Houston Methodist. Leading Medicine

Hand FAQ


Please, please help me figure out what to do. I've had some nerve tests that show moderate carpal tunnel syndrome. I'm self-insured, so trying to pick the least expensive path with the best results. My choices are therapy with splinting and exercises or surgery straight away. Therapy is less expensive unless I end up having surgery anyway. Should I just toss a coin and pick one? Is there any logic to this decision?


Well, we sympathize with your dilemma. With thousands of people affected by carpal tunnel syndrome every year (and around the world, not just in the US and Canada), this is a decision faced by many people. In fact, carpal tunnel syndrome is the most common nerve entrapment problem affecting the hand. As the name suggests, nerve entrapment is a condition of pressure on the nerve (in this case, the median nerve) from some outside force. It could be from swelling inside the wrist, ganglion cysts, tumors, scar tissue, thickening of the ligament that crosses over the nerve, or one of dozens of other musculoskeletal or systemic causes. That's why a proper diagnosis is important -- to be successful, treatment must be aimed at the underlying cause of the problem. It sounds like you've crossed the first and most important hurdle: diagnostic testing. Nerve conduction velocity tests help identify those patients who would be best served with conservative (nonoperative) versus surgical care. Studies now show that patients with changes in nerve function (as shown by the electrodiagnostic tests you have had) should jump right to surgery as their first-line of treatment. Splinting and hand therapy just have not been proven effective for moderate-to-severe median nerve compression. You might get some relief of symptoms, but usually there is not complete pain relief or the symptoms are only improved for a short time before they come back again. A recent study from Harvard Medical School confirmed this recommendation. They compared actual costs between conservative and surgical care. Patients were divided into two groups according to these two treatment approaches. They all had a diagnosis of carpal tunnel syndrome confirmed by nerve conduction velocity tests. They were evenly matched by age, gender, body mass index, severity of carpal tunnel syndrome, and so on. In the end, half the nonsurgical group opted for surgery (after completing weeks of therapy). Only patients with mild carpal tunnel syndrome were helped by conservative care and all of those patients reported persistent pain and numbness even after therapy. When it came to counting the cost, surgery was faster and less costly for most patients with confirmed carpal tunnel syndrome. Jay Pomerance, MD, et al. The Cost-Effectiveness of Nonsurgical Versus Surgical Treatment for Carpal Tunnel Syndrome. In The Journal of Hand Surgery. September 2009. Vol. 34. No. 7. Pp. 1193-1200.

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