Carpal Tunnel Syndrome - Is Surgery Really Necessary?

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 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.

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 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!

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 cause is swollen tendons (tendonitis) then, I believe, it is better treated by tackling the cause of the inflammation - such as too much stress or tension on the tendons - than by surgery.

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.

My recommendation is always to begin with the least risky option. If these treatments don't bring the desired relief, then, certainly, surgery can be considered.

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