Carpal Tunnel Syndrome - Is Surgery The Only Answer?

By: Dr. Steven Trembecki, D.C

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.

Often surgery is the recommended treatment, it is obviously the most invasive form of treatment. It is also not the only option. The better understand the different options available we need first to look at 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.

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.

The palm of the hand, complete with the thumb, first three and a half fingers, and also the backs of the same fingertips are all supplied by the median nerve. The rest of the hand is covered by the ulnar nerve. Therefore Carpal Tunnel Syndrome can cause symptoms only in the thumb-side of the hand. Any symptoms on the other side are 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).

The EMG is done by sending a small electrical impluse from the forearm to the hand. If the current is decreased when it is picked up at the hand by the EMG probe, then the diagnosis is probably Carpal Tunnel Syndrome.

The treatment most commonly recommended is the surgical cutting of the flexor retinaculum so as to provide more room for the nerve in the tunnel. This often works very well - but it is by no means the only solution.

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.

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.

Repetitive use of a muscle often results in the muscle getting too tight. Since muscles are attached to tendons, this results on the tendon being too tight and that, in turn, can lead to tendonitis and 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.

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.

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