue, 5th Floor
New York, NY 10003
Near East 14th Street in Manhattan
Call (212) 533-4900 or book an appointment online.