Carpal tunnel syndrome is normally defined as a condition involving tingling, numbness,  weakness, pain and/or muscle wasting of the hand along the distribution of the median nerve.  This relates to the thenar or thumb-side of the hand.

Although surgery is often the recommended choice of treatment, it is the most invasive form of treatment and is not the only treatment available.  To better understand this, one needs to better understand 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.

It is ultimately the compression of the median nerve that leads to carpal tunnel syndrome.  Medical testing for carpal tunnel syndrome usually entails the use of an electromyelogram (EMG).

This entails putting one electrical probe into the median nerve on either side of the carpal tunnel.  An electrical current is then put into the nerve on one side and checked to see if it is picked up by the probe on the other side.  If the current is diminished to a great degree, it is deemed that carpal tunnel syndrome is present.

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!

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.

Unfortunately, an EMG cannot tell you which of these two causes is the problem. And that, in turn, 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.

The most common way for this to happen is to have the muscle tighten too much due to repetitive use of the muscle.  Since the tendon is responsible for connecting the muscle to the bone, if the muscle tightens up, so does the tendon.  This can result in the tendonitis which can cause the symptoms of carpal tunnel syndrome.

Treatment for tendonitis can include stretching, physiotherapy, ergonomics (eg. typing posture), chiropractic manipulation, nutritional support, and so on. These are all a lot less invasive and have fewer side effects than surgery.

Surgery can certainly work. But my preference is to start with the simpler, less risky alternatives.  If having tried those, things are no better, then by all means consider surgery.

–Tired of suffering caused by carpal tunnel syndrome? Read more articles by Dr. Steven Trembecki, D.C. on this and other medical and chiropractor treatments. Get your own version of this article at

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