Surgery is often recommended as the best treatment. However, it is a serious undertaking, and sometimes a more conservative approach might be better. To know what route to take, we first need to have a good understanding of the different causes of Carpal Tunnel Syndrome.



The carpal tunnel is made of two rows of four bones, called carpal bones, which sit in a semi-circle at the back of the wrist. This forms one side of the tunnel. The opposite side of the tunnel is formed by a strong ligament, the flexor retinaculum, which completes the carpal tunnel.

Through this tunnel pass a number of crucial structures, including the tendons that bend the fingers, and the median nerve. With Carpal Tunnel Syndrome, this nerve gets squeezed and compressed. The result is a decrease in its conductivity, meaning the nerve does not function as it should.

The palm of the hand, complete with the thumb, first three and a half fingers, and also the backs of the same fingertips are all supplied by the median nerve. The rest of the hand is covered by the ulnar nerve. Therefore Carpal Tunnel Syndrome can cause symptoms only in the thumb-side of the hand. Any symptoms on the other side are NOT Carpal Tunnel Syndrome.

Diagnosis of Carpal Tunnel Syndrome is usually done by EMG (electromyelogram) which measures the conductivity of nerves. If the median nerve is compressed (as in Carpal Tunnel Syndrome) then this will show up on the EMG test.

The EMG is done by sending a small electrical impluse from the forearm to the hand. If the current is decreased when it is picked up at the hand by the EMG probe, then the diagnosis is probably Carpal Tunnel Syndrome.

The treatment most commonly recommended is the surgical cutting of the flexor retinaculum so as to provide more room for the nerve in the tunnel. This often works very well - but it is by no means the only solution.

Carpal Tunnel Syndrome is commonly caused by one of two things: either the collapse of the bony arch owing to deterioration of the joints between the small carpal bones, or else swelling of the tendons which then take up more space in the narrow tunnel and so put pressure on the nerve.

Choosing the right treatment depends on knowing which of these is the cause in any particular case. However, and EMG cannot tell you that and so reliance on the EMG alone for diagnosis can result in unnecessary surgery.

If, in fact, it is swollen tendons (tendonitis) which is the problem, I believe that a better way to go is to treat the inflammation. Often this is the result of too much strain or tension being placed on the tendons for too long - eg from repetitive tasks such as typing.

Repetitive use of a muscle often results in the muscle getting too tight. Since muscles are attached to tendons, this results on the tendon being too tight and that, in turn, can lead to tendonitis and Carpal Tunnel Syndrome.

In this case, using treatments such as stretching, physiotherapy, nutritional support, soft tissue manipulation, good typing posture, and chiropractic manipulation can be effective. And much less invasive with fewer side effects than surgery.

My recommendation is always to begin with the least risky option. If these treatments don't bring the desired relief, then, certainly, surgery can be considered.