Hey guys, Dr. Lell here. Are you or someone you know considering carpal tunnel surgery? I’m sure everyone knows someone with carpal tunnel syndrome (CTS). It’s estimated that about 15% of the general population has some of the symptoms while in some high-risk professions, like clerical workers, the percentage can jump to 81%. Many people consider surgery to be their only option and for some, this is true. Ignoring those gradually increasing symptoms to the point where the pain is unbearable and you’ve got tremendous functional deficits could make surgery a very appropriate option. But consider some facts. Carpal Tunnel surgery only helps about 71% of people. Complete restoration (being “all better”) occurs in less than 60%. The surgery could leave you with permanent weakness and there’s about a 50% chance you’ll need it again in 6 years. Given the cost (the range is around $5-10,000), invasiveness of the procedure,the down-time to recover, and the limited long term success – I always encourage people considering surgery to consider some alternatives. But first, let’s talk about why this surgery isn’t all it’s cracked up to be.
Why does the surgery have such a poor track record? For starters, many people consider it to be a condition of the wrist – but it’s not. It’s a condition of the arm. The nerves that feed your hand come from the neck and they travel down your arm through your chest, shoulder, and all the muscles of the upper extremity. There are several points along this path where the nerve can get pinched. When a nerve gets pinched, its local circulation decreases meaning it doesn’t work as well. When the same nerve gets pinched in multiple sites, the effects combine to be worse than at any one site. Think of these areas where the nerve gets pinched like a river and a dam. If you dam a river, the pants at the end of the river will go dry before the plants at the dam. Now think of a river with several dams. Your hand is at the end of the river and your wrist is the last dam. That’s why carpal tunnel surgery has such limited success – because it doesn’t treat the entire condition.
Cervical radiculopathy, thoracic outlet syndrome, pronator teres syndrome, impingement syndrome, and carpal tunnel syndrome – these are all the same thing in different parts of the neck, shoulder, and arm. But when you look at the human body through a microscope – only focusing on the wrist – you lose the forest for the trees.
Everything described above is the biomechanical aspect of the condition. There may also be an inflammatory aspect that is often overlooked before a patient is rushed under the knife. The carpal tunnel is just that – a small tunnel where everything fits just right. The majority of the tunnel is made of bones and the roof is made of a fibrous sheath called a retinaculum. A local or systemic inflammatory process can cause swelling inside the tunnel thus squeezing the delicate nerves that are inside. This is, in effect, just another “pinch” but the underlying cause is different than the pinches described above.
When it comes to long developing conditions, there is no such thing as a shoulder problem, an elbow problem, or a wrist problem. It’s an arm problem. Treating just one piece rarely offers long-standing benefits – especially in the case of carpal tunnel syndrome.
In my next blog, I’ll go over some good alternatives to surgery. Treatments that I and my patients have had good success with and treatments that others have been trying. If you’d like to stay updated and in the loop, subscribe to my feed! As always, your questions, comments, and arguments are welcome. Until then, stay well.