That May Not Really Be Carpal Tunnel Syndrome…

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Not just unnecessary, but also ineffective. About 50% of carpal tunnel surgeries are considered unsuccessful (reference). With that noted, it’s not that the procedure itself doesn’t work. It’s that, a lot of the time, the problem to begin with wasn’t actually carpal tunnel syndrome. And therefore no resolution is gained from the procedure.

What actually is Carpal Tunnel Syndrome?

The REAL carpal tunnel syndrome is characterized by the following pathophysiology:

• • Compression of the median nerve in the wrist
• • Loss of elasticity of the median nerve
• • Increased cross-sectional area of the median nerve
• • Decreased nerve conduction velocity

(references: pubs.rsna.org & ncbi.nlm.nih.gov/)

These physical characteristics manifest symptoms of peripheral neuropathy, and may be felt as numbness, muscle weakness, and pain. These symptoms are constant, and can often cause atrophy of the muscle tissue.

What is the operation for Carpal Tunnel Syndrome?

The reason this is an important topic to discuss is because the operation for carpal tunnel syndrome is no minor thing. The operation entails the surgical cutting of the transverse carpal ligament (an important component of the carpal tunnel). Then, it is simply left cut, leaving the casing that is designed to house and protect your major nerves and blood vessels completely open.

Now let’s be clear. When CTS is diagnosed correctly and this procedure is truly warranted, resolution of the condition is almost a certainty given the pathophysiology of the condition. In this instance [correct diagnosis] it is a useful procedure, even though it is still a relatively extreme thing to do, physiologically speaking.

So what then is the problem?

The problem is that carpal tunnel syndrome is too commonly given out as a diagnosis. We should be seeking to exhaust all our alternative diagnoses before consigning someone to the knife.

What’s a differential diagnosis?

Emerging in the literature over the last 25 years is the science of Trigger Points. By all means, it is an evolving and largely unexplored science, so some of the information available on the topic will change over time. However, as a theory and mechanism for explaining much of our musculoskeletal pain syndromes, it is gaining consistent support and a growing body of evidence.
An overview of Trigger Points can be found here. Essentially, these small segments of muscle can cause remarkable amounts of pain, even though the dysfunction of the tissue, or the pathology of the condition is quite minor.

There is a strong likelihood that at least the other 50% of diagnosed cases of carpal tunnel syndrome are caused by (or at minimum confounded by) Trigger Points. We can make this extrapolation of information based on the fact that both manual and physical therapy have approximately the same success rate when it comes to the resolution of carpal tunnel syndrome symptoms (references: jospt.org & catedradefisioterapia).

Why is this good to know?

Investigating the presence of Trigger Points as the cause of your “CTS-like” pain is well worth your while. The treatment intervention for Trigger Points is not at all invasive, requires substantially less time to recover from, and it almost eliminates the need for rehabilitation. Surgery on the other hand, is a significantly disruptive method.

Treatment of Trigger Points requires manual therapy. You need to find someone (trained or not) who has the sensitivity and the patience to explore tissues in order to locate the rather elusive Trigger Point/s. One of the most difficult things about Trigger Points is that they can be remarkably difficult to find given their size and their ability to confuse the nervous system by referring pain to different locations around the body.

If You Find One –

It’s not about how much pain you can grit your teeth through, or how hard you need to press on it. The more important factor to consider is the frequency with which you massage the trigger point. Consistent work over a series of days and weeks generally produces significant and beneficial results (as long as you’re getting the right spot!). Start by exploring all around the elbow. Even though it seems a long way from your wrist, it’s generally going to house a few ‘money-spots’. If you come up empty after extensive searching there, progress from the elbow to the shoulder girdle- specifically in the chest around pectoralis minor (yes, all that way from the wrist).

The Point is this –

Before getting sliced and diced, invest some time in the exploration of manual therapy and physical therapy techniques to resolve your “carpal tunnel syndrome”. You might not have to go under the knife, and if you ask me, that’s a really good thing and well worth it.

Article last edited: June 26, 2018.

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For related reading, check these out: “Did You Know? Herniated Discs Actually Don’t Hurt” & “Delicious Pain. It’s Actually A Real Thing In Massage“.