When individuals experience pain, numbness, weakness, and other abnormal symptoms in the hand and wrist, their first thought is that it’s carpal tunnel syndrome (CTS) followed by a worry that they’ll inevitably need surgery to resolve the condition. Some sufferers may even contact a surgeon as their first option for care. However, treatment guidelines do not recommend surgical consultation as an initial treatment approach for CTS. In fact, outside of emergency situations, like a major fracture, surgery is generally only recommended after exhausting all non-surgical options.
Part of this reason has to do with outcomes and the other part is the inherent risks associated with surgery such as reaction to anesthesia, bleeding, infection, injury to the median nerve and/or its nerve branches; nearby blood vessel injury; a sensitive scar, and a prolonged time off work post-surgically. Regarding time off work, one study reported that more than a third of patients do not return to work within eight weeks after an operation. Another study found that patients may experience reduced strength and dexterity in the hand following their procedure.
With respect to outcomes, one study that included 56 middle-aged adults who received surgical care for CTS found that only two-thirds reported an improvement in their symptoms and just one in four experienced complete resolution.
On the other hand, there are several studies showing that conservative treatment approaches—such as chiropractic care—are as or more effective than surgery for the CTS patient. In one study that included 120 women. half of participants received three manual therapy treatments and the other half underwent a carpal tunnel decompression/release procedure. The results showed that non-surgical care achieved superior results in the short term and similar results at the one-year point.
Doctors of chiropractic are trained to evaluate the whole patient and not to focus on just the area of chief complaint. In the case of CTS, pressure applied to the median nerve at any point on its way to the hand can create CTS-like symptoms. Hence the importance of reviewing the patient’s history (which may be more helpful in diagnosing CTS than diagnostic testing) and a thorough examination of the entire course of the median nerve as it travels from the neck and through the shoulder, elbow, forearm, and wrist. In many cases, a patient may have CTS in addition to another condition that’s affecting the median nerve, and both will need to be addressed to achieve a satisfactory outcome.