Carpal Tunnel Surgery, Is It Necessary?

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Carpal tunnel syndrome is a painful condition that is characterized by pain, numbness, tingling and paresthesia (pins and needles) in the thumb, index and middle fingers, with advanced cases revealing loss of strength and coordination.

Carpal tunnel is the most common nerve entrapment disorder and is generally caused by a muscle imbalance in the hand and wrist that results in the compression and impingement of the median nerve. Other contributing factors include direct or blunt trauma or injury to the wrist that can induce swelling, such as sprain or fracture; over activity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal. In some cases no cause can be identified.

   

There are many treatments for carpal tunnel syndrome including medication, exercise, wrist splinting, cortisone injections but most commonly surgery in the prescribed remedy. Although surgery is one of the most common options for treating this condition; however, it remains a controversial choice and it is important to fully understand the risks and benefits involved. Surgery is by far the most invasive procedure and it merits careful forethought, as the success rate is not as high as the medical industry would like people to think. The reason for this misdirection is often due to the fact that a surgeon will make between $4-5,000 for each 30-minute surgical procedure, a sum that is not to be taken lightly.

The statistics listed below provide insight to the poor success rate often experienced by patients that are subjected to carpal tunnel surgery:

•  ONLY 23% of all carpal tunnel syndrome patients returned to their previous professions following surgery, according to the Bureau of Labor & Statistics and the National Institute for Occupational Safety & Health (1997-2000 Statistics).

•  Up to 36% of all Carpal Tunnel Syndrome patients require unlimited medical treatment.

•  Carpal tunnel surgery has about a 57% failure rate following patients from 1-day to 6-years. At least one of the following symptoms re-occurred during this time: Pain, Numbness, Tingling sensations. Source: Nancollas, et al, 1995. J. Hand Surgery.

There are multiple forms of surgery for carpal tunnel syndrome including "open" and "endoscopic" surgery, which is a less invasive incision made through the muscle in the palm that requires less time for post-operative recovery. Post-surgery symptoms such as pain and numbness usually begin to improve in two to six weeks, depending upon the procedure, severity of symptoms, gender and age of the patient. Muscle coordination, control, and strength may initially worsen following surgery, and a return to pre-operative status may take several months. Significant improvement to pre-injury status may take as much as two years to achieve, if it comes at all.

The optimal method of treatment for carpal tunnel syndrome is simple corrective stretches and exercises. The vast majority of patients do quite well with conservative treatment and it is estimated that less than 1/4 require surgical intervention. Only in severe cases is surgery recommended, such as when there is persistent, debilitating pain or muscle atrophy / flattening.

The complications associated with surgery as well as the timeline to substantial recovery make it as last choice resort for most patients. Thankfully, there are numerous effective alternatives that are much less invasive, such as a good balancing exercise and stretching program for the hand (Flextend, Restore, Cats Paw, etc.), wrist and forearm. Once the muscles are in balance, compression of the median nerve is eliminated and the symptoms disappear.

Be sure to consult your doctor before starting any type of exercise or therapy program.

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