Carpal Tunnel Syndrome surgery is on the rise. In fact, it’s big business. The only problem is that patient after patient has come to me for treatment after they had failed surgery for carpal tunnel syndrome.
Why does carpal tunnel surgery fail so often? I believe that there are several reasons. These are the topics that will be discussed in this article. I will also discuss part of my highly successful natural and non-invasive treatment methods for people who suffer from carpal tunnel syndrome and other forms of radiculopathy or nerve pain.
Is the Nerve Conduction Velocity Test Accurate for Detecting Carpal Tunnel Syndrome?
The Nerve Conduction Velocity Test (NCV) is considered the gold standard test to diagnose carpal tunnel syndrome. Unfortunately, the NCV test isn’t always accurate. Surgical decisions made off of this one diagnostic criteria aren’t always accurate leading to an increased number of failed surgeries.
In fact, the NCV test is known to have a high rate of false positives. This means that the NCV test can show a positive finding (which is bad) for something that was actually normally functioning.
This study reported in Pubmed, False Positive Electrodiagnostic Tests in Carpal Tunnel Syndrome, showed that of 50 “normal” subjects that did an NCV test checking for carpal tunnel syndrome, 46% of the test subjects had at least one false positive test for carpal tunnel syndrome.
In plain English, 46% of normal subjects tested had a false positive finding on their test that could lead Drs. to the diagnosis of carpal tunnel syndrome even when carpal tunnel syndrome isn’t present.
For me, this is a staggering number because of the high failure rate of carpal tunnel surgery to begin with. What if many carpal tunnel surgeries are unnecessary? I believe that they are often unnecessary from what I have seen with so many of my patients. Continue reading to learn more.
Of course, the NCV test was done for a reason, right? They just don’t do NCV tests on people for no reason. Hand pain, tingling, numbness, or weakness are all valid reasons for doing an NCV test, but the findings can’t be taken as gospel. The problem could be coming from somewhere else.
What Nerve Causes Carpal Tunnel Syndrome?
In the wrist there are 8 small bones called the carpal bones. Carpal tunnel syndrome is caused by entrapment and compression of the median nerve in the carpal tunnel.
There are 3 nerves that go into the hand: the radial, median, and ulnar nerves. The median nerve goes into the hand through what is called the carpal tunnel. Therefore, the median nerve is the nerve that is involved when carpal tunnel syndrome is present.
Generally speaking, the 3 nerves go to different parts of the hand. The radial nerve supplies more of the sensation around the thumb. The median nerve supplies nerve sensation to the palm. The ulnar nerve supplies sensation to the pinky finger.
Very specifically, the median nerve which is the culprit of carpal tunnel syndrome goes to the palm of the hand. The median nerve does not go to the back of the hand. The median nerve goes to the palm side of the thumb, first, second, third and half of the 4th finger and all 5 fingernails.
The median nerve does not go into the pinky (5th finger) at all. The ulnar nerve goes into the 4th and 5th fingers. So, if there is numbness, pain, weakness or altered sensation of the pinky finger (and not the palm the hand or any of the other fingers), carpal tunnel syndrome can be automatically ruled out.
In fact, if there is 5th finger involvement, possibilities such as cubital tunnel syndrome in the elbow or nerve entrapment in the mid to lower cervical spine need to be considered instead of carpal tunnel syndrome.
The median nerve only goes to the palm of the hand. I believe that this is the most critical component of proper diagnosis and also misdiagnosis of carpal tunnel syndrome.
For me, the most consistent finding of carpal tunnel syndrome is tingling, numbness, or pain in the palm of the hand (with no 5th finger involvement). If there are symptoms in the palm of the hand that don’t include the pinky finger, then the findings are consistent with a true carpal tunnel syndrome.
What are Possible Causes of Carpal Tunnel Syndrome?
Of course, the most common cause of carpal tunnel syndrome is median nerve entrapment in the carpal tunnel. However, the median nerve is a long nerve with many branches and the median nerve anatomy is complex.
I always attempt to look at the body as a whole. In doing so, I believe that it is important to consider that the median nerve comes out of what is called the brachial plexus in the neck or “cervical spine”.
Most people know about a “plexus” because they have been hit in the solar plexus and it took their breath away. Once you have taken a blow to the solar plexus, you will never forget it.
A plexus is a bundle of nerves. The plexus or bundle of nerves that sends branches into the median nerve is in the cervical spine and is called the Brachial Plexus. Remember, the median nerve is what causes carpal tunnel syndrome but the median nerve actually comes out of the spinal column the neck.
Brachium in Latin means arm. So, the bundle of nerves (plexus) that goes into the arm (brachium) is in the cervical spine.
The way I explain it to my patients is that a water hose carries water. You can have a severe crimp in the water hose in one location and it will stop the water flow.
You can have a small crimp in one location and another small crimp in another location and the two small crimps can stop the water flow just the same as the one large crimp.
So, what if there is some pressure in the carpal tunnel but not intense pressure but there is also some degenerative disc disease, a bulging disc, or a herniated disc in the middle to lower cervical spine that is causing some pressure as well?
All nerves understand is pressure. It’s the same as the two small crimps stopping the water flow in the water hose. Two small pressure points along the course of the median nerve could be combining to change the way the nerve is going to send signals to and from the brain.
I believe that this is HUGE when it comes to understanding nerve pain in the upper extremities (arms and hands). A nerve could be “pinched” or compressed in a far away location and the symptoms can show up in a completely different location.
What if Carpal Tunnel Surgery Doesn’t Work?
There are always risks with any surgical procedure. I always recommend that patients seek out every possible alternative to surgery that is available to them before going under the knife.
When I work with a patient who is suspicious that they have carpal tunnel syndrome (or those who had a positive NCV test and a surgeon told them they need carpal tunnel surgery), my first line of questioning is, “Where are your symptoms located?”
I’m looking to see if they have pinky finger involvement, if they have pain, tingling, numbness, or altered sensation on their palm or back of the hand. I look to see if they have any thenar eminence atrophy (decreased size in the fat pad below the thumb).
But, I’m also asking questions of previous whiplash injuries, falls, traumas, etc… that could be contributing to degenerative disc disease. I check cervical range of motion to see if they have normal and free movement of their head and neck.
I ask them if they hear popping, grinding, sandpaper sounds when they turn their head side to side or look up and down which is a sign of degenerative disc disease.
Degenerative disc disease can turn into a bulging disc, a herniated disc, spinal stenosis and facet joint hypertrophy which can all put pressure on the brainstem in the cervical spine.
Pressure on the brainstem can lead to disruption of nerve signaling from the brain to the hand and vice versa. The source of the problem or the root cause of the abnormal nerve function in the hand could be the initial “crimping” of the nerve or spinal cord 2-3 feet away from the hand.
Does Carpal Tunnel Surgery cause Scar Tissue?
All surgeries break the skin and therefore will create scar tissue. For some people, the scar tissue will be minimal and no big deal. For others, it can be life altering.
There isn’t a month that goes by in my practice where I don’t meet someone who had surgery and got a staph infection. A month doesn’t go by without me consulting with at least one and it’s sad to say that it is often more.
I’d say that even over increased pain, permanent nerve damage, paralysis, and other possible side effects of surgery, infections are the most significant because an infection can cause death within 2-3 days if it can’t be controlled.
We are in an era where antibiotic resistant bacteria are getting stronger and mutating at such a rapid rate. Medications just don’t have the same effect that they used to.
Consider that many patients who have carpal tunnel surgery are diabetics, elderly, cancer survivors, or suffering from some type of autoimmune disease. Our population isn’t getting healthier.
Surgeries are often being performed on people who have a weak immune system and the environment is ripe for infection. One of the natural healing responses to a bad infection is to create a scar tissue like response to heal the area.
So, whether a surgical site develops an infection or not, scar tissue will be in the equation with any surgery.
Do Wrist Braces or Wrist Splints help Carpal Tunnel Syndrome?
Often, patients will come in wearing night splints or braces on their wrists in an attempt to get help from carpal tunnel syndrome. There are many types, shapes, and sizes of carpal tunnel supports out there.
I hear mixed reviews as to whether or not they give patients relief. Some people say that they help them and some don’t. I think that there are some important points that need to be considered before wearing a wrist splint or brace for carpal tunnel syndrome.
- Wrist “joints” are joints and they need motion to be healthy. An immobilized joint will become more inflamed over time. Inflamed joints (in this instance carpal bones) will develop arthritis at a much faster rate than healthy joints.
- Wrist splints and braces can cause a decrease in circulation to the joints and tissues of the hand. Over time, a decrease in circulation can cause damage to the tissues and nerves due to a lack of oxygen.
- Some people who wear wrist splints and braces will develop numbness in their hands with prolonged use. Numbness is a sign of nerve irritation or damage and could become permanent if the damage is severe.
What if Both Hands are Numb?
Carpal Tunnel Syndrome isn’t considered a “bilateral” a condition which means that it is in both hands. Carpal Tunnel Syndrome is most often a “unilateral” condition which means that it is in one hand but not both.
Overall, the reasoning here is pretty straight forward. The right hand has its own median nerve. The left hand has its own median nerve.
If someone has numbness, tingling, or burning in both hands then it is most likely coming from a common source. The common link between the right and left median nerves is the brainstem in the cervical spinal cord.
Therefore, if there are symptoms in both hands, it is quite possible that degeneration of the cervical spine is the culprit of the carpal tunnel like symptoms.
What is a Natural Treatment for Carpal Tunnel Syndrome?
As I explained above, I like to take a whole body approach. Often when one area of the body is malfunctioning, it is a sign of greater dysfunction overall. I analyze my patients overall health and look for markers of inflammation on laboratory testing.
Once identified, I explain to my patients what can be done from a holistic and natural approach to not only help their carpal tunnel symptoms but to help their body get into a state where healing can take place.
I also use Deep Tissue Laser Therapy over the area of the carpal tunnel and mid to lower cervical spine as well. The lasers help reduce inflammation of the nerves, bring oxygen to the nerves and other tissues, flush out cellular waste products, and bring in fresh proteins and salts so that the nerves can work better.
Additionally, I recommend hydrating the discs in the cervical spine to remove any possible “minor crimps” that could be causing the nerve to malfunction all the way at the other end.
There is much that goes into my protocol and every patient is different. People travel from great distances to receive my unique treatments. I would encourage you to come see me if you are suffering from any type of nerve pain in your neck, shoulders, arms, or hands.
Health is Happiness,
Dr. Keith Currie