The median nerve passes through the carpel tunnel which is formed by the transverse ligament superiorly, the pisiform and hamate bones medially, and the navicular and trapezium carpels are laterally.  The carpel tunnel also contains the flexor tendons for the fingers and the thumb.  When compression of this tunnel mounts, it puts pressure on the median nerve causing pain, swelling, and decreased range of motion, especially in flexion and extension.  Symptoms of carpel tunnel cause numbness and tingling of the lateral 3 ½ fingers along the radial side.  The patient may having troubles gripping objects, suffer lower neck, and/or elbow pain.  These areas should also be addressed and treated with chiropractic care and therapeutic modalities.  The following orthopedic tests exhibit positive findings: Tinel’s sign, Phalen’s test, and Pressure provocative test.  Tinel’s sign is performed by tapping over the carpal tunnel on the flexor part of the wrist.  Phalen’s is performed by having the patient press the backs of their hands together, exerting forced passive flexion of the wrist.  Reverse Phalen’s is performed palm to palm, exerting forced passive extension.  The pressure provocative test is done by applying direct pressure with a cuff or thumb directly over the carpel tunnel.  These tests are positive when reproduction of the patient’s symptoms of numbness and tingling occur.  X-rays are not always necessary in the diagnosis of carpel tunnel syndrome unless there is a suspected or noted trauma.  Treatment includes chiropractic care assisting in manipulation of the carpel bones, myofascial release over the flexor and extensor muscles and tendons, wrist bracing (usually a cock-up splint), therapeutic modalities, and a home-stretching program to increase range of motion.