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Is Surgery Necessary For Carpal Tunnel Syndrome?

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Manual therapy (like chiropractic) has proven to be as effective as surgery for releasing the median nerve compressed by the carpal ligament. Both methods are comparable with regard to restoration of wrist strength and functionality and reduced hypersensitivity. Manual therapy involves stretching techniques, a night brace, and management of other factors like arthritis.

Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy—that is, it’s the most common place to trap a nerve in the extremities (arms or legs).

What Is Carpal Tunnel Syndrome?

The median nerve, the culprit behind CTS, starts in the neck and travels down through the shoulder, elbow, forearm, and finally through the carpal tunnel, which is made up of eight small carpal bones that form the arch of the bridge.

Entrapment of the median nerve occurs when the normally tight quarters within the carpal tunnel combines with the inflamed nine sheathed muscle tendons that push the nerve into the floor of the tunnel (a ligament), which results in CTS!

CTS affects 6-11% of adults in the general population, and it occurs in women more often than men. The cause is often difficult to determine but the most common reasons can include trauma, repetitive maneuvers, certain diseases, pregnancy, being over the age of 50, and obesity.

Comparing Surgery And Manual Therapy For CTS

So, is surgery the only answer? The short answer is, No.

The goal of therapy — both surgical and manual therapy — is to reduce the pressure within the tunnel and free up the compression of the median nerve.

In fact, in a recent randomized clinical trial published in the Journal of Pain, researchers observed similar improvements in function when they compared the outcomes of patients who underwent surgery vs. those who received manual therapies, such as those performed several times a day at chiropractic clinics around the world after six months and one year intervals.

The improvements included increased strength, function, and decreased hypersensitivity in both the surgical and non-surgical groups. Interestingly, the manual therapy group did better at the one and three month assessments when compared with the surgical group (with no difference at six and twelve months).

How Manual Therapy Works?

Manual therapies focus on joint mobilization and manipulation to reduce joint fixations, muscle release techniques in the forearm and hand, stretching techniques, and at-home exercises that emphasize a similar stretch, the night brace, and management of any underlying contributing factor.

These “underlying factors” might include diabetes, hypothyroid, taking birth control pills, weight management, and inflammatory arthritis.

Dr. Blake Kalkstein DC, MS, CCSP, TPI, ART

While earning his D.C. degree, Dr. Blake worked as a chiropractic intern at the Walter Reed National Military Medical Hospital in Bethesda, MD where he had the privilege to work in the amputee rehabilitation center. Dr. Blake’s post graduate sports medicine internship with John’s Hopkins Sports Medicine orthopedic surgeons allowed him to observe all types of injuries. Guidance from Dr. John Wilckens, team orthopedist for the Baltimore Orioles and his internship supervisor, led Dr. Blake to better understand advanced orthopedic and sports injuries and ways to appropriately manage each condition.

Dr. Blake Kalkstein DC, MS, CCSP, TPI, ART

While earning his D.C. degree, Dr. Blake worked as a chiropractic intern at the Walter Reed National Military Medical Hospital in Bethesda, MD where he had the privilege to work in the amputee rehabilitation center. Dr. Blake’s post graduate sports medicine internship with John’s Hopkins Sports Medicine orthopedic surgeons allowed him to observe all types of injuries. Guidance from Dr. John Wilckens, team orthopedist for the Baltimore Orioles and his internship supervisor, led Dr. Blake to better understand advanced orthopedic and sports injuries and ways to appropriately manage each condition.