Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is an injury caused by a pinched nerve in the wrist, resulting in pain and numbness in the index and middle fingers and weakness of the thumb. The carpal tunnel receives its name from the eight bones in the wrist, called carpals, which form a "tunnel" through which the nerve leading to the hand extends.

Signs and Symptoms

Some easy-to-recognize signs and symptoms of CTS include the following.

• Nighttime painful tingling in one or both hands, frequently causing sleep disturbance
• Feeling of uselessness in the fingers
• A sense that fingers are swollen even though little or no swelling is apparent
• Daytime tingling in the hands, followed by a decreased ability to squeeze things
• Loss of strength in the muscle at the base of the thumb, near the palm
• Pain shooting from the hand up the arm as far as the shoulder

What Causes It?

The carpal tunnel is filled with tendons (bundles of collagen fibers that attach muscle to bone) that control finger movement. Tasks requiring highly repetitive and forceful movements of the wrist can cause swelling around the tendons, resulting in a pinched nerve and producing CTS.

Who's Most At Risk?

People working with small hand tools in manufacturing and those using a computer keyboard on a regular basis are especially at risk.

Women are more likely than men to develop CTS. It most commonly occurs in people between the ages of 40 and 60. CTS is associated with health conditions such as Lyme disease, rubella, pregnancy, and menopause. High caffeine, tobacco, or alcohol intake are contributing risk factors.

What to Expect at Your Provider's Office

If you are experiencing symptoms of CTS, you should see your health care provider. He or she can help guide you in determining which treatment or combination of therapies will work best for you.

Your provider will perform a physical examination and some simple tests to determine if there is a loss of sensation or some weakness in your thumb or fingers. He or she may also perform more sophisticated diagnostic procedures ranging from a nerve conduction study to electromyography (EMG). X rays or magnetic resonance imaging (MRI) may be used to reveal the cause and the nature of the injury.

Treatment Options

Your provider may put your wrist in a splint or brace to keep your wrist from bending, and to minimize or prevent pressure on the nerve. You'll probably need to wear the splint full-time for 3 to 4 weeks, then at night only.

Prevention

You can help prevent CTS or alleviate symptoms by making some simple changes in your work and leisure habits.

• Stretch or flex your arms and fingers before beginning work and at frequent intervals.
• Alternate tasks to reduce the amount of repetitive movements.
• Modify or change daily activities that put pressure on your wrists.
• Modify your work environment. If you use a computer, have an adjustable keyboard table and chair, and a wrist rest.

Drug Therapies

Your provider may prescribe the following medications:

• Anti-inflammatory drugs, such as ibuprofen, to reduce inflammation (swelling, pain, and redness)
• Corticosteroids, a type of steroid, injected at the site of the carpal tunnel to reduce tendon swelling
• Diuretics, if needed

Surgical and Other Procedures

Patients who do not improve with medication and splinting may require surgery. Surgery provides complete relief in 95 percent of cases.

Complementary and Alternative Therapies

A comprehensive treatment plan for CTS may include a range of complementary and alternative therapies.

Nutrition

Use of vitamin B6 supplements (50 to 200 mg a day) for up to 3 months provides patients with pain relief and increased function in 85 percent of cases. B-complex may be used as an adjunct to B6. The following nutrients may have an anti-inflammatory effect: essential fatty acids (1,500 to 3,000 mg a day), and curcumin (250 to 500 mg) and bromelain (250 to 500 mg), both taken between meals. Lipoic acid (100 mg twice a day) can help reduce swelling. Modifying your diet to reduce or eliminate saturated fats and fried foods will also decrease inflammation.

Herbs

A combination of the following herbs in equal parts may decrease inflammation, provide some pain relief, and enhance healing.

• Cramp bark (Viburnum opulus)
• St. John's wort (Hypericum perforatum)
• Wild yam (Dioscorea villosa)

These herbs are available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). If you use the teas, add 1 heaping tsp. of herb to 1 cup of water and steep for 10 minutes (roots need 20 minutes). The recommended dose is 1 to 3 cups of tea per day or 30 drops of tincture three times per day.

Homeopathy

An experienced homeopath can prescribe a regimen for treating CTS that is designed especially for you. Some of the most common acute remedies are listed below. An acute dose is three to five pellets of 12X to 30C every one to four hours until symptoms clear up.

• Apis mellifica for joints that are red, hot, or swollen
• Arnica montana, four times per day, for a bruised, beat-up feeling, soreness, achy muscles after trauma or overuse; this treatment may be especially effective if the gel or cream form is used topically
• Guaiacum for CTS that is improved by the use of cold applications

Physical Medicine

Contrast hydrotherapy—alternating hot- and cold-water applications—may offer relief from CTS symptoms. This approach decreases inflammation, offers pain relief, and enhances healing. Immerse your wrists fully in hot water for three minutes followed by one minute in cold water, and repeat three times. Do this two to three times daily.

Acupuncture

According the National Institutes of Health, acupuncture may be useful in treating CTS. Studies suggest that acupuncture restores normal nerve function and can provide long-term relief of pain associated with CTS. Acupuncturists treat people with CTS based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of CTS, acupuncturists will often target the liver, gallbladder, and kidney meridians.

Chiropractic

CTS is commonly treated by chiropractors. The methods most chiropractors use to treat CTS include manipulation of the wrist, elbow, and upper spine, ultrasound therapy, and wrist supports. Two studies support the use of chiropractic treatment for CTS.

In the first study, 25 individuals diagnosed with CTS reported significant improvements in several measures of strength, range of motion, and pain after receiving chiropractic treatment. Most of these improvements were maintained for at least 6 months.

A second study compared the effects of chiropractic care with conservative medical care (wrist supports and ibuprofen) among 91 people with CTS. Both groups experienced significant improvement in nerve function, finger sensation, and comfort. The researchers concluded that chiropractic treatment and conservative medical care are equally effective for people with CTS.

Massage

Massage may help prevent or relieve symptoms, especially when rosemary and/or St. John's wort oil are used.

Prognosis/Possible Complications

Most people's symptoms clear up within a few months with conventional treatment. If left untreated, CTS in advanced stages can become quite serious, involving a loss of sensation, muscle deterioration, and permanent loss of function.

Following Up

If your wrist is placed in a splint or you receive corticosteroids, you'll need ongoing evaluation by your health care provider until treatment is completed. If you undergo surgery for CTS, a single follow-up visit is normally all that is requi

References

Banner R, Hudson EW. Case report: acupuncture for carpal tunnel syndrome. Can Fam Physician. 2001;47:547-549.

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers;1995:100, 369-370.

Cecil R. Cecil Textbook of Medicine. 20th ed. Philadelphia, Pa: W.B. Saunders: 1996.

Bonebrake AR, Fernandez JE, Dahalan JB, Marley RJ. A treatment for carpal tunnel syndrome. J Manipulative Physiol Ther. 1993;16(3):125-139.

Bonebrake AR, Fernandez JE, Marley RJ, Dahalan JB, Kilmer KJ. A treatment for carpal tunnel syndrome: evaluation of objective and subjective measures. J Manipulative Physiol Ther. 1990;13(9):507-520.

Branco K, Naeser MA. Carpal tunnel syndrome: clinical outcome after low-level laser acupuncture, microamps transcutaneous electrical nerve stimulation, and other alternative therapies - an open protocol study. J Altern Complement Med. 1999;5(1):5-26.

Carpal Tunnel Syndrome. NMIHI. Accessed at http://www.nmihi.com/c/carpal.htm on May 13, 2018.

Chen GS. The effect of acupuncture treatment on carpal tunnel syndrome. Am J Acupunct. 1990;18(1):5-9.

Dambro MR. Griffith's 5-Minute Clinical Consult. 1999 ed. Baltimore, Md: Lippincott Williams & Wilkins, Inc.; 1999.

Davis PT, Hulbert JR, Kassak KM, Meyer JJ. Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial. J Manipulative Physiol Ther. 1998;21(5):317-326.

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill: 1998.

Gabapentin. NMIHI. Accessed at http://www.nmihi.com/f/gabapentin.html on May 13, 2018.

Gruenwald J, Brendler T, Jaenicke C, et al, eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Company; 1998:906, 809-10.

Ibuprofen. NMIHI. Accessed at http://www.nmihi.com/i/ibuprofen.html on May 13, 2018.

Koopman WJ, ed. Arthritis and Allied Conditions.13th ed. Baltimore, Md: Williams & Wilkins, Inc.; 1997.

Living with carpal tunnel syndrome. American Academy of Family Physicians Accessed at https://familydoctor.org/ on May 13, 2018.

Median nerve entrapment. MedlinePlus. Accessed at https://medlineplus.gov/ on May 13, 2018.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:174, 27-29, 36-38.

Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. Rocklin, Calif: Prima Publishing; 1998: 189-91.

Naproxen. NMIHI. Accessed at http://www.nmihi.com/n/naproxen.html on May 13, 2018.

NSAIDs. NMIHI. Accessed at http://drugs.nmihi.com/nsaids.htm on May 13, 2018.

Rosen P, ed. Emergency Medicine: Concepts and Clinical Management. 4th ed. St. Louis, Mo: Mosby-Year Book; 1998.

Sabiston DC, ed. Textbook of Surgery. 15th ed. Philadelphia, Pa: W.B. Saunders; 1998.

Sildenafil. NMIHI. Accessed at http://www.nmihi.com/s/sildenafil.html on May 13, 2018.

Treatment of CTS. Ada Health. Accessed at https://ada.com/ on May 13, 2018.

Werbach M. Nutritional Influences on Illness. New Canaan, Conn: Keats Publishing Inc.;1987:123-125.