Carpal tunnel surgery may not be the best option for most people.
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is caused by the median nerve of the forearm getting pinched at the wrist. The median nerve is in charge of sensations at the thumb and fingers, on the palm, as well as impulses to some hand muscles that move the thumb and fingers. This nerve is housed in the carpal tunnel, which is “a narrow, rigid passageway of ligament and bones at the base of the hand”. Swelling and irritation to tendons can narrow that tunnel and compress the nerve. Symptoms include weakness, numbness, and pain that can radiate along the arm. Carpal tunnel syndrome is a type of entrapment neuropathy. The pain from this disorder could interfere with sleep as well as daytime activities. Decreased grip strength and reduced temperature sensations can also be a result.1
Some people are more prone to developing carpal tunnel syndrome. It may also be triggered by injury, hypothyroidism, rheumatoid arthritis, repetitive strain (repetitive stress, RSI), or fluid retention, such as during menopause or pregnancy. It is unclear if “repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome”, but repeatedly using “vibrating hand tools” and “work stress” could lead to this disorder. Tendonitis, bursitis, and “writer’s cramp” can be brought on by repetitive activities. Those most at risk of carpal tunnel syndrome are women and people in certain industries, such as assembly line workers in manufacturing, meatpacking, and sewing.2 The excessive pressure on the wrist causes inflammation. Usually there is an underlying medical problem that causes the swelling and interferes with blood flow. Aside from the pregnancy, menopause, thyroid dysfunction, and autoimmune disorders, diabetes and high blood pressure are a couple of other medical conditions that are linked with carpal tunnel syndrome. Repeated over-extension of the wrist worsens the situation, and compression of the nerve can be aggravated by “poor positioning of the wrists while using your keyboard or mouse”, vibrating power tools, typing, and playing piano.3
When to Consider Surgery
Most patients do not require carpal tunnel surgery. It becomes a consideration, though, when symptoms are not abating after weeks to months of treatment, assuming that there are symptoms without nerve damage. Nerve damage makes surgery urgent. Severe symptoms that interfere with daily activities include “persistent loss of feeling” in the hand or fingers, “decreased strength in the thumb”, and sleep disturbances. The most common of the carpal tunnel surgeries “involves cutting the transverse carpal ligament”, and this can be done by “open carpal tunnel release surgery” or “endoscopic carpal tunnel release surgery”. With the former, recovery time is longer, with a larger scar, but there are fewer complications than with the latter option. Recovery time and scarring from endoscopic surgery are less, but there is a higher chance of needing a future surgery. There is a new procedure called “small- or mini-open release surgery” that is meant to reduce scarring and healing time and may “minimize danger to the nerve”, but more studies need to be done to compare this option to the other surgeries.4
Open carpal tunnel release surgery cuts the transverse carpal ligament to release the median nerve pressure. The gap left by the cut is left to develop scar tissue. The surgery is performed through “an incision…made…at the base of the palm of the hand”, and “after surgery, the hand is wrapped”. The stitches are removed a couple of weeks later. Numbness and pain symptoms might be alleviated immediately or it could take months. Patients should avoid using their hand too much for three months after surgery. Physical therapy rehabilitation can speed recovery. Surgery is an option only for patients who have tumors, a damaged median nerve, and for those with very severe symptoms or who do not respond to nonsurgical treatment. Surgery can work for most patients, but for some the numbness and pain return, “or there may be temporary loss of strength” when gripping or pinching. If a patient has wasted thumb muscles, surgery has limited results.5
Non-Surgical and Alternative Therapy Options
Carpal tunnel syndrome should be treated early. Rest, avoiding activities that worsen the condition, using a splint, and cold packs can all be employed to alleviate symptoms. Chiropractors can use joint manipulation, suggest strengthening and stretching exercises, and help with “soft-tissue mobilization techniques”. The American Chiropractic Association suggests light exercises and stretches at work, taking rest breaks, wearing splints, using “correct posture and wrist position”, and ergonomic modifications. Yoga might be beneficial for CTS.6 There are various massage techniques that can also relieve the symptoms of carpal tunnel syndrome. These include deep tissue massage, for trigger points and adhesions, as well as “myofascial release through stripping, compression and active engagement”.7 The International Journal of Clinical Rheumatology published a recent piece about non-surgical options for CTS. Bracing and steroid injections are two such alternatives, but “the benefits may be short term”. Further studies are needed to see if exercise, yoga, therapy, acupuncture, and lasers are effective. Acupuncture, performed with “needles and low-level lasers” shows some promise, as does yoga. Yoga positions should “focus on upper body postures and awareness of proper structural alignment”. Activity modification can lead to the improvement of CTS symptoms.8 Another alternative treatment for carpal tunnel syndrome is “wet cupping”, which is an ancient Chinese therapy that uses glass cups and suction on acupuncture points. It may work by providing a “counterirritant”.9
Home treatments for carpal tunnel syndrome include splinting, NSAID medications, and lifestyle changes. It is important to take breaks from repetitive activities, rotate the wrists and stretch the fingers and palms, and avoid sleeping on the hands. Aside from yoga, hand therapy might be a useful alternative option. Physical and occupational therapists can assist with these techniques to improve the CTS symptoms. Another alternative treatment option is ultrasound therapy, in which “high-intensity ultrasound…(raises) the temperature of a targeted…tissue to reduce pain and promote healing”. Of course, prevention is also useful. Patients should relax their grip and reduce their force with manual tasks such as hitting keyboard keys and writing. Aside from taking frequent breaks, it is necessary to watch hand position and form, such as avoiding bending the wrist “all the way up or down”. The “relaxed middle position” with the wrist at elbow height may be helpful. Patients should also improve their posture and not roll their shoulders forward. A shoulder-forward position shortens the shoulder and neck muscles, compressing neck nerves, and that impacts the arms all the way down to the fingers. The work environment should also be warm, as it is important to keep the wrists and hands from being cold and stiff.10 Patients may also want to consider self-massage and doing carpal tunnel stretches at home. One exercise is to touch the tips of the thumb and little finger together, bending the middle fingers over the bridge, towards the palm. The other hand can then pull the middle fingers in an effort to straighten them, thus stretching the carpal tunnel and making room for the nerve. This should be done 5 times per session, 3 times per day.11
1, 2 http://www.ninds.nih.gov/disorders/Carpal_tunnel/detail_carpal_tunnel.htm
Learn more information about carpal tunnel syndrome.