NON-SURGICAL OPTIONS FOR DEALING WITH CARPAL TUNNEL SYNDROME
"In general, Carpal Tunnel Syndrome develops when the tissue around the Median Nerve of the hand swell and press on the nerve. Early in the disorder, the process is reversible. Over time, however, the insulation on the nerves may wear away, and permanent nerve damage may develop. It is critical to begin treating early phases of Carpal Tunnel Syndrome before the damage progresses. A conservative approach to CTS...... is the first step in treating this disorder." The University of Maryland Medical Center's Carpal Tunnel Syndrome webpage.
"Carpal Tunnel Syndrome is a very common condition, caused by 'The Pill', pregnancy, Rheumatological, or Endocrine disorders; and involves compression of the Median Nerve in the Carpal Tunnel" The Carpal Tunnel Anatomy video below from England's University of Warwick.
Carpal Tunnel Syndrome. It's one of THOSE PROBLEMS that has become increasingly common in our stress-filled society. The main symptoms are pain, numbness, and tingling. Due to a wide array of factors, the tunnel (seen in purple above) becomes crowded due to swelling and INFLAMMATION. As the swelling increases, the Median Nerve becomes irritated, causing the symptoms, and if left untreated, weakness. The real shocker about this problem is what experts now think causes it. According to an August 2013 issue of Medical News Today (What Is Carpal Tunnel Syndrome? What Causes Carpal Tunnel Syndrome?), this problem, according to brand new research from Harvard Medical School, is not nearly as associated with chronic overuse or computer use as we have been led to believe. In fact, there are those who believe it is an AUTOIMMUNE DISEASE similar to Raynaud's Phenomena. And if you look at the list below, you will see that Carpal Tunnel Syndrome is intimately associated with several such (Autoimmune) diseases.
What does this list tell me? It tells me that the same factor that is heavily involved in nearly all sickness and disease seems to be at work in Carpal Tunnel Syndrome as well. What would that factor be? Can anyone say INFLAMMATION? Here's the problem though. Unless you begin to understand what actually causes Inflammation, you will end up being treated by physicians intent on prescribing you non-steroidal anti-inflammatory drugs (NSAIDS) or even worse; corticosteroids. And when those don't work --- and frequently they do not --- it's on to Carpal Tunnel Syndrome Release Surgery.
Is surgery an effective / cost-effective option for CTS? Depends on who you talk to. I am here to tell you, however, that for many of you, there's a better way to deal with this and many other INFLAMMATORY HEALTH PROBLEMS than simply taking another drug. Since Carpal Tunnel Syndrome is not necessarily what you thought it was, it might make sense that it needs to be dealt with in ways that you might not necessarily have thought of or even heard of. In other words, you may need to step outside the box.
According to most sources (see quote from the top of the page), Carpal Tunnel Syndrome can typically be effectively dealt with in a conservative manner ---- if it is caught early enough. The questions now become, what constitutes "conservative treatment" and when is "early enough"? Let me first tell you what it is not considered conservative. Despite the medical community's inference that virtually anything falls into the "conservative" category so long as it does not involve surgery; is not really the most accurate way of thinking about this issue. Case in point; corticosteroids.
An April 2007 study (A Systematic Review of Conservative Treatment of Carpal Tunnel Syndrome) published in the medical journal Clinical Rehabilitation, looked at the evidence from over 30 randomized studies on Carpal Tunnel Syndrome. Although they mentioned NSAIDS as showing "limited" efficacy in the treatment of CTS (something that is recommended by most physicians, and touted on sites like MayoClinic and WebMD), their big brother (CORTICOSTEROIDS -- injected and / or oral) was the only form of treatment that made the "strong evidence" category. Yes; I understand that steroids have the ability to at least temporarily relieve the symptoms of CTS. The problem is, they also have a crazy array of common and frequently severe side effects.
While I'm all about helping people avoid surgery, one must be careful about trading tomorrow for today --- which is exactly what you are likely doing with corticosteroid injections. Although the short term effects of corticosteroids such as cortisone range from mood swings, swelling of the limbs and face, SEXUAL DYSFUNCTIONS, INDIGESTION, BLOOD SUGAR DYSREGULATION, WEIGHT GAIN, INSOMNIA, ACNE, ANXIETY / DEPRESSION, and a slew of others, they are not my biggest concern. The real problem with corticosteroids (particularly when they are injected) is local degeneration. While it was dealing with chronic back problems and not Carpal Tunnel Syndrome, a 2004 study published in the Spine Journal said, "no conclusive evidence exists to determine that spinal steroid injections give lasting improvement...". This is just as true with Carpal Tunnel Syndrome
WebMD's "Carpal Tunnel Syndrome Health Center" carries an article called, Corticosteroids for Carpal Tunnel Syndrome. Listen to what the authors have to say about this mode of treatment. "Although they may relieve pain and inflammation, corticosteroids can also slow healing and weaken tendons and bones (osteopenia or OSTEOPOROSIS). Other side effects of corticosteroid injection include pain that gets worse after the injection, loss of strength and movement in the tendon, breakdown (degeneration), tearing, or rupture of the tendon, scarring of the tendon, or accidental injury to the median nerve in the wrist during injection." And even though the meta-analysis we looked at earlier essentially said that NSAIDS were a wash as far as their effectiveness in dealing with this Carpal Tunnel Syndrome, they were touted by WebMD as a preferred form of treatment ---- probably because they are less dangerous than the steroids.
The bottom line is that corticosteroids, while undoubtedly providing some temporary relief of symptoms, are a terrible long term 'solution' to Carpal Tunnel Syndrome. In fact, one of the studies I looked at actually talked about a side effect called Wallerian Degeneration. This is where the nerve actually begins degenerating / deteriorating back up the arm (I know someone who had this happen). When these so-called "conservative" treatment methods don't work, surgery is the next option. What exactly is Carpal Tunnel Release Surgery and what does it entail?
In Carpal Tunnel Release Surgery, an incision is made in the Transverse Carpal Ligament (aka the Flexor Retinaculum --- see the pic at the top of this page) in order to "release" the bound ligament, and thus 'release' or take pressure off of the contents of the Carpal Tunnel. Read between the lines as you listen to what a popular online encyclopedia had to say about the success rates of Carpal Tunnel Release Surgery.
Think for a moment about what the authors are really saying in light of what many of you already know. If you have worked in an industry where Carpal Tunnel Release Surgery is common, you already know that recurrence of symptoms after the surgery are likewise common --- despite the fact that according to the quote above, you are likely being told that your symptoms are no longer caused by Carpal Tunnel Syndrome. This sort of reminds me of a doctor I once asked the question of why so many people come down with the worst case of flu ever, shortly after getting a FLU SHOT. His answer was that technically speaking, they don't come down with the Flu. It is merely "Flu-like symptoms".
Put all this in the computer, add it up, and it tells me that somewhere we are missing the boat with this problem we call Carpal Tunnel Syndrome. Surely there must be a better way to deal with Carpal Tunnel Syndrome. Often times there is. How would I go about helping someone struggling with Carpal Tunnel Syndrome? There are several steps that make sense in light of the most current peer-reviewed literature.
If you are interested in learning more about AVOIDING CARPAL TUNNEL SURGERY, just click the link and begin reading.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).