Carpal Tunnel Syndrome (CTS) affects 3% of the adults in the United States and is the most common of the “entrapment neuropathies” (pinched nerves in the arms or legs). Treatment for CTS is frequently delayed because the symptoms are usually mild at first and progress gradually. Because CTS symptoms may be more advanced by the time a patient seeks treatment, he or she may think surgery is the only viable option. So, when should a patient consider surgery for CTS?
CTS has many causes. Hence, managing it relies on an accurate diagnosis. The condition is associated with the following: female (4x more likely than male), obesity, rheumatoid arthritis, pregnancy, diabetes, thyroid dysfunction, renal dialysis (amyloid), and trauma, especially fractures. Certain medications such as oral contraceptives and other hormone replacement therapies can also increase the risk of developing CTS. In cases with a strong family history of CTS, a hereditary risk factor may also exist. Because compression of the median nerve at locations other than the wrist can also lead to carpal tunnel-like symptoms, it’s important for a doctor to check the course of the median nerve from its origin in the neck down to the wrist.
So WHEN should a non-surgical approach be used? Short answer: almost always. Exceptions include acute carpal tunnel syndrome, which occurs rarely but should be considered urgent since permanent problems may QUICKLY result if it’s NOT surgically managed. One example is when a wrist fracture places compression on the median nerve. Bleeding (from any cause) into the carpal tunnel is another scenario when emergency surgery is necessary. A third (rare but serious) situation is if infection is present in the carpal tunnel. More commonly, the decision to have vs. not have surgery depends on the amount of nerve damage (weakness, pain, numbness/tingling), the resulting loss of function or inability to perform desired work or home activities, and the length of time CTS has been a problem. The AAOS (American Academy of Orthopaedic Surgeons) recommends a course of nonsurgical treatment (as do most guidelines) with treatment options that include the use of bracing (wrist cock-up splint), local steroid injection, or ultrasound. When other conditions co-occur with carpal tunnel syndrome symptoms, the AAOS found insufficient research evidence to provide specific recommendations. This means a patient should WAIT on surgery until the co-existing condition/s (like diabetes, double crush, hormone imbalance, and/or work place/ergonomic problems) are properly managed to see if their symptoms persist.
With this in mind, consider a four-to-six week trial (or longer if you are responding and satisfied) of non-surgical care prior to consulting with a surgeon. A 2010 study described conservative treatment options to include physical therapy, bracing, steroid injection, and alternative medicine (like chiropractic). More research is needed to make strong recommendations for treatments such as exercise, yoga, acupuncture, and lasers. The authors of the study do cite mobilization exercises (tendon gliding & nerve gliding) as being helpful WHEN patients comply with the treatments and the recommended exercises (a definite problem). Chiropractic management includes bracing, manipulation, mobilization, exercise training, nutrition, and ergonomic / work station modifications. Doctors of chiropractic understand the limitations to these approaches and work with other healthcare providers when pharmaceutical and/or surgical intervention may be needed.
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