Q: Our son is 21 and a full time wheelchair user and has recently been diagnosed with carpal tunnel syndrome. Is surgery usually the best treatment for such cases, or should we be considering non-surgical intervention, exercises, alternative medicine, etc.?

A:

Carpal tunnel syndrome (CTS) is a common complication in people who use wheelchairs for much of their mobility. CTS occurs when the area in the wrist, where a major nerve to the hand (the median nerve) traverses, becomes inflamed/irritated from repetitive motions such as pushing the wheels of the wheelchair to propel forward. This is called a repetitive motion injury. It can cause pain and numbness, initially from the wrist out towards the fingers. As the problem worsens, the pain and numbness can start to move up the arm.

There are several possible treatments for CTS, usually starting with the least invasive non-surgical options, and progressing to surgery if all else fails. Sometimes, if the severity of the condition is already advanced, surgery is the best option because the more conservative treatments may no longer work. Testing with EMG/NCS (electromyelography/nerve conduction studies) may help determine how severe the irritation of the nerves has become. These tests are often performed by neurologists or physiatrists (physical medicine and rehabilitation specialists).

Conservative treatments prior to surgery include:

1. Wearing wrist splints that limit the bending of the wrist. These are most effective if worn as much of the day as possible. It is also important to wear them at night because most people bend their wrists when sleeping. Many wheelchair users find wearing wrist splints difficult when trying to propel the wheels.
2. Making sure the wheelchair is fitted appropriately for the user, so as to minimize the repetitive movements at the wrist.
3. Using alternative mobility such as power-assist chairs, full-power chairs, or scooters.
4. Taking anti-inflammatory medications with the input of a physician.
5. Injecting anti-inflammatory steroid medication into the carpal tunnel space.

The most important conservative, non-surgical approach is to rest the wrist and minimize the repetitive movements. None of the above treatments are curative if the repetitive injury to the wrist continues.

Surgery usually involves cutting the band-like tissue (fascia) and opening up the carpal tunnel space. This can be curative but will require a period of recovery where the wrist cannot be used. Even after this surgery, modifications will be needed to minimize repetitive movements at the wrist to prevent recurrence. In a small percentage of people some pain and numbness persists after the surgery.

There are several specialists who can provide valuable input into your decision. These include the previously mentioned neurologist or physiatrist. Also a wheelchair vendor can demonstrate mobility options with less stress on the wrist. A physical and/or occupational therapist can also demonstrate ways to minimize the workload on the wrist.

* This information does not constitute medical advice for any individual.As specific cases may vary from the general information presented here, SBA advises readers to consult a qualified medical or other professional on an individual basis.