A neurologic disorder of the wrist and hand, characterized by pain and loss of sensation along the course of the median nerve. True carpal tunnel syndrome is nerve entrapment at or distal to the wrist. Carpal tunnel syndrome is the most common entrapment syndrome.

Protocol:

Acute Phase:

1. Volar cock-up splinting or taping of wrist, especially at night to decrease edema.
2. Cryotherapy (ice massage) for the first 24 to 48 hours to prevent contracture and reduce edema.
3. Ultrasound (pulsed) 20% at .5 W/cm-2- under water for 5 minutes. Ultrasound causes the resolution of inflammatory exudates and increases blood flow.

Subacute Phase:

1. High-volt galvanic and interferential may be used to decrease inflammatory process and edema.
2. Microcurrent, positive polarity during acute phase. Increases protein synthesis to promote healing. Some modulation of pain and inflammation.
3. Scan and treat myofacial trigger points in the forearm flexor and/or extensor musculature by compressing each trigger point for 5 to 7 seconds and repeating this procedure three times or use Active Release Technique procedures.
4. Transverse Friction Massage, at the site of involvement, stroking perpendicular to the fiber alignment to increase fiber mobility without longitudinal stress. In addition, TFM has a mechanical influence on tissue maturation.
5. Extremity adjusting: adjust posterior radius, elbow extension technique, and wrist. Reduce subluxation of lunate and capitate; traction of wrist in direction of subluxation to gap the joint; with thumb over the bone, perform a light thrust to adjust carpals.
6. Follow with adjustment of cervical spine.