Articles by Dr. Erdman are for informational purposes, and are not to be taken as specific medical advice.
Do you or someone you know have hand pain, numbness or
tingling? Have you been diagnosed with carpal tunnel syndrome (CTS)? Do you
think surgery is the only answer? I’m writing to give you a different
perspective on this pervasive problem.
First we will start with some statistics on the second most
common musculoskeletal surgery (back surgery is number one). There are more
than 250,000 carpal tunnel surgeries performed every year in the United States,
and growing. More than 8 million people are affected, and employers spend over
$7.4 billion in workers comp costs yearly. Only 23% of all CTS surgery patients
were able to return to their previous profession following surgery!
Here are some statistics on the CTS surgery. Initially after
surgery, 80% of patients report about 75% relief of symptoms. The outcomes up
to 36 months are a different story. Only
27% are reported as good outcomes, 42% fair and 32% poor. There are 57% of the
people who have recurrent symptoms at 2 years. At 5.5 years 57% still have pain,
and 40% have permanent hand weakness!
A Canadian study showed that 4 years post operatively 46%
still had moderate to severe pain, 52% had moderate to severe numbness and 40%
had difficulty grasping small objects. Only 14% were symptom free!
So what is the carpal tunnel? It is literally a tunnel in
the wrist formed on 3 sides by the bones of the wrist and covered by the flexor
retinaculum ligament. Just picture a tunnel through a mountain, the concrete
tunnel is made of bones and the road is the ligament connecting the two sides.
Through that tunnel go many tendons of forearm muscles and the median nerve. Lying
just above the ligament is the ulnar nerve.
The definition of carpal tunnel syndrome (CTS) is a painful
condition with median nerve entrapment at the wrist most commonly from anything
that causes a decrease in the size of the tunnel or anything that increases the
contents of the tunnel. So the next time someone tries to tell you that CTS is
caused by pregnancy, diabetes, obesity or whatever, this is technically not
true. Those are contributing factors to CTS but not a cause. It has only 2
causes, but many contributing factors.
Most people (doctors included) think CTS is solely a
repetitive stress condition, or chronic problem. It is not. Research says that
even minor compression or angular forces may restrict local blood flow enough
to prolong nerve conduction times. So if minor forces can cause this, what do
you think gripping a steering wheel during an accident can do to your wrists?
This brings us to the most commonly used diagnostic test to
confirm CTS, the nerve conduction test. As stated before, even minor trauma can
affect nerve conduction. Studies of nerve conduction testing show they are only
about 40% accurate, at best; and highly dependent on the skill of the
practitioner. Inter-practitioner reliability is not very good, meaning one
clinician finds one outcome and another clinician can’t confirm it or finds
different results.
Injecting the wrist with cortisone shots does seem to reduce
the pain temporarily, mainly due to the numbing agent found in the shot, not
the inflammatory relief supposedly given by the cortisone. The bad part of shots is that in the long run
it increases the contents of the canal, and we said that is one of the causes
of pain to begin with, right?
The reason surgery has such a high failure rate is that the
body repairs soft tissue injury with fibrotic scar tissue. Once the ligament is cut, it does give
immediate relief… which doesn’t last. Wait
3 months to 5 years and all that scar tissue being made has just filled up the
canal again, and you are right back to where you started, hence the 5 year
symptom free rate of only 14%!
This information begs the question, “What do I do for my
painful, numb hands if surgery is not likely to help?” My answer is that there
are a “handful “of chiropractors specifically trained in manipulation of the
bones of the elbow, wrist and hand with the Mally method. The whole problem
starts with the bones that border the canal on three side crushing down on the
canal causing a decrease in the size of the canal. Repetitive injury or acute trauma can cause
this to occur. Manipulating these bones
to decrease the compression is the way to decrease canal pressure.
Laser therapy is also a big help in these conditions. These
options are not a quick cure by any means, but surgical statics are so bad that
conservative care must be attempted before any cutting is done. Ask your
chiropractor if they are trained in the Mally method of extremity adjusting,
and let them help you figure out some help for your condition.