Carpal Tunnel

Numb, Tingling Hands That Wake You Up at Night

Reviewed by Dr. Dustin Dukart, DC

It’s the thumb, index, and middle fingers — pins and needles that flare at night or when you’re holding a phone or a steering wheel, and a grip that isn’t as sure as it used to be. Carpal tunnel syndrome is common, and for mild-to-moderate cases there’s more that can be done before surgery than most people are told.

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What Carpal Tunnel Actually Is

The median nerve passes through a narrow tunnel at the wrist. When pressure builds in that space, the nerve gets irritated — hence the numbness, tingling, and night symptoms in the thumb-side fingers. It’s worth confirming, though: similar-feeling symptoms can come from the neck, the forearm, or the elbow, and those need a different approach. Part of the first visit is telling them apart. One quick tell we check — whether the numbness reaches into the palm or stays in the fingers — helps separate two of the most common causes (more on that on our repetitive strain page).

What the Evidence Supports

For mild-to-moderate carpal tunnel syndrome, conservative care has a genuinely strong evidence base. A randomized trial comparing manual physical therapy to carpal tunnel release surgery found the hands-on approach — nerve and tendon gliding, plus soft-tissue and neurodynamic techniques for the nerve’s whole path — produced better results in the short term and comparable results at one year. A 4-year follow-up of the same patients found the outcomes held up. That doesn’t make surgery the wrong choice for everyone — it makes conservative care a reasonable first step for the right cases, alongside the splinting and activity changes that are standard first-line care.

When Surgery Is the Better Call

Conservative care is not the right first step for everyone. See a hand surgeon rather than starting a chiropractic plan if you have:

• Constant (not intermittent) numbness in the thumb-side fingers
• Visible thinning or weakness of the muscle at the base of the thumb
• A nerve conduction study showing significant nerve damage
• Symptoms that came on suddenly after a wrist fracture or injury

If your exam here points in that direction, that’s the referral you’ll get. We’d rather send you to the right place than run a plan that delays care that would actually help.

Ready When You Are

Most new patients are seen within a few days.

Book Your Visit → or call (612) 314-9482