It is helpful to review the state of medicine regarding Carpal Tunnel Syndrome (CTS). Most people in the US have heard of CTS. It is common in the general population. Most have a friend or family member who has had CTS; many have had a carpal tunnel release operation themselves. As with any common entity there are all sorts of tales told about CTS, various ways to treat it, and even some real horror stories about bad outcomes.
CTS has long been regarded in the medical community as a “simple problem.” Unfortunately there have been very few comprehensive publications in either the medical or the lay literature that clear up some of the misinformation about it. Until the very early 1990s, “…the treatment of carpal tunnel syndrome has not been an area where successful
outcomes were the norm.” (“Improved Treatments for Carpal Tunnel and Related Syndromes,” P. Michael Leahy, D.C., C.C.S.P.1)
First use and history.
“Carpal Tunnel Syndrome” was a term first used in the 1930s to describe an entrapment neuropathy of the median nerve at the wrist. There is nothing new whatsoever about CTS: chronic entrapment of the median nerve at the wrist is probably the most common peripheral nerve lesion and affects 10% of the population. Human beings have had carpal tunnel syndrome for as long as there have been carpal tunnels.
The first open carpal tunnel release was described in 1947. We suggest that nothing changed very much for 50 years until the development of the endoscopic procedure in 1990 by Michael G. Brown, M.D.
About the same time, the media publicized the fact that some individuals involved in repetitive activities, such as those who work on computers all day, were suffering an increased incidence of CTS. In fact, most people who come in the hand surgeon’s office with CTS are perplexed about why they have this disease because they do not engage in classical repetitive work activities.
Understanding CTS.
Begin with the anatomy. The carpal tunnel is formed by a semi-circle of carpal bones on three sides. The fourth side that forms the carpal tunnel is the transverse carpal ligament. The ligament cannot stretch. Thus the carpal tunnel is a defined space that cannot enlarge. There is only so much room in that opening. Through that opening passes the median nerve, nine tendons, and spongy tissue around the tendons called tenosynovium. We start our lives with that extra space. When we run out of extra space due to the swollen tenosynovium then pressure is placed on the nerve. When this happens, one begins to develop carpal tunnel symptoms.
Symptomology.
Classic textbook carpal tunnel syndrome symptoms are tingling and numbness in the thumb, index and middle finger (median nerve distribution); aching in the forearm which can radiate to the shoulder; and clumsiness or weak grip.
Only about one or two patients out of ten presents with a classic textbook carpal tunnel picture. Some present with tingling in all fingers while others present with tingling only in the thumb or the middle finger. Some present with aching and pain in the hand while others have radiating pain to the shoulder or back.
A nerve test is done to confirm the diagnosis. Once the patient has been diagnosed with CTS, a treatment decision must be made. Keep in mind what is going on with the nerve: it is being squeezed. A simple example may serve. If one has a wedding band on the ring finger and the hand is crushed between two objects, then the entire hand begins to swell and the ring acts as a tourniquet, cutting off the flow of blood to the finger. It is easy to understand that the ring has to be cut off the finger or else the finger will die.
In CTS, the nerve fibers are being pinched; they will be deprived of blood flow and undergo irreversible changes and ultimately die unless the pressure is released before those irreversible changes take place.
The goal of treating CTS is not simply to reduce the pressure on the nerve so that the symptoms are tolerable and the patient can live with it. Rather, we seek to alleviate the pressure entirely. Waiting “until it gets too bad” is not advised and one may actually end up with permanent nerve damage.
Inefficacious CTS treatments.
Sadly, carpal tunnel is big business. Countless millions of dollars have been wasted on gimmicks and gadgets trying to prevent CTS, treat CTS, and avoid surgery. We further suggest that almost none of them exhibit long-term efficacy. Ergonomic devices rarely succeed. “Therapy” and “exercises” are not quality-of-life improvement solutions.
When the condition is considered, these failures are understandable.
- Repetitive motion contributed to the carpal tunnel to begin with in many cases. It is not a problem that can be exercised away.
- “Cold” lasers waved over the hand have not been proven effective by scientific evaluation. There is no evidence to suggest that they actually decrease the flexor tenosynovium.
- Splints worn during the day decrease the muscle pumping action of the hand, cause more swelling in the hand, and increase carpal tunnel symptoms. (Splints can be helpful at night for positioning the hand to avoid sleeping in marked inflection which puts increased pressure on the nerve.)
- Vitamin B-6 is almost always ineffective.
- Topical creams by “renowned doctors” do not work.
- Magnets do not work.
- Dietary supplements do not work.
- Steroid injections are only temporary and can cause permanent injury to the nerve if the needle is accidentally placed in the nerve, which usually happens on the third or fourth injection.
An open carpal tunnel release procedure can effect a cure, but it can also cause weeks or months of pain and inability to work.
What’s the answer?
We propose that there is an efficacious treatment: The Brown Procedure is widely considered to be the first major breakthrough in 50 years. It will perhaps be the standard by which all other treatments are measured in years to come.
Michael G. Brown, M.D., has trained hundreds of other surgeons from across the U.S. and from foreign countries who seek out his skills, particularly in The Brown Procedure endoscopic carpal tunnel treatment. Thousands of people have been effectively treated in this manner, which requires about seven days of inconvenience. Afterwards, patients can do whatever they choose to do.
The Brown Procedure is a hallmark of The Hand Center and its physicians.
http://www.activereleasetechnique.com/pdf/Treatments-Carpal-Tunnel.pdf
