Carpal Tunnel Syndrome - The Alternatives to Surgery

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.

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 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.

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!

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.

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.

Treatment for tendonitis can include stretching, pysiotherapy, ergonomics (eg typing posture), chiropractic manipulation, nutritional support etc. These are all a lot less invasive and 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.

Tired of suffering caused by carpal tunnel syndrome? Check out our other articles by Dr. Steven Trembecki, D.C. on chiropractor treatments.
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