Carpal Tunnel Syndrome
- Asked By: Mike
- Category: Chiropractic
Dr. O’Donnell,
This is a great resource! Thanks!
I do a lot of typing at work, and I’ve been diagnosed with carpal tunnel syndrome. I’ve done the splint and medications, and now my doctor wants to do surgery.
Is surgery my only option? Does it work?
Thanks again!
Mike
Dr. O’Donnell,
This is a great resource! Thanks!
I do a lot of typing at work, and I’ve been diagnosed with carpal tunnel syndrome. I’ve done the splint and medications, and now my doctor wants to do surgery.
Is surgery my only option? Does it work?
Thanks again!
Mike
DrWJODonnell
Posted 11 months ago
Mike,
Glad you found the Q&A to be helpful. Feel free to post more questions at any time!
First, the second question – “Does it [carpal tunnel surgery] work?” I will say that yes, it certainly can work. If it did not, my guess is that surgeons would no longer be performing it!
To explain: There is a nerve that goes into the hand supplying the thumb and first few fingers called the median nerve. In order to get into the hand and supply sensation to the hand (among other things) it passes over a bony groove on the bottom (formed by carpal bones) and under a ligament called the flexor retinaculum on top. These two structures form a passageway called the carpal tunnel.
When the amount of room in that tunnel becomes less through a shifting of the bones, a tightening of the ligament, inflammation or other cause, the tunnel becomes narrow and compresses that nerve. The most common first sign of this is a general numbness in the hand to the skin that the median nerve supplies. There is actually a small patch of skin in the middle of this area that is always spared in a “true” carpal tunnel syndrome (CTS) due to this area being supplied by a very small nerve that does NOT pass through the tunnel – this is one easy test to discover if you have CTS. More on this later.
By cutting the flexor retinaculum to allow the tunnel to open up, surgery can be helpful. It is a relatively easy surgery, and has shown success. There are however a few issues with it.
First, the surgery causes scar tissue to form which causes contraction of the ligament and also takes up space in the tunnel (if you cut your hand, no matter how well it heals, scar tissue always forms). This can decrease the size of the tunnel and, well, you get CTS!
The second problem is not one of the surgery but one of misdiagnosis. I don’t know how many doctors (Medical doctors, osteopaths, chiropractors, etc) I have seen look at hand numbness and immediately call it CTS but it is a LOT. And this is a HUGE problem, because there are a number of other problems than can cause hand numbness that are NOT carpal tunnel syndrome including other nerve entrapments in the forearm, elbow, shoulder and neck. There are also issues where more than one area of the nerve can be insulted in different areas called a double or triple crush (imagine two or three people stepping on a garden hose at different places…you get one to step off, but the water still would not flow through the hose because of the other person). Disc injuries, problems in the neck, thoracic outlet syndrome and more can all cause problems that can look like carpal tunnel syndrome but in fact are not. One of the keys to finding this out is looking for that small patch of skin that is spared in carpal tunnel. If that patch is numb, it is not carpal tunnel. That simple. I have met few docs who actually look for this fact.
This is the leading cause I have seen for failed carpal tunnel surgery – inappropriate diagnosis.
So now to the first question – “Is surgery my [the] only option?”
Definitely not.
First I am glad you have tried other options. While antiinflamatories can stop the symptoms if there is inflammation in the tunnel and splints can keep the tendons and nerve from being stressed, there are other options.
In the chiropractic and manual therapy realms, adjusting the carpal bones to get appropriate alignment is of utmost importance (what good will a brace do if it is bracing bones that are out of alignment?). Massage, ultrasound, and other techniques to lengthen the retinaculum and break up adhesions are often effective. Learning proper biomechinics for the hands and wrist while typing, often through the use of an ergonomic evaluation (ergonomic keyboard, wrist pad, appropriate elbow and arm angles, etc) is very important to remove the cause and prevent future recurrence. I have acupuncturists that I work with that have told me they can help, but I have no idea how this actually works so I won’t comment further on it, but know that it is a viable option, at least according to acupuncturists.
So yes, you have more options but be aware – carpal tunnel syndrome is often a bad diagnosis. It is not as common as it is diagnosed. Find a specialist who knows how to diagnose carpal tunnel and verify that it is not any of the other conditions I mentioned. A chiropractic doctor would be the best choice in my opinion because they can find not only the thoracic outlet, double crush injuries, and other points of entrapment, but they often look to the neck where the roots of the median nerve arise and take care of problems that are often overlooked by other doctors there.
With Corvallis being a young, tech-savy, and all-too-keyboard-friendly town, I am not surpised to see your problem here. But I know that most of the Corvallis carpal tunnel surgeries that do happen can be avoided, and getting the appropriate diagnosis and care will rid you of that problem. I tell people to go ahead and schedule the surgery if it makes them comfortable, but come and see me. If I can’t help, the surgery is always there. But if I can, and I haven’t lost one to surgery yet, I will get rid of the problem and the surgery can be cancelled.
William J. O’Donnell, DC
Chiropractic Physician
http://www.VertebrataChiropractic.com