Surgery May Be Best for Carpal Tunnel Problems
Studies find better function and symptom relief after operations
(HealthDay News) -- Carpal tunnel syndrome -- a pinched nerve at the wrist -- can be treated without going under the knife, but surgery might be the better option for people who don't have severe nerve damage.
A study reported in a special surgery issue of The Lancet found that one year after treatment, surgery resulted in modestly better outcomes than non-surgical interventions, such as hand therapy and ultrasound.
Also, Dutch researchers reported separately that carpal tunnel surgery seems to be more effective than splinting or anti-inflammatory drugs plus hand therapy. Their report, in the Archives of Physical Medicine and Rehabilitation, was based on an analysis of relevant reviews and randomized controlled trials.
The carpal tunnel is a space in the wrist at the base of the palm. When the tunnel gets compressed because of swollen tendons in the wrist, fluid retention or other causes, it squeezes a key nerve in the wrist -- called the median nerve -- that controls sensation in the palm side of the thumb and fingers, explains the U.S. National Institute of Neurological Disorders and Stroke.
When pressure in the carpal tunnel disrupts nerve function, it can cause numbness, tingling and pain in the hand and fingers, says the American Society for Surgery of the Hand.
Factors that contribute to carpal tunnel syndrome, according to the American Academy of Orthopaedic Surgeons, include:
Heredity. Carpal tunnels are smaller in some people, and this trait can run in families.
Hand use over time. Carpal tunnel syndrome is often associated with repetitive hand movements, such as typing.
Pregnancy-related hormonal changes.
Age. The condition occurs more frequently in older people.
Health. Certain medical conditions, including diabetes, rheumatoid arthritis and thyroid gland imbalance, can play a role.
If the condition is diagnosed and treated early, symptoms often are treated without surgery. Non-surgical options include wearing a brace or splint to immobilize the wrist, taking non-steroidal anti-inflammatory drugs such as ibuprofen, avoiding activities that aggravate symptoms and getting a corticosteroid injection to reduce swelling around the nerve.
However, most people with carpal tunnel syndrome will find that their condition progressively worsens over time without treatment, according to the academy.
The Lancet study included 44 people who had surgery and 52 who had non-surgical treatment. A year later, 46 percent of the surgery group, versus 27 percent of those who didn't have surgery, showed improvement on three criteria: function, symptoms and minimal interference in daily work or household activities.
However, some people who had surgery experienced persistent symptoms. In addition, those who had non-surgical treatment improved over time -- but not as much as those who underwent surgery.
Surgery, called "carpal tunnel release," is generally recommended if symptoms last for six months, says the national institute. While most people recover completely, the recovery process can take months. Nearly everyone gets physical therapy to regain wrist strength, and some may need to change jobs to avoid repetitive wrist movements that could cause future problems.
"Not everyone will benefit from surgery, and some people will improve just as much without surgery," Dr. Jeffrey Jarvik, professor of radiology and neurosurgery at the University of Washington and director of the Comparative Effectiveness, Cost and Outcomes Research Center, said in a university news release about The Lancet study.
"The decision to have surgery should take into account patients' own preferences about surgery, as well as their physician's advice," he said. "This study helps to inform that decision."
On the Web
To learn more about carpal tunnel syndrome, visit the American Academy of Orthopaedic Surgeons.
SOURCES: HealthDay News; The Lancet, news release, Sept. 24, 2009; University of Washington, news release, Sept. 25, 2009; July 2010, Archives of Physical Medicine and Rehabilitation; U.S. National Institute of Neurological Disorders and Stroke (www.ninds.nih.gov); American Society for Surgery of the Hand (www.assh.org); American Academy of Orthopaedic Surgeons (orthoinfo.aaos.org)
Author: Karen Pallarito
Publication Date: Sept. 30, 2010
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