Carpal Tunnel Syndrome (CTS)

a woman's hands typing on a typewriter

Carpal Tunnel Syndrome is the most common form of mononeuropathy caused by entrapment and compression of the median nerve as it passes through the carpal tunnel in the wrist. Its symptoms and functional limitations can significantly penalize the daily activities and quality of life of many people. It results in loss of sensory and motor function of the nerve along its distribution, causing pain, weakness, or sensory disturbances. CTS is usually caused by repetitious injury; however it can be caused by a single high-velocity or high-vibrational injury, such as a motor vehicle accident or trauma from a fall. Other conditions that are associated with repetitious movement include trigger-finger and nerve spasms. CTS is a multi-factorial condition that requires a multi-faceted therapeutic approach.

The median nerve controls control the thumb muscle, wrists and three fingers and is responsible for feeling of sensations there. The carpal (from the Greek word karpos, meaning wrist) tunnel is a very narrow opening about one quarter of an inch below the skin surface. The median nerve is vulnerable to injury, trauma or compression from injuries, pregnancy, diabetes, bone spurs, gout, inflammation and/or tendonitis. CTS may be caused by occupational injury, acute trauma, and systemic diseases such as arthritis (gout), rheumatoid arthritis, and hypothyroidism. It may also be caused by spine and shoulder cervical nerve and blood blockage from sleeping on the abdomen with neck twisted or hands over head. Also, repetitive movements with a tight grip, especially with the wrists bent, will cause nerve and joint swelling against a ligament, deadening the hand and fingers. In a recent health and science study, it was discovered that typing on computer keyboards does not cause carpal tunnel, even though it seems to have been a major workplace issue since computers started flooding offices in the early 1980s.

Symptoms include pain, tingling, numbness, weakness and atrophy around the wrist and hand. (Adding cold compresses or ice packs to wrists relieves the pain.) To test for carpal tunnel syndrome, extend your arm out in front and make a fist with the palm facing up. If there is no pain it is not carpal tunnel, it may be arthritis.

DIET

Although no specific diet is associated with causing or curing CTS, it is suggested that foods associated with antagonizing the body’s supply of Vitamin B6 (pyridoxine) can be problematic. Vitamin B6 antagonists include food colorings, additives and preservatives, birth control pills, hormone replacement therapy and smoking.

A diet high in processed and refined sugar, excessive protein, fat and refined carbohydrates can also lead to a B6 deficiency. Good food sources of vitamin B6 include soybeans, walnuts, beans, lentils, brown rice, brewer’s yeast and bananas.

Consume foods that lead to the production of oxalic acid in moderation only. These include eggs, fish, asparagus, beets, parsley, and spinach. Eat pineapple (bromelane has anti-inflammatory effects) daily for one or two weeks until symptoms are relieved.

ALTERNATIVE FORMS OF TREATMENT

Benefits may be achieved with chiropractic adjustment and massage from the cervical and thoracic spine to the wrist. Apply heat directly to the area and apply gentle massage. Myofacial release using the thumb or hand to lengthen the muscle or tissue works well. This manual technique in which shortened muscles and fascia are lengthened has a 96 percent success rate. Surgery appears to sometimes be necessary to open release the carpal tunnel, but symptoms can return if modification is not taken.

Ultrasound therapy may be beneficial in long-term management. There still needs to be further scientific data before it can be recommended consistently.  Wrist supports and braces are important for maintaining the wrist at a neutral angle to reduce the incidence and intensity of symptoms.

SUPPLEMENTAL PROTOCOL

  1. VITAMIN B6 (PYRIDOXINE)
    Vitamin B6 supplementation is the best chance of cure. Vitamin B6 has a diuretic effect but also improves tissue oxygenation and relieves nerve inflammation. When taken at higher doses for 6 weeks it may cure over 90 percent of cases. Long-term high doses may cause a ‘rebound’ effect which could actually increase inflammation. Dosage: 200-300 mg daily for six weeks, then decrease dosage to half strength. Maintain 100 mg daily.
  2. B-COMPLEX
    B-complex vitamins are essential for nerve function and may improve tissue oxygenation. In addition to extra vitamin B6, CTS patients have deficiencies found in Vitamin B1 (Thiamine), Vitamin B2 (Riboflavin) and Vitamin B12. Riboflavin (Vitamin B2) when given concomitantly with Vitamin B6 has been shown to be helpful with CT. Dosage: Supplement with a higher-dose B-complex 100 mg daily.
  3. BROMELAIN and BOSWELLIA
    These herbs block the enzyme COX-2 which leads to less inflammation. Bromelain, the enzyme derived from pineapple, also has a smooth muscle relaxant effect and helps to heal wounds. Boswellia is a well known Ayurvedia medicine and has been shown effective in treating arthritis and other inflammatory conditions. Boswellia may be as effective as non-steroidal anti-inflammatory drugs, like ibuprofen and Naproxyn. Using either herb is safe and non-toxic and long-term usage should not cause any problems. Dosage: 1000 mg 2-3 times a day, or as directed.
  4. OMEGA 3, 6 ESSENTIAL FATTY ACIDS (FISH OIL OR FLAXSEED)
    These fatty acids enhance the production of anti-inflammatory eicosanoids and reduce the production of the body’s pro-inflammatory ones. Studies have shown that EFAs may reduce pain and improve tolerance. Over time the Omega 3 and 6 fatty acids can reduce the evolution of CTS. Dosage: 1-4 grams a day.
  5. GLUCOSAMINE/CHRONDROITIN
    Supplementation with Glucosamine/chrondroitin may definitely help to build or replace cartilage that may be affected by CTS. Glucosamine usually is more effective if taken in combination with Omega 3 fatty acids and COX-2 inhibiting herbs. Dosage: 500-1500 mg/day.
  6. ALPHA LIPOIC ACID
    Studies have shown that supplementation with Alpha-lipoic acid (especially in concert with gamma linolenic acid (GLA)) had significant efficacy in controlling symptoms and improving the evolution of CTS, especially in its early stages. Dosage: 600 mg daily for 90 days.
  7. MSM (METHYLSULFONOMETHANE)
    MSM is a naturally occurring sulfur compound that has anti-inflammatory effects, reduces muscle spasms, improves blood supply, and decreases pain. Dosage: 500-2,000mg daily.
  8. ANTIOXIDANTS
    Antioxidants have immune boosting and some anti-inflammatory effects, especially against free radicals caused by stress, chemical exposure and drugs. Co-enzyme Q10 helps improve tissue regeneration. Zinc enhances healing. Vitamin C can reduce inflammation and also promote healing. Vitamin A and Vitamin E are important antioxidants that are free-radical scavengers. Dosage: See a qualified practitioner.
  9. LECITHIN
    Lecithin supplies choline and inositol for nerve function. Lecithin has a positive effect on collagen which can help build strength and integrity to the inflamed area. Dosage: 1,000-4.000mg daily.
  10. NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)
    For acute pain, NSAIDS such as Ibuprofen, Naprosyn or Aleve may be given for acute relief. Dosage: As directed on label.
  11. MANGANESE
    This mineral may be helpful in nerve problems. Dosage: 15-30mg daily.
  12. ARNICA GEL or CAPSICUM CREAM
    When applied topically these linaments can relieve pain and inflammation and help the person suffering from CTS to get through the day with more relief. Dosage: Apply each morning.

 

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Majeski, T. Study: Typing Not Cause of Carpal Tunnel Syndrome. Pittsburgh Post-Gazette, Wed. June 13, 2001. A3.

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