When someone receives a diagnosis of carpal tunnel syndrome (CTS), there’s an automatic assumption that surgery is imminent. However, treatment guidelines for CTS should be followed by ALL healthcare professionals. Healthcare professionals ALWAYS recommend an initial course of non-surgical treatment instead of jumping directly to surgery. Unfortunately, evidence-based treatment guidelines are not always followed. Many patients don’t have an option for anything other than surgery.
An excerpt from the 2017 Washington State CTS Treatment Guideline:
All of the following criteria must be met for surgery authorization:
- The clinical presentation is consistent with CTS
- The electrodiagnostic studies criteria for CTS have been met
- A patient has failed to respond to conservative treatment that included wrist splinting and/or injection
Medical-based non-surgical care for CTS includes neutral position wrist splints worn at night and during the day. Studies report that 30-70% of patients respond favorably within several months of initial wrist splint use. Glucocorticoid injections into the carpal tunnel provide short-term relief with about 50% of patients requiring surgery within one year. Non-surgical care can also include forearm and wrist exercises.
Chiropractors often use a combined approach based on the patient’s unique case. This can include wrist splints and exercise training along with manual therapies. Also, manipulation and mobilization on the wrist and elsewhere along the course of the median nerve. Physical therapy modalities are laser therapy, ultrasound, and pulsed electromagnetic field. Nutritional counseling, especially anti-inflammatory herbs like ginger, turmeric, and Boswellia is also helpful. Ergonomic medications such as changing a workstation setup or the grip on tools used to perform job functions are helpful.
Studies show in most cases, mild-to-moderate CTS can respond to non-surgical approaches just as well as surgery. Though without the potential side effects associated with going under the knife, it underscores the importance of seeking care for CTS as soon as possible.
