Carpal Tunnel Syndrome - The Alternatives to Surgery
Carpal tunnel syndrome causes tingling, numbness, pain, and wasting of the muscles on the thumb side of the hand - the area that is supplied by the median nerve.
Surgery is often recommended as the best treatment. However, it is a serious undertaking, and sometimes a more conservative approach might be better. To know what route to take, we first need to have a good understanding of the different causes of Carpal Tunnel Syndrome.
The wrist is formed by four bones, the carpal bones, which make an arch across the back of the wrist. This arch is spanned by a strong ligament, the flexor retinaculum, which forms the front of the wrist. The space between the bones and the ligament is the carpal tunnel.
Through this tunnel pass a number of crucial structures, including the tendons that bend the fingers, and the median nerve. With Carpal Tunnel Syndrome, this nerve gets squeezed and compressed. The result is a decrease in its conductivity, meaning the nerve does not function as it should.
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.
Diagnosis of Carpal Tunnel Syndrome is usually done by EMG (electromyelogram) which measures the conductivity of nerves. If the median nerve is compressed (as in Carpal Tunnel Syndrome) then this will show up on the EMG test.
The EMG is done by putting a probe on the nerve in the forearm and again in the hand. A small current is then passed between the two of them to see how good the conduction is. A decrease in conduction means Carpal Tunnel Syndrome.
The surgical option is then to cut the flexor retinaculum in order to provide more space in the tunnel for the nerve. It can often be a very effective treatment. But is it the only option. Of course not!
Carpal Tunnel Syndrome is commonly caused by one of two things: either the collapse of the bony arch owing to deterioration of the joints between the small carpal bones, or else swelling of the tendons which then take up more space in the narrow tunnel and so put pressure on the nerve.
Choosing the right treatment depends on knowing which of these is the cause in any particular case. However, and EMG cannot tell you that and so reliance on the EMG alone for diagnosis can 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.
Too much repetitive use of the muscles in the forearm cause them to tighten up. This then makes the tendons tight too, and that can cause them to become inflamed and swollen - a common cause of Carpal Tunnel Syndrome.
In this case, using treatments such as stretching, physiotherapy, nutritional support, soft tissue manipulation, good typing posture, and chiropractic manipulation can be effective. And much less invasive with fewer side effects than surgery.
Surgery can certainly work. But my preference is to start with the simpler, less risky alternatives. If having tried those, things are no better, then by all means consider surgery.
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