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Carpal Tunnel Syndrome - Is Surgery The Only Answer?

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 formed by an arch of four bones, the carpal bones, which form the back of the wrist. The front of the wrist is formed by the flexor retinaculum, a strong ligament which spans the arch. The tunnel thus forms between them.

The tendons that bend the fingers, and the median nerve all pass through this tunnel from the arm to the hand. What happens in Carpal Tunnel Syndrome is that, for various reasons, the space in the tunnel becomes overcrowded, the nerve gets compressed, and the result is that the nerve no longer conducts signals as it should.

The median nerve supplies the palm side of the hand including the thumb and the first three and a half fingers. It also supplies the tips and the backs of the same fingers. When the nerve gets compressed, it is only in this area that symptoms are felt. So, if you are getting symptoms in your little finger, for example, then that is NOT caused by 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 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 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.

So what causes Carpal Tunnel Syndrome? The first common cause is a deterioration of the joints between the carpal bones. This causes the tunnel to collapse and, in turn, compresses the median nerve. The second cause is a swelling of the tendons. The enlarged tendons take up more space, 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, in fact, it is swollen tendons (tendonitis) which is the problem, I believe that a better way to go is to treat the inflammation. Often this is the result of too much strain or tension being placed on the tendons for too long - eg from repetitive tasks such as typing.

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.