Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.
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Are There Alternatives To Surgery When Treating Carpel Tunnel Syndrome?

Monday, 28 Jun 2010 03:05 PM


Question: I was diagnosed with Carpel Tunnel Syndrome. Is there any alternative to surgery?

Dr. Hibberd's Answer:

Carpal Tunnel Syndrome (CTS) is the most frequently occurring disorder of the nerve. This condition is most common in middle aged women and usually affects the dominant hand. It is often related to repetitive motion injury of hands and wrists.

Localized inflammation of tendon sheath tissue is a frequent cause of CTS.

CTS occurs in increased frequency in the presence of underlying medical conditions such as pregnancy, prior wrist trauma, diabetes, renal failure on dialysis, and gout. Bilateral CTS should generate an investigation for underlying disease.

Treatment of this condition is initially conservative with the use of a cock-up wrist splint primarily worn at night together with a course of NSAID anti-inflammatory medication often taken with vitamin B 6 supplementation.

Workplace modification should also be made.

The next step is a single corticosteroid injection in an area close to the carpal tunnel. X-rays are usually unnecessary unless arthritis or trauma is suspected.

The next step is surgery. Surgery involves cutting the flexor retinaculum/transverse carpal ligament, which relieves the pressure on the median nerve. Surgery is very effective provided the diagnosis was confirmed using electrodiagnostic testing (a simple needle stimulation test). Surgery is most often used for persistent symptoms or in the presence of muscular abnormalities.




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