Carpal tunnel syndrome (CTS) is a condition that occurs when the median nerve is compressed as it passes through the wrist. One treatment option available to patients is carpal tunnel release surgery, which severs the carpal tunnel ligament to reduce pressure on the affected nerve to resolve the numbness, pain, tingling, and weakness symptoms associated with CTS. When is surgical treatment for CTS necessary and when should a non-surgical option be pursued?
The short answer is that surgery should only be considered as a first option in an emergency situation, such as a serious wrist fracture that pinches the median nerve. Beyond that, treatment guidelines generally advise patients to exhaust non-surgical, conservative approaches before consulting with a surgeon. Aside from potentially higher healthcare costs and a prolonged recovery, surgery also carries the risk for serious complications. Another thing to consider is that the current research suggests that jumping straight to surgery may not necessarily produce better long-term outcomes than non-surgical treatment options.
In one randomized clinical trial, researchers recruited 120 female CTS patients to receive either surgery or a conservative treatment approach that involved manual therapies. The research team evaluated each patient after one month, three months, six months, and one year. In the short term—one month and three months—the results favored the conservative approach. However, both groups reported similar outcomes after six months and one year.
The same research team repeated the study with another group of female CTS patients and reported similar results. In the short term, conservative care achieved greater results while both approaches had similar outcomes over the long term.
A systemic review that looked at results from ten studies involving patients with confirmed CTS in one or both hands came to a similar conclusion. The review found that non-surgical care provided more satisfying results in the short term with both approaches achieving similar results over time.
While these studies show that conservative treatment to reduce pressure in the carpal tunnel is an effective option for the CTS patient, doctors of chiropractic will also examine the full course of the median nerve to identify other places the it may be compressed, such as the neck, shoulder, and elbow. Median nerve compression in these areas can often co-occur with CTS and will need to be addressed to achieve a satisfactory result.
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