Carpal Tunnel Syndrome - Is Surgery the Best Treatment?

Carpal Tunnel Syndrome - Is Surgery the Best Treatment?
May 31, 2007

Carpal tunnel syndrome is defined as a condition involving numbness, tingling, weakness, pain and/or muscle wasting of the hand along the distribution of the median nerve. This relates to the thenar or thumb-side of the hand. Although surgery is often the choice of treatment, it is the most invasive form of treatment and is not the only treatment available. To better understand this, one needs to better understand the different causes of carpal tunnel syndrome.

The carpal tunnel is made of two rows of four bones, called carpal bones, which sit in a semi-circle at the back of the wrist. This forms one side of the tunnel. The opposite side of the tunnel is formed by a strong ligament, the flexor retinaculum, which completes the carpal tunnel. There are then a few structures that travel through the carpal tunnel into the hand. These include some of the flexor tendons for the wrist and the median nerve. With carpal tunnel syndrome, the median nerve undergoes too much pressure being exerted on it, known as compression, leading to a decrease in electrical conductivity in the nerve. This nerve innervates the palm side of the hand over the thumb and first three and a half fingers. It also innervates the backs of the fingertips over this same area. Therefore, compression of the median nerve can only result in irritation over this area of the hand. If the trouble area is over the back of the hand or over the little finger, it is not carpal tunnel syndrome.

It is ultimately the compression of the median nerve that leads to carpal tunnel syndrome. Medical testing for carpal tunnel syndrome usually entails the use of an electromyelogram (EMG). This entails putting one electrical probe into the median nerve on either side of the carpal tunnel. An electrical current is then put into the nerve on one side and checked to see if it is picked up by the probe on the other side. If the current is diminished to a great degree, it is deemed that carpal tunnel syndrome is present. The surgery for this condition would then include cutting some of the flexor retinaculum to allow less pressure on the median nerve by essentially expanding the carpal tunnel. This procedure may often help to decrease the symptoms of carpal tunnel syndrome, but is it the only option? Absolutely not.

There are two main reasons for carpal tunnel syndrome to present itself. The first is a deterioration of the joints between the carpal bones leading to a collapse of the carpal tunnel. The second reason is a swelling of the tendons which pass through the carpal tunnel taking up too much space resulting in compression of the median nerve.

The problem with using solely EMG to determine the presence of carpal tunnel syndrome is that it doesnÌt differentiate between the two causes. This leads to a lack of differentiation of treatment which may, in turn, result in unnecessary surgery. If the problem is arising from tendonitis, I believe it is much better to treat the tendonitis. The way tendonitis occurs is from having too much strain or tension placed on the tendon for too long of a time. The most common way for this to happen is to have the muscle tighten too much due to repetitive use of the muscle. Since the tendon is responsible for connecting the muscle to the bone, if the muscle tightens up, so does the tendon. This can result in the tendonitis which can cause the symptoms of carpal tunnel syndrome.

If the symptoms are due to tendonitis in the wrist flexor tendons, the treatment may include stretching, the use of physiotherapy modalities, nutritional support, ergonomics, soft tissue manipulation, and/or adjusting the arm and wrist. These protocols are much less invasive and may have fewer side-effects than surgery. This does not mean that surgery is not a viable option. My preferred method, of course, is to begin with the least invasive form of therapy. If these options do not bring relief of symptoms, then surgery can be looked at.

Filed under Carpal Tunnel Syndrome by Steven Trembecki, D.C.

Copyright 2007
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