Healthy Everytime

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.

Surgery is often recommended as the best treatment. However, it is a serious undertaking, and sometimes a more conservative approach might be better. To know what route to take, we first need to have a good understanding of 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.

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.
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.

This entails putting one electrical probe into the median nerve on either side of the carpal tunnel. An electrical current is then put into the nerve on one side and checked to see if it is picked up by the probe on the other side. If the current is diminished to a great degree, it is deemed that carpal tunnel syndrome is present.

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.

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.

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.