Woman holding her wrist

By Dr John Barnett

There may be a lot that you do or don’t know about Carpal Tunnel Syndrome (CTS) so let’s start with some basics. CTS is the most common diagnosis for wrist and hand pain in the United States. CTS is also responsible for the highest number of days off due to work related injury.  About half a million Americans get carpal tunnel operations each year, making it the most frequent surgery of the wrist.

Unfortunately, ever after surgery the pain and numbness of CTS often returns. The medical journal, Hand, has a 2012 article, Long-term outcomes of carpal tunnel release: a critical review of the literature.  Their conclusion; ” While the short-term literature is well substantiated, the long-term literature has rarely exceeded 2 years of follow-up, which may be inadequate for a chronic and potentially recurring disease such as carpal tunnel syndrome. Further high-quality research is needed.”

You read that right, the great results you see reported for CTS surgeries all over the web (especially by Orthopedic surgeons and their associations) are based on outcomes within 1 year of the surgery. That is just not enough for a chronic condition.  The one ‘long term’ study I found was a 2011 article in the journal Advances in Orthopedics.  This study was done at 45 months after surgery. They found that only 59% of patients were satisfied with their surgery, and a meager 3% had complete relief of their CTS symptoms. In fact, about 45% of the patients found that their CTS symptoms were either unchanged or worse!

What else should you know about CTS, but probably don’t? Carpal Tunnel Syndrome is probably the most commonly misdiagnosed chronic pain condition.  Many medical practitioners automatically diagnose pain that shoots down the arm into the hand and wrist as CTS. Often surgery is recommended when the actual cause of pain has nothing to do with the nerve, but has everything to do with muscle imbalances which trigger points mimicking “carpal tunnel like” symptoms

Many job related activities such as using a computer, cutting hair, and carpentry, can overload the muscles of the forearm with daily repetitive tasks. Trigger points that refer pain to wrist are likely to develop from the muscular overload. Symptoms such as numbness and tingling sensations in the fingers may also result from trigger points in muscles of the neck and shoulder region. People with these symptoms may even be diagnosed as having Thoracic Outlet Syndrome.  Both Thoracic Outlet Syndrome and CTS are disorders that are more likely to be created by muscular trigger points than by anatomical or structural malformations. Not only can trigger points refer pain that mimics these disorders, but the muscle tension created by these trigger points will frequently compress nerves as they travel in the neck, shoulder, and forearm regions, and produce the symptoms associated with these syndromes.

This is probably the main reason that the post-surgery outcomes are good in the short term, when patients are not doing the activities that caused the trigger point problems. Then months later after they resume their normal activities the trigger points return and so do the symptoms.

The last thing about CTS that you probably didn’t know is that Acupuncture is great at treating it.  In fact a 2009 study in the Clinical Journal of Pain compared 8 acupuncture treatments to 4 weeks of oral steroids.  Not only did the acupuncture group have no side effects but it slightly outperformed the steroids in pain reduction and improved nerve function at the end of the 4 weeks.   A 2012 study compared real acupuncture to sham (“fake”) acupuncture for CTS and found that the real acupuncture worked better, and reduced symptoms by an average of 40% after 4 weeks.

So why is Acupuncture so effective?  Simple, its because acupuncture can treat both inflammation in the median nerve by increasing blood circulation to the hand and wrist area in true cases of CTS, and we can also treat muscular trigger points to relieve the symptoms of CTS that are not caused by nerve problems.

If you or someone you know is suffering from CTS or similar symptoms be sure to look at all of your options including acupuncture, and massage therapy before deciding upon surgery.