A 70 year old new patient came in with three overlapping complaints: neck stiffness and shoulder pain, left shoulder pain on specific movements, and numbness in the middle finger of his right hand consistent with carpal tunnel syndrome. Here is how we start a case like this on the first visit when imaging has not been reviewed yet.
Presenting complaint
The patient was new to chiropractic and came in with several issues at once. His main pattern was neck stiffness with pain across the top of the shoulders. On top of that he had sharp left shoulder pain on certain movements, which can be a sign of a muscle tear and may need an ultrasound to rule out. The third complaint was numbness in the third finger of his right hand, which had been diagnosed previously as carpal tunnel syndrome.
He mentioned a previous neurologist had told him he has some degeneration in his neck. He had also had earlier imaging done at another radiology clinic, which we had not yet seen.
What the assessment showed
The neck was globally restricted, particularly in the lower cervical segments on the right side, which is the same side as the carpal tunnel complaint. The left shoulder had a painful arc on abduction, consistent with soft tissue involvement rather than a frank joint problem. The right wrist showed reduced range through flexion and some mild tenderness over the median nerve pathway at the carpal tunnel.
Nothing on examination suggested the need for emergency referral, so we were safe to make a conservative start today while his previous imaging was chased up.
The clinical thinking
Carpal tunnel is a case where chiropractic can genuinely help in a lot of patients, which not everyone realises. The median nerve runs from the lower neck through the shoulder, down the arm, and into the hand through the carpal tunnel at the wrist. Pressure anywhere along that path can present as numbness or tingling in the fingers. If we work both the wrist and the lower neck on the complaint side, we often free up enough space in the nerve pathway that the symptoms settle. Surgery is a reasonable option when conservative care has not worked, but in practice we see patients being pushed toward it earlier than it needs to be. We like to try the conservative route first.
The second decision was how much to do on a first visit without the imaging yet. The patient had reported previous findings of degeneration, which if confirmed on X-ray can be a limiting factor in how much manual force is appropriate at the neck. Rather than treat heavier before seeing the films, we kept the first visit light and set up to review his imaging before the next session.
Care plan today
General mobilisation and stretching through the neck. An upper thoracic sitting manoeuvre to free up the mid back, since restriction there often locks the lower neck. A gentle shoulder lift on the left to coax some movement through the painful arc without provoking it. A wrist flick type adjustment on the right to start working the carpal tunnel from the local end.
Next steps: we will contact the previous radiology clinic this week to pull his earlier imaging. He is booked back in next week for his Report of Findings visit, where we will go through the imaging, what we found on examination, and formulate a treatment plan together. The initial stage of care in a case like this is typically four to eight weeks, with a progress exam at the twelfth visit.
How he is now
After the first visit the patient tolerated the light work well and had slightly more comfortable neck movement at the end of the session. We expect to have a clearer picture at next week’s Report of Findings once the previous imaging is in front of us. If the left shoulder does not settle with early care, we will refer for an ultrasound to rule out a tear.
Rebates at the counter
As a Bupa Member First member, the standard new patient initial consultation of $101 was partly covered by his fund. Bupa paid $76.40 directly through our TYRO terminal, leaving a gap of $24.60 which he paid on his credit card at the counter. No forms, no lodging a claim later, just the gap on the day.
If you are still deciding
Carpal tunnel symptoms, shoulder pain and neck stiffness often arrive together because the nerves to the hand all pass through the neck and shoulder on their way down. If any of these have been bothering you and you have been told to consider surgery for carpal tunnel, it is worth seeing whether conservative chiropractic care can help first. Call us on (07) 3272 4622 or book an initial consultation online.
Patient details have been changed to protect privacy. Individual results vary. In accordance with AHPRA and the Chiropractic Board of Australia advertising guidelines, this case study is provided for educational purposes and does not represent typical outcomes or constitute a testimonial.
Frequently asked questions
Can chiropractic help carpal tunnel syndrome?
In many cases, yes. Carpal tunnel symptoms often respond to work on both the wrist and the lower neck on the same side as the complaint. The idea is to free up any nerve impingement along the whole pathway from the neck down to the hand. Surgery can be a reasonable option when conservative care has been exhausted, but in our experience it is often considered earlier than it needs to be. We like to try conservative chiropractic care first and see what change we can get.
What happens at the first chiropractic visit versus the second one?
The first visit is an assessment plus a light start if it is safe to begin that day. We take a history, check movement and relevant tests, and often do a conservative first adjustment. The second visit is called the Report of Findings. We review any imaging you have had done, go through what we found on examination, and formulate a treatment plan together. The initial stage of care is typically four to eight weeks, re-examined at the twelfth visit.
How much does a Bupa Member First chiropractic visit cost?
For a new patient initial visit, the fee is $101 and Bupa Member First covers $76.40 of that, leaving a $24.60 gap paid at the counter. The claim goes through our TYRO terminal instantly, so you only pay the gap on the day and there is nothing to lodge yourself.
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