My hands hurt all the time and my right one is pretty painful/stiff. My massage therapist says surgery is dangerous and not necessary, and that massage will help. Do you think this is true? Have you had surgery and regretted it? Any other details you can share would be great!!! My wife went to a chiropracter and asked them about it, they poped something in her hand (hurt real bad) but was just fine after a while. Much better than surgery, so go get it massaged! have you received a definite diagnosis of carpal tunnel? did you go to an orthopedic doctor and/or a neurologist? did you have an EMG/NCS?
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a painful progressive condition caused by compression of a key nerve in the wrist. It occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. Symptoms usually start gradually, with pain, weakness, or numbness in the hand and wrist, radiating up the arm. As symptoms worsen, people might feel tingling during the day, and decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In some cases no direct cause of the syndrome can be identified. Most likely the disorder is due to a congenital predisposition - the carpal tunnel is simply smaller in some people than in others. However, the risk of developing carpal tunnel syndrome is especially common in those performing assembly line work.
Is there any treatment?
Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease pain. Cool (ice) packs and prednisone (taken by mouth) or lidocaine (injected directly into the wrist) can relieve swelling and pressure on the median nerve and provide immediate, temporary relief.
What is the prognosis?
Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely. To prevent workplace-related carpal tunnel syndrome, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, wear splints to keep wrists straight, and use correct posture and wrist position. Wearing fingerless gloves can help keep hands warm and flexible.
Carpal Tunnel Syndrome: The Facts
I doubt there are few people in the United States who have not heard of carpal tunnel syndrome. Most have a friend or family member who has had carpal tunnel syndrome and many have had a carpal tunnel release operation themselves. As with any common entity there are all sorts of tales told about carpal tunnel syndrome, various ways to treat it, and even some real horror stories about bad outcomes. Carpal tunnel syndrome (CTS) has long been regarded in the medical community as a 鈥渟imple problem鈥?and unfortunately there have been very few comprehensive publications in either the medical or the lay literature to clear up some of the misinformation that surrounds carpal tunnel syndrome.
Carpal tunnel syndrome was a term first used in the 1930鈥檚 to describe an entrapment neuropathy of the median nerve at the wrist. There is nothing new whatsoever about carpal tunnel syndrome. 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 and nothing changed very much for 50 years until the advent of the endoscopic procedure in 1990.
Along about the same time, the media publicized the fact that some individuals involved in repetitive type work activities, such as those who work on computers all day, have an increased incidence of carpal tunnel syndrome. In point of fact, most people who come in the hand surgeon鈥檚 office with carpal tunnel syndrome are perplexed as to why they have this disease because they do not engage in classical repetitive type work activities.
Carpal tunnel syndrome is easily understood if one begins 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. 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 just medial to the back.
A nerve test is done to confirm the diagnosis. Once the patient has been diagnosed with carpal tunnel syndrome, a decision verses treatment must be made. One must keep in mind what is going on with the nerve. The nerve is being squeezed. 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. Likewise the nerve is being pinched. The nerve fibers are being pinched and 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.
Thus the goal of treating carpal tunnel syndrome is not simply to reduce the pressure on the nerve so that the symptoms are tolerable and the patient can live with it but rather to alleviate the pressure entirely. Waiting 鈥渦ntil it gets too bad鈥?is not advised and one may actually end up with permanent nerve damage.
Treatment of Carpal Tunnel Syndrome
Make no mistake; carpal tunnel is big business. Countless millions of dollars have been wasted on gimmicks and gadgets trying to prevent carpal tunnel, treat carpal tunnel, and avoid surgery. Almost all of them do not work. Rarely do ergonomic devices work. 鈥淭herapy鈥?and 鈥渆xercises鈥?do not work. Think about it, repetitive motion contributed to the carpal tunnel to begin with in many cases. It鈥檚 not a problem that can be exercised away. Magic 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 鈥渞enowned doctors鈥?don鈥檛 work. Magnets don鈥檛 work for carpal tunnel syndrome. Dietary supplements don鈥檛 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 works, but it can cause weeks or months of pain and inability to work.
What鈥檚 the answer?
So why do carpal tunnel sufferers, employers, and insurance carriers fall for all of these worthless remedies? Simple. In the United States, one can sell just about anything if it鈥檚 packaged right, even if it is worthless. Carpal tunnel is big business.
Unfortunately, that means a lot of hard-earned money is being wasted and people are going untreated. Not only are they suffering, but also they risk permanent damage to the nerve the longer the condition persists.
There is an excellent treatment however. It鈥檚 not magic. It is a quantum leap forward in the treatment of carpal tunnel. It is the first major breakthrough in 50 years. It will almost certainly be the standard by which all other treatments are measured in years to come. Tens of thousands of people have been effectively treated in this manner, which requires about eight days of inconvenience; afterwards one can do whatever they choose to do. This is the treatment that informed people choose. Non-surgical treatments
Drugs - In special circumstances, various drugs can ease the pain and swelling associated with carpal tunnel syndrome. Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease symptoms that have been present for a short time or have been caused by strenuous activity. Orally administered diuretics ("water pills") can decrease swelling. Corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into the wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve and provide immediate, temporary relief to persons with mild or intermittent symptoms. (Caution: persons with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels. Corticosterioids should not be taken without a doctor's prescription.) Additionally, some studies show that vitamin B6 (pyridoxine) supplements may ease the symptoms of carpal tunnel syndrome.
Exercise - Stretching and strengthening exercises can be helpful in people whose symptoms have abated. These exercises may be supervised by a physical therapist, who is trained to use exercises to treat physical impairments, or an occupational therapist, who is trained in evaluating people with physical impairments and helping them build skills to improve their health and well-being.
Alternative therapies - Acupuncture and chiropractic care have benefited some patients but their effectiveness remains unproved. An exception is yoga, which has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome.
Surgery
Carpal tunnel release is one of the most common surgical procedures in the United States. Generally recommended if symptoms last for 6 months, surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. Surgery is done under local anesthesia and does not require an overnight hospital stay. Many patients require surgery on both hands. The following are types of carpal tunnel release surgery:
Open release surgery, the traditional procedure used to correct carpal tunnel syndrome, consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical considerations.
Endoscopic surgery may allow faster functional recovery and less postoperative discomfort than traditional open release surgery. The surgeon makes two incisions (about 陆" each) in the wrist and palm, inserts a camera attached to a tube, observes the tissue on a screen, and cuts the carpal ligament (the tissue that holds joints together). This two-portal endoscopic surgery, generally performed under local anesthesia, is effective and minimizes scarring and scar tenderness, if any. One-portal endoscopic surgery for carpal tunnel syndrome is also available.
Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Some patients may have infection, nerve damage, stiffness, and pain at the scar. Occasionally the wrist loses strength because the carpal ligament is cut. Patients should undergo physical therapy after surgery to restore wrist strength. Some patients may need to adjust job duties or even change jobs after recovery from surgery.
Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely. I had the surgery about 9 years ago on my right hand. The relief was wonderful. I don't have a problem with it anymore.
You need to do your research and find a good surgeon if you decided to have surgery. There are quacks out there...I had run into a few of them. One told me that he was going to cut me from the palm of my hand to mid-wrist. I finally found a surgeon who made a small incision (less than an inch) and I healed just great.
Don't settle for just one doctor tells you. Get a second and third opinion. Go to your local chiropractor. I worked for a chiropractor for 3 years and they can adjust your hands and wrists to rid you of pain. It is much safer than surgery, as surgery does not always fix the problem. Sometimes it can make it worse! Massage is probably a temporary solution. You should see a hand specialist. If you continue to do a repetitive type job, massage would eventually stop working.Surgery will correct the sittuation but there maybe complications. You should also speak to your doctor about non surgical options. An EMG should be conducted to confirm the diagnosis . I'm a massage therapist, and completely agree that surgery can be avoided with massage. Do it, try it, what can you lose. Surgery is going to be much more expensive, and could possibly end up worse than before. Massage, promise ;) I also had the surgery on both hands 10 years ago. It worked like a charm. It is coming back in one hand now, and they told me it might, but for 10 years of relief I have no regrets. I had carpal surgery 1 month ago, it has been horrible!!! My arm is now in a cast because it is not healing correctly. The docs want to do my right arm now, no way. Increase your vitamin b and wear a wrist brace at night. My doctor always told me there is a 80% chance the surgery won't even help, so why bother, they don't bother me since I retired, but when I worked they were numb most of the time & hurt.I think chiropractor would be your best bet. I have just had cubital tunal ( funny bone nerve transplantion surgery, sympoms are same as carpal tunel on diferant parts of the hand and arm) and diagnosed with carpal tunnal. I have many frends who have had carpal tunel surgery and there isnt anything to it really. Unlike cubital tunel ( very invasive procedure, the ulnar nerve-funnybone,is cut away from the elbow and reatached on forearm. Corpal tunel procedure is non invasive, the tunel which the nerves going to the hand pass through is mearly reemed out. the nerves themselves are not even touched. so dont wory its a easy procedure and fast painless recovery Massaging doesnt work. My mom had surgery and it doesnt bother her any more. Go for it, have surgery. Just make sure you trust your doctor though go to the massage therapist first. you may not have carpal tunel, you may have thorasic outlet syndrom which is when the muscles in your neck get to tight and begin pinching nerves. it causes the same effects as carpal tunel. avoid surgery if possible, try other resources carpal tunnel syndrome are best treated with conservative management. There is no need for surgery. just seek a physical therapist and you will be fine. |
