Can surgery on one hand fix problems in the other hand? Sounds impossible, but in select cases, it in fact happens. Several researchers posed the question of what happens to patients with carpal tunnel syndrome in both hands if only one hand is operated on. They found that a substantial number of patients have relief of their carpal tunnel symptoms, such as numbness, tingling and cramping, in the hand that did not have surgery. How could this be? Releasing the ligament that is pinching the median nerve in carpal tunnel surgery on one hand does nothing physically to change the ligament or pinching of the nerve on the other hand. How could the un-pinching of one nerve affect another nerve on the opposite hand and arm almost five to six feet away?
Carpal tunnel syndrome is understood to be caused most commonly by compression of the median nerve within the carpal canal at the wrist due to increased swelling of the adjacent tendons or their tenosynovium, which lines and lubricates the tendons. When a surgeon releases the transverse carpal ligament, or roof of the canal, all of the tissues of the canal have additional room. Therefore, the median nerve does not get pinched or squished. It makes sense mechanically that the released nerve works better. But, how does the mechanical release on one arm help the other hand and nerve? This effect does not fit within the mechanical model of what causes carpal tunnel syndrome. In fact, some patients after carpal tunnel surgery will find relief of elbow or shoulder pain. Scientists can’t explain this from a mechanical standpoint either, but it has nevertheless been shown in several studies.
The nervous system, which includes the brain, spinal cord, peripheral nerves, somatic and autonomic nerves, is amazing, and amazingly complex with many systems within the system, and many layers and levels of communication. Scientists are really only beginning to scratch the surface of how the nervous system works. It is clear from the scientific observation of another nerve improving after releasing its twin on the other hand that there is more communication among the nerves than we realize. The nervous system communicates via nerve tubes that look like wires, but also is able to communicate through chemicals in the blood as well as in the spinal cord to send non-electrical signals. It is theorized at this time that these other, to be discovered, signals explain the improvement of symptoms in the hand with carpal tunnel syndrome which had no surgery, or the improvement of elbow or shoulder pain after carpal tunnel release.
Interestingly, many trainers and athletes have learned to take advantage of some of the observed but not understood oddities of the nervous system. A popular treatment among athletes is the neon tape stuck on their shoulder, back or knee. Ultimately, the “kinesio” tape, as it is called, does not transmit much force to the underlying muscles at all. But, it does affect the skin and how the associated skin sensory nerves and nerves around the joints feel, and therefore changes the way an athlete feels when performing or training.
Another example is that of herniated or bulging discs. Herniated or protruding discs can cause tremendous back pain and searing pain down the leg, but not all of the pain is mechanical. Much of the pain from a herniated disc comes from inflammation or chemical irritation of the nerve. In fact, some patients will experience other nerve pains in other locations or limbs, unrelated to the mechanical compression of particular nerve root. Thus, irritation of one nerve either mechanically or chemically can affect other nerves and be a source of misunderstood pain, or chronic pain.
Medicine constantly marches forward in its understanding of the miracle of the human body, but in many ways, especially with the nervous system, we are only taking rudimentary baby steps. FBN
By John Flint, M.D.
Dr. John Flint specializes in surgical and nonsurgical treatment options for the hand, elbow and shoulder. For additional information or to schedule an appointment visit www.flagstaffboneandjoint.com or call 928.773.2280. The Hand Center at Flagstaff Bone and Joint is located at 77 W Forest Ave. (in the Physicians & Surgeons Offices attached to Flagstaff Medical Center).
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