Often surgery is the recommended treatment, it is obviously the most invasive form of treatment. It is also not the only option. The better understand the different options available we need first to look at the different causes of Carpal Tunnel Syndrome.

The wrist is formed by four bones, the carpal bones, which make an arch across the back of the wrist. This arch is spanned by a strong ligament, the flexor retinaculum, which forms the front of the wrist. The space between the bones and the ligament is 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 median nerve supplies the palm side of the hand including the thumb and the first three and a half fingers. It also supplies the tips and the backs of the same fingers. When the nerve gets compressed, it is only in this area that symptoms are felt. So, if you are getting symptoms in your little finger, for example, then that is NOT caused by 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 surgical option is then to cut the flexor retinaculum in order to provide more space in the tunnel for the nerve. It can often be a very effective treatment. But is it the only option. Of course not!

So what causes Carpal Tunnel Syndrome? The first common cause is a deterioration of the joints between the carpal bones. This causes the tunnel to collapse and, in turn, compresses the median nerve. The second cause is a swelling of the tendons. The enlarged tendons take up more space, 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 the problem is arising from tendonitis, I believe it is much better to treat the tendonitis. The way tendonitis occurs is from having too much strain or tension placed on the tendon for too long of a time.

Too much repetitive use of the muscles in the forearm cause them to tighten up. This then makes the tendons tight too, and that can cause them to become inflamed and swollen - a common cause of 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.