Carpal Tunnel Syndrome - Is Surgery The Only Answer?

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.

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.

This nerve innervates the palm side of the hand over the thumb and first three and a half fingers. It also innervates the backs of the fingertips over this same area. Therefore, compression of the median nerve can only result in irritation over this area of the hand. If the trouble area is over the back of the hand or over the little finger, it is not 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 treatment most commonly recommended is the surgical cutting of the flexor retinaculum so as to provide more room for the nerve in the tunnel. This often works very well - but it is by no means the only solution.

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.

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.

Too much repetitive use of the muscles in the forearm cause them to tighten up. This then makes the tendons tight too, and that can cause them to become inflamed and swollen - a common cause of 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.


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