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.
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 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.
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 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.
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 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!
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.
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.
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.
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.
