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Carpal Tunnel Syndrome - Prevention Vs. Surgery?

Perspectives Vary on Best Treatment for Carpal Tunnel Syndrome

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Updated June 29, 2012

Reports Differ on Prevention or Surgery for Carpal Tunnel Syndrome

Carpal tunnel syndrome, now affects millions of Americans, and is recognized as one of the most common causes of:

Two reports point to different solutions for relief from symptoms of carpal tunnel syndrome.

What Causes Carpal Tunnel Syndrome?

The carpal tunnel is a narrow passage in the wrist, formed by bones and ligaments which shield the nerves and tendons that extend into the hand. Symptoms of carpal tunnel syndrome (pain, numbness, and tingling in the hand and wrist) occur when tissues within the carpal tunnel become inflamed and swollen and press on the median nerve.

Carpal tunnel syndrome is a known repetitive stress injury, diagnosed most often in people whose occupations require repetitive hand motion and consequentially cause strain on the wrist tendons. Among those subjected to the repetitive hand motion which can become problematic are:

  • computer operators
  • cashiers
  • assembly-line workers
  • writers
  • surgeons

According to the Bureau of Labor Statistics, "disorders associated with repeated trauma account for about 60 percent of all occupational illnesses." Of all these disorders, carpal tunnel syndrome is the condition most frequently reported.

Study Shows Surgery More Effective for Carpal Tunnel Syndrome Than Wrist Splinting

In the Journal of the American Medical Association (JAMA), results of a randomized study, conducted at 13 neurological outpatient clinics in the Netherlands suggest that surgery was more effective than wrist splinting for treating carpal tunnel syndrome.

Open carpal tunnel release surgery involves making a small incision in the wrist for the purpose of cutting the carpal tunnel ligament away from the median nerve to relieve pressure. In the study, 176 patients with confirmed carpal tunnel syndrome were assigned to either wrist splinting during the night for a duration of at least six weeks or open carpal tunnel release surgery. 147 of the 176 study participants completed the final assessment 18 months later. The assessment measured:

  • general improvement
  • number of nights waking up due to symptoms
  • severity of symptoms

The success rates based on general improvement after 3 months were:

  • 80 percent for the surgery group.
  • 54 percent for the splinting group.

After 18 months, the success rates increased to:

  • 90 percent for the surgery group.
  • 75 percent for the splinting group.

Prevention Urged for Carpal Tunnel Syndrome

A few days following the report in JAMA, the American Academy of Orthopedic Surgeons (AAOS) as part of the Prevent Injuries America Program urged that prevention is a first line of defense against carpal tunnel syndrome.

Specifically, the AAOS offered the following advice:

  • Avoid activities requiring excessive up-and-down and side-to-side movements of the wrist.
  • Position and align your hands properly while working. Wrists should be parallel and elbows should be at a 90 degree angle to your work surface (i.e. desk or keyboard).
  • Take frequent breaks to stand, walk, and stretch.
  • Ask your orthopedic surgeon about splints to limit wrist movement.
  • Avoid direct pressure on the heel of the hand.
  • Don't wear restrictive watchbands/jewelry or clothing with tight elastic sleeves.
  • Learn proper use of the computer mouse.
    • Use the mouse with an open, relaxed hand posture.
    • Don't grip the mouse between the thumb and little finger.
    • Use the entire arm to move the mouse as opposed to shifting it with a side-to-side wrist motion.
    • Do not use a wrist rest.
    • Keep the mouse close to the keyboard.

Though there is yet to be a consensus on what is the best treatment for carpal tunnel syndrome, treatment must be decided for each individual patient by their doctor.

Sources:

The Best Cure for Carpal Tunnel Syndrome Is Prevention, Newswise. 9/20/02,/p>

Study: Surgery Best for Most Carpal Tunnel Syndrome Cases, CNN. 9/11/02

Carpal Tunnel Syndrome: American Academy of Orthopedic Surgeons
www.aaos.org

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