Friday, October 3, 2008

Carpal Tunnel Syndrome - The Alternatives to Surgery

By Dr. Steven Trembecki, D.C

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.

Although surgery is often the choice of treatment, it is the most invasive form of treatment and is not the only treatment available. To better understand this, one needs to better understand 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.

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 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.

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.

Unfortunately, an EMG cannot tell you which of these two causes is the problem. And that, in turn, 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.

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. - 14130

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