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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.
Often 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.
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.
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.
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 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 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.
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, 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 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 can be looked at. Looking for some relief from carpal tunnel syndrome? Click now for more advice from Dr. Steven Trembecki, D.C. on effective chiropractor treatments.
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