 Carpal tunnel syndrome is one of the most misdiagnosed musculoskeletal conditions of our time. It seems that any type of wrist, forearm or hand pain is called carpal tunnel syndrome; and the most typical treatment for this condition is the ol' snip, snip—carpal tunnel surgery. Being a chiropractic sports physician in Los Angeles, West Hollywood, and Beverly Hills, I seem to be treating more and more of these cases (forearm and wrist pain) every year. Why is this condition increasing in its prevalence, and what can be done about it? Better yet, what can be done to prevent you from having a surgery with a very low success and satisfaction rate, and also allow you to return to normal functioning? If carpal tunnel surgery has been recommended and you just aren't sure of what to do, then please read on.
What Exactly Is Carpal Tunnel Syndrome?
The first step is to clarify what carpal tunnel syndrome really is: Carpal tunnel syndrome is a form of neuropathy—a nerve condition involving the median nerve. The median nerve runs down the arm and forearm and distributes into the hand controlling the thumb, index and middle fingers. When the median nerve is irritated or injured, it will cause symptoms into this portion of the hand and wrist. The median nerve can be injured or irritated in different ways, including impingement within the carpal tunnel—a space beneath the flexor retinaculum (or transverse carpal ligament) in the wrist. The symptoms that qualify a condition as carpal tunnel syndrome are numbness and tingling—or a sensation of pins and needles—in the hand and wrist. That's it. Those two symptoms are necessary for carpal tunnel to be properly diagnosed. Now, there may be accompanying symptoms of pain, weakness, loss of control, and such, but in the absence of numbness and tingling, carpal tunnel syndrome is simply not present.
Now why should that matter? Because if you go to a doctor for pain, weakness, and a loss of hand coordination or control, you just might get a carpel tunnel syndrome misdiagnosis; and as I said in the beginning, that could lead to an unnecessary carpal tunnel surgery.
I'll bet you can surmise that I don't look too favorably upon carpal tunnel surgery. It's not that I think it's a bad thing, per se, because, obviously, if you have true carpal tunnel syndrome, and it's chronic, and you've tried all other conservative treatments to no avail, then you might actually need the surgery after all. However, if you have been misdiagnosed, then getting carpal tunnel surgery will not only be useless, it will probably change your life for the worse (please see this interesting clip describing the ugly facts behind carpal tunnel surgery). Believe me when I say that you'll be happier if you can continue to use your hand and wrist normally, and not have to act like an invalid or become a one-handed person because somebody was too quick to jump to the ol' snip-snip.
I have treated so many people whose main symptoms were intense pain, soreness, weakness and the inability to do certain hand movements, who were told that they needed carpal tunnel surgery, that it's frightening to me. I have also encountered many people who have had the surgery—some multiple times—to no avail; they still have their symptoms. It is pretty well known (at least we hope so) that a recurrence of symptoms following carpal tunnel surgery is due to a misdiagnosis. So why would someone need to have two, three, and—gasp—four surgeries? I have my definite opinions, which I will not go into detail here, but suffice it to say that carpal tunnel syndrome is one of the most prevalent worker's comp claims leading to billions of dollars in revenue every year.
Who Gets It?
So what kinds of people come into my office with wrist and hand pain, soreness, and loss of function? I find this situation happening most often in contractors, electricians, hair stylists, musicians, writers, weekend warriors (mostly people who lift weights), and anyone else who uses his hands for a living. I see it in chiropractors and massage therapists; and I especially see it in people who do lots of computer work. Professional computer users—like office workers, data entry people, computer technicians, IT people, electricians, writers, teachers, and so on spend hours with their forearms flexed, wrists bent, and their fingers doing hard core calisthenics. That'll usually do it. It'll easily cause pain, soreness, and a loss of function over time. Those symptoms come on gradually, and they intensify over time. As the muscles and tendons of the forearm get stronger (you're working them out as you would any muscle with repetitive use), they shorten (get tighter) and increase in girth. This can shrink the space in the carpal tunnel and cause nerve irritation leading to true carpal tunnel syndrome. That's why it's important to get your wrist, forearm or hand checked early on—when pain first crops up—because it's better to prevent true carpal tunnel syndrome from happening in the first place than to wait until you have it to get treated.
Carpal Tunnel Surgery As I've already pointed out, for people who have chronic numbness and tingling, and have tried all other conservative treatments for carpal tunnel syndrome, surgery may be necessary. Carpal tunnel surgery requires snipping the flexor retinaculum in two to open up the carpal tunnel and allow more room for the flexor tendons and median nerve to breathe. The flexor retinaculum acts as a support for the tendons of the hand, as well as protection for the tendons and the median nerve. Cutting the retinaculum eliminates this protection and removes an important stabilizer necessary for the gripping function. This leads to altered biomechanics and permanent loss of strength. Although the surgery can lead to an immediate relief of true carpal tunnel syndrome's symptoms, recovery from the surgery itself can take months, and can cause some unpleasant and damaging side effects including infection, nerve damage, stiffness, and pain at the scar site. How We Treat It
Conservative treatment, or what I do in my office, consists of ultrasound, myofascial release, stretches, strengthening exercises, coordination training, and chiropractic adjustments of the elbow. Ice therapy is always a must in treating this syndrome. I have found this routine so effective in treating pre-carpal tunnel syndrome (that's what we're gonna call it from now on, OK?), that I'm certain I have saved hundreds of people from the permanent disability associated with unnecessary carpal tunnel surgery. Like I said in the beginning of this article, carpal tunnel syndrome is misdiagnosed way too often. And far too many people elect for carpal tunnel surgery when a regimen of conservative chiropractic care and physiotherapy would really do the trick.
So what should you do if you have pain in your hand, wrist and forearm? The first thing is to get yourself evaluated by your chiropractor (and if you're in Los Angeles, West Hollywood, or Beverly Hills please contact me). I am certain that by doing this one simple step at the first indication of pain, numbness or tingling, you'll save yourself a lot of grief—grief that is certain to come if you go in too early for the often unnecessary, and usually debilitating, ol' snippety snip. - April 30, 2008
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