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Carpal Tunnel Syndrome

Introduction

What should I know about Carpal Tunnel Syndrome?

Carpal tunnel syndrome has gained a lot of attention over the past decade. Some say it is a sign of our technology-based society because so many patients complaining of the syndrome found that it resulted from constant computer use. However, this syndrome can result from many exercises in which the hand or wrist is over-used. Understanding the condition, how it progresses, and what the healing process is like will help in avoiding the condition or in assisting with the treatment process.

The carpal tunnel is a passageway through the wrist that protects the nerves and tendons that extend into the hand. The median nerve, a nerve is both motor and sensory, within the carpal tunnel is very close to nine tendons. When the tissues that which make up the tunnel become inflamed or swollen, or if one or more of the tendons becomes injured, the median nerve is compressed. This compression of the median nerve within the carpal tunnel produces numbness in the thumb and the second, third, and radial half of the fourth fingers. In some cases the muscles of the thumb may even waste away oratrophy. (1)

Sometimes the nerve becomes entrapped because of reasons that may not relate to overuse. It could be the result of diabetes, arthritis, or hypothyroidism. However, patients with carpal tunnel syndrome secondary to these diseases represent a very small percentage of total cases. It also may occur during pregnancy as a result of weight gain and fluid retention, and may additionally be associated with edema or trauma. (2)

The healthcare professional will usually give a diagnosis of Carpal Tunnel Syndrome when having the patient touch their two flexed wrists together results in numbness (Phalen’s sign) or there is numbness when thumbing the palm of the hand (Tinel’s sign).

Statistic

National Institute of Neurological Disorders and Stroke, 2002.

    Women are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men. Carpal tunnel syndrome usually occurs only in adults. Carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel. A 2001 study by the Mayo Clinic found heavy computer use (up to 7 hours a day) did not increase a person's risk of developing carpal tunnel syndrome. During 1998, an estimated three of every 10,000 workers lost time from work because of carpal tunnel syndrome. Half of these workers missed more than 10 days of work. The average lifetime cost of carpal tunnel syndrome, including medical bills and lost time from work, is estimated to be about $30,000 for each injured worker.

Signs and Symptoms

The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.

Carpal tunnel syndrome has several basic symptoms that could easily be caused by other health conditions. The more general symptoms are numbness and/or a tingling sensation in the hands and fingers, not including the little finger. Pain may be present in the wrist, which may shoot up the arm or down into the hand. The pain or numbness is frequently worse at night.

General

  • Numbness and/or tingling sensation in hands and fingers, not including the little finger
  • Pain in the wrist, which may shoot up the arm or down into the hand
  • Pain or numbness is frequently worse at night

Treatment Options

Conventional

Often, conservative measures are tried by simply splinting the wrist to relieve tension on the median nerve. General anti-inflammatories such as NSAID’s are often recommended. If this does not help, steroid injections, such as cortisone, may be used or surgery may be recommended. Surgery of the carpal ligament will relieve entrapment.

Nutritional Suplementation


Vitamin B6

Studies conducted and published back in the late-1970's reported that many patients with carpal tunnel syndrome were deficient in vitamin B6, and vitamin B6 supplementation reportedly provided relief and sometimes even enabled patients to avoid surgery. (3) , (4) The physician who pioneered this work reported that vitamin B6 (100 to 200 mg daily) for a period of 12 weeks helped a large percentage of patients and that laboratory determination of vitamin B6 status was useful in diagnosing deficiency and in making decisions relative to surgery. (5) This research also directs particular attention to prevention of carpal tunnel syndrome during pregnancy.

While even another investigator also reported that satisfactory improvement was obtained in 68 percent of 494 patients treated with a vitamin B6 at a dosage of 100 mg twice daily, (6) there are still some studies that have reported that vitamin B6 is not effective in the treatment of carpal tunnel syndrome. (7) More research needs to be done, but the outlook is promising with this nutrient.

Herbal Suplementation


Boswellia

Boswellia has anti-inflammatory activity and therefore is sometimes recommended for treatment of conditions where inflammation is a problem. Also, it appears that Boswellia can help with some of the side effects of using NSAID’s. (8) , (9)


Turmeric

The laboratory and clinical research indicates that turmeric has unique antioxidant and anti-inflammatory properties. (10) , (11) The anti-inflammatory strength of turmeric is comparable to steroidal drugs such as indomethacin. (12) Turmeric has been reported to be anti-rheumatic, anti-inflammatory, and antioxidant. (13) Curcuminoids reportedly inhibit enzymes which participate in the synthesis of inflammatory substances and it is claimed they are comparable in activity to the NSAID. (14)


Cayenne

Externally, topical preparations of capsicum oleoresin (0.25-0.75%) is used for pain associated with arthritis, rheumatism, inflammation, and cold injuries. Taken orally, capsicum has been reported to increase peripheral circulation and improve digestion.

Topically, capsaicin has been reported to be useful in alleviating post-herpetic neuralgia, post-mastectomy pain syndrome, arthritis and rheumatoid arthritis, painful diabetic neuropathy, psoriasis, pruritus, and other conditions. (15) , (16)

References

  1. Cush JJ, Lipsky PE. Approach to Articular and Musculoskeletal disorders. In: Fauci AS, Braunwald E, Isselbacher KJ, et al. eds. Harrison’s Principles of Internal Medicine 14th ed. New York: McGraw-Hill; 1998:1933.
  2. Bader AM. The High-Risk Obstetric Patient Neurologic and Neuromuscular Disease in the Obstetric Patient. Anesthesiology Clinics of North America Volume 16, Number 2. Jun1998.
  3. Ellis JM, et al. Vitamin B6 deficiency in patients with a clinical syndrome including the carpal tunnel defect. Biochemical and clinical response to therapy with pyridoxine. Res Commun Chem Pathol Pharmacol. Apr1976;13(4):743-57.
  4. Ellis JM, et al. Survey and new data on treatment with pyridoxine of patients having a clinical syndrome including the carpal tunnel and other defects. Res Commun Chem Pathol Pharmacol. May1977;17(1):165-77.
  5. View Abstract: Ellis JM. Treatment of carpal tunnel syndrome with vitamin B6. South Med J. Jul1987;80(7):882-4.
  6. View Abstract: Kasdan ML, James C. Carpal tunnel syndrome and vitamin B6. Plast Reconstr Surg. Mar1987;79(3):456-62.
  7. View Abstract: Franzblau A, et al. The relationship of vitamin B6 status to median nerve function and carpal tunnel syndrome among active industrial workers. J Occup Environ Med. May1996;38(5):485-91.
  8. View Abstract: Redini F, et al. Modulation of Extracellular Matrix Metabolism in Rabbit Articular Chondrocytes and Human Rheumatoid Synovial Cells by the Non-steroidal Anti-inflammatory Drug Etodolac. II: Glycosaminoglycan Synthesis. Agents Actions. Nov1990;31(3-4):358-367.
  9. View Abstract: Boswellia serrata. Altern Med Rev. Aug1998;3(4):306-307.
  10. View Abstract: Rao CV. Chemoprevention of colon carcinogenesis by dietary curcumin, a naturally occurring plant phenolic compound. Cancer Res. Jan1995;55(2):259-66.
  11. View Abstract: Srivastava KC, et al. Curcumin, A Major Component of Food Spice Turmeric (Curcuma longa) Inhibits Aggregation and Alters Eicosanoid Metabolism In Human Blood Platelets. Prostaglandins Leukot Essent Fatty Acids. Apr1995;52(4): 223-27.
  12. Deodhar SD, et al. Preliminary Studies on Anti-Rheumatic Activity of Curcumin. Ind J Med Res. 1980;71:632.
  13. View Abstract: Ammon HP, et al. Pharmacology of Curcuma longa. Planta Med. Feb1991;57(1):1-7.
  14. View Abstract: Ammon HP, et al. Mechanism of Anti-inflammatory Actions of Curcumin and Boswellic Acids. J Ethnopharmacol. 1993;38:113.
  15. View Abstract: Magnusson BM. Effects of Topical Application of Capsaicin to Human Skin: A Comparison of Effects Evaluated by Visual Assessment, Sensation Registration, Skin Blood Flow and Cutaneous Impedance Measurements. Acta Derm Venereol. Mar1996;76(2):129-32.
  16. View Abstract: Rains C, et al. Topical Capsaicin. A Review of Its Pharmacological Properties and Therapeutic Potential in Post-herpetic Neuralgia, Diabetic Neuropathy and Osteoarthritis. Drugs Aging. Oct1995;7(4):317-28.