Carpal Tunnel Syndrome - The Alternatives to Surgery

By: Dr. Steven Trembecki, D.C The core symptoms of Carpal tunnel syndrome include numbness, tingling, weakness, pain and/or wasting of the muscles in the hand. All this occurs along the distribution of the median nerve, which is the one that supplies the thumb-side of the hand.

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.

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.

To diagnose Carpal Tunnel Syndrome requires finding evidence of loss of conductivity as a result of median nerve compression. This is usually done by using an 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.

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.

The problem with using solely EMG to determine the presence of carpal tunnel syndrome is that it doesn't 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.

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.

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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