Carpal tunnel syndrome
Carpal tunnel syndrome
•A.D.A.M. Editorial Team: David Zieve, MD, MHA, Greg Juhn, MTPW, David R. Eltz. Previously reviewed by Steven D. Ehrlich, NMD, private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network (5/9/2008).

Introduction:
Carpal tunnel syndrome (CTS) is an injury caused by a pinched nerve in the wrist. The injury causes 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:
Signs and symptoms of CTS include:

•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 ages 40 -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 have symptoms of CTS, you should see your health care provider. Your health care provider can help you determine which treatment or combination of therapies will work best for you.

Your health care 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. Your health care provider 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 health care 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 - 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, such as:

•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 need surgery. Surgery provides complete relief in 95% of patients.

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

Nutrition and Supplements
Following these nutritional tips may help reduce symptoms:

•Eliminate all suspected food allergens, including dairy (milk, cheese, eggs and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your health care provider may want to test you for food allergies.
•Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
•Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell pepper).
•Avoid refined foods, such as white breads, pastas, and sugar.
•Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
•Use healthy oils in foods, such as olive oil or vegetable oil.
•Reduce or eliminate trans fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
•Avoid coffee and other stimulants, alcohol, and tobacco.
You may address nutritional deficiencies with the following supplements:

•A multivitamin daily, containing the antioxidant vitamins A, C, E, D, the B-complex vitamins and trace minerals such as magnesium, calcium, zinc, and selenium.
•Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful of oil daily, to help decrease inflammation. Fish oils may increase bleeding in sensitive individuals, such as those taking blood thinning mediations (including aspirin).
•B-complex vitamin, 1 tablet daily, for symptoms of carpal tunnel. Some studies suggest low levels of riboflavin in the blood is associated with carpal tunnel syndrome and other inflammatory diseases.
•Vitamin C, 500 - 1,000 mg daily, as an antioxidant.
•Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
•Methylsulfonylmethane (MSM), 3,000 mg twice a day, to help decrease inflammation.
•Resveratrol (from red wine), 50 - 200 mg daily, to help decrease inflammation and for antioxidant effects.
Herbs
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

•Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for inflammation and antioxidant and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
•Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg two to three times daily, for detoxification support.
•Bromelain (Ananus comosus) standardized, 40 mg three times daily, for pain and inflammation.
•Turmeric (Curcuma longa) standardized extract, 300 mg three times a day, for pain and inflammation.
•Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, for inflammation.
Homeopathy
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider remedies for the treatment of carpal tunnel symptoms based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for you individually.

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 1 - 4 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 3 minutes, followed by 1 minute in cold water, and repeat three times. Do this two to three times daily.

Castor Oil Packs -- Apply castor oil to a cloth, loosely wrap around wrist, and then cover with Saran Wrap. Apply a heating pad for 1 hour, or without using a heating pad, sleep with the application on the wrist. Do this for four to five nights per week until improvement occurs.

Acupuncture
According to the National Institutes of Health, acupuncture may help treat 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 in combination with rosemary or St. John's wort oil.

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 have surgery for CTS, you may need only a single follow-up visit.


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