Articles

Carpal Tunnel Syndrome

Introduction

The carpal tunnel is a passageway through the wrist that protects the nerves and tendons that extend into the hand. The median nerve within the carpal tunnel is in close proximity to nine tendons. When the tissues that constitute 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 paresthesia in the thumb and the second, third and radial half of the fourth fingers as well as, in some cases, atrophy of thenar musculature. (1)

Entrapment of the nerve at the wrist may be secondary to excessive use of the wrist, tenosynovitis with arthritis, or local infiltration, for example, by a thickening of connective tissue as in acromegaly, by deposit of amyloid, or by one of the mucopolysaccharidoses. (2) The development of carpal tunnel syndrome may also be secondary to other diseases such as diabetes mellitus, rheumatoid arthritis, and 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. (3)

Diagnosis is suggested when the physician finds a positive Phalen’s sign (pressing the extensor surface of the two flexed wrists against each other causing paresthesia) or Tinel’s sign (thumping of the volar aspect of the wrist to see if paresthia is induced).

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 general symptoms that could be attributed to 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 fingerPain in the wrist, which may shoot up the arm or down into the handPain 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. If this does not help, steroid injections, such as cortisone, may be employed, or surgery may be recommended. Surgical section of the carpal ligament will relieve entrapment.

Nutritional Supplementation


Vitamin B6

Studies conducted and published back in the late-1970s reported that many patients with carpal tunnel syndrome were deficient in vitamin B6, and vitamin B6 supplementation reportedly provided clinical relief and frequently enabled patients to avoid surgical intervention. (4) , (5) The physician who pioneered this work reported that vitamin B6 (100 to 200 mg daily) for a period of 12 weeks proved helpful for a large percentage of patients and was also useful in diagnosing vitamin B6 deficiency and in making decisions concerning surgery. (6) This research also directs particular attention to prevention of carpal tunnel syndrome during pregnancy.

Other investigators 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. (7) However, some studies have reported that vitamin B6 is not effective in the treatment of carpal tunnel syndrome. (8)


Vitamin B2

One study reported that a patient with a 3-year history of carpal tunnel syndrome was found to have a vitamin B2 deficiency as determined by the activity of erythrocyte glutathione reductase. Riboflavin for 5 months caused nearly complete disappearance of the carpal tunnel syndrome. Subsequently, combined therapy with vitamin B2 and vitamin B6 normalized B2 and B6-dependant enzyme activities and resulted in a complete disappearance of the patient’s carpal tunnel syndrome. (9)

Herbal Supplementation


Boswellia

Animal studies performed in India reported ingesting an extract of boswellia decreased polymorphonuclear leukocyte infiltration and migration, decreased primary antibody synthesis and caused almost total inhibition of the classical complement pathway. (10) An in vitro study of the isolated chemical constituent b-boswellic acid on the complement system reported a marked inhibitory effect on both the classical and alternate complement systems. (11)

Boswellia’s anti-inflammatory activity seems to be produced by blocking the synthesis of 5-lipoxygenase products, including 5-hydroxyeicosatetraenoic acid (5-HETE) and leukotriene B4 (LTB4). (12) , (13) Also, it is known that NSAIDs can cause a breakdown of glycosaminoglycan synthesis which can speed up the articular damage in arthritic conditions. (14) Boswellia was reported to significantly reduce the degradation of glycosaminoglycans compared to controls, whereas the NSAID ketoprofen was reported to cause a reduction in total tissue glycosaminoglycan content. (15)


Turmeric

The laboratory and clinical research indicates that turmeric and its phenolics have unique antioxidant and anti-inflammatory properties. (16) , (17) The anti-inflammatory strength of turmeric is comparable to steroidal drugs such as indomethacin. (18) Turmeric has been reported to be anti-rheumatic, anti-inflammatory and antioxidant. (19) Curcuminoids reportedly inhibit enzymes which participate in the synthesis of inflammatory substances (leukotrienes and prostaglandins) derived from arachidonic acid, and it is claimed they are comparable in activity to the NSAID. (20)

Curcumin reportedly has a similar action to that of aspirin and aspirin-like anti-inflammatory agents. (21) However, an advantage of curcumin over aspirin is claimed, since curcumin, unlike aspirin, is reported to selectively inhibit synthesis of inflammatory prostaglandins but does not affect the synthesis of prostacyclin. (22) Curcumin may be preferable for individuals who are prone to vascular thrombosis and require anti-inflammatory and/or anti-arthritic therapy.


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.

Capsaicin is reported to selectively activate some un-myelinated primary afferent sensory neurons (Type "C"). Many of cayenne’s positive effects on the cardiovascular system are thought to be due to excitation of neurons in the vagus nerve. (23) Some of the unmyelinated sensory fibers sensitive to capsaicin contain the neuropeptides Substance P and somatostatin. Capsaicin reportedly stimulates the release of these neuropeptides from both central and peripheral terminals of these primary afferent neurons. (24) The release of the neuropeptide Substance P is associated with desensitization, analgesia and anti-inflammatory activity. Prolonged exposure to capsaicin results in a gradual desensitization to acute effects, potentially due to the depletion of substance P and somatostatin from the primary afferent neurons. 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. (25) , (26)

Acupuncture & Acupressure

40 cases of carpal tunnel syndrome were treated with acupuncture by puncturing Da Ling (PC 7, as the primary acupoint), He Gu (LI 4), Er Bai (EX-UE 2), and Wai Lao Gong (EX-UE 8). 1 - 3 acupoints were used during each session. Da Ling (PC 7) was stimulated with the mild needling method with the acupuncture needle tip being inserted into the carpal tunnel. He Gu (LI 4), Er Bai (EX-UE 2), and Wai Lao Gong (EX-UE 8) were stimulated with the strong needling manipulation until the patient experienced soreness, numbness, and swelling in the local area. The needles were retained for 15 minutes. This acupuncture treatment was given once a day. 10 sessions constituted one therapeutic course of treatment. The results indicated that among the 40 cases treated, 23 were resolved, 14 had improved, and 3 cases had apparent improvement. The total effectiveness rate was 92.5%. (27)

25 cases of carpal tunnel syndrome were treated with electroacupuncture. The main acupoints used were Hand-Yang Ming Meridian and San Jiao Meridian. Gauge-26 filiform needles were inserted straight into Qu Chi (LI 11), He Gu (LI 4), Wai Guan (TE 5), Zhong Du (GB 32), and Da Ling (PC 7). After achieving needling sensations, the acupoints were stimulated with electrical pulses. The Shi Xuan (EX-UE 11) acupoint was used for blood-letting. The treatment was conducted once a day. 10 sessions constituted one therapeutic course of treatment. The results showed that 15 cases were resolved, 5 cases showed significant improvement, 4 cases had improved, and one case had no improvement. The total effectiveness rate was 96.0%. (28)

Combined treatment with acupuncture and herbal medicines
65 cases of carpal tunnel syndrome were treated with electroacupuncture and Wen Jing Huo Xue San. The points Wai Guan (TE 5) and Lao Gong (PC 8) were used as a group, while Da Ling (PC 7) and Zhong Du (GB 32) were used as another group. One group was used in every session of treatment. After insertion and achieving needling sensations, the needle handles were connected with an electroacupuncture therapeutic apparatus to stimulate the acupoints 30 minutes each time. The acupuncture treatment was conducted once every other day. In addition, the following herbs were used: dried Chuan Wu (Sichuan Aconite Root), dried Cao Wu (Wild Aconite Root), Pian Jiang Huang (Curcuma), Zhang Nao (Camphora), Wei Ling Xian (Clematis), Gui Zhi (Cinnamon Twig), and Chi Shao (Peony Red). These herbs were grounded into a powder. Then the powder was mixed with honey to be made into paste and applied to the affected wrist joint. The paste was changed once every other day. 10 sessions constituted one therapeutic course of treatment. The results indicated that among the 65 cases, 16 were resolved, 31 had remarkable improvement, 13 cases had improved, and 3 cases had no apparent improvement. (29)

In another report, 23 carpal tunnel syndrome cases were treated with acupuncture and herbs. Yang Chi (TE 4), Nei Guan (PC 6), and He Gu (LI 4) on the affected side were punctured and stimulated with the uniform reinforcing-reducing method, and the needles were retained for 15 minutes. The acupuncture treatment was given once a day. The herbs used included Gui Zhi (Cinnamon Twig), Bai Shao (White Peony Roots), Tou Gu Cao (Impatiens), Hong Hua (Carthamus), Wei Ling Xian (Clematis), Dang Gui (Chinese Angelica Root), Zhi Chuan Wu (prepared Sichuan Aconite Root), Xi Xin (Wild Ginger), and dried Di Huang (Rehmannia Root). The herbs were immersed in water (2500ml) for 30 minutes, and decocted with soft fire for one hour. The decoction was mixed with wine (100ml) and rice vinegar (100ml) for washing the wrist and forearm, about 30 ~ 40 minutes twice every day. In the control group, 23 cases were treated with local block therapy by injecting prednisolone acetate plus procaine, once a day. 4 sessions constituted one therapeutic course of treatment. The results for the combined acupuncture and herbal treatment group and the control group were, respectively: 16 and 4 cases had marked improvement, 5 and 10 improved, and 2 and 9 had no improvement. The total effectiveness rates were 91.3% and 60.9%, respectively (P

Traditional Chinese Medicine

Carpal Tunnel Syndrome

Extensive information regarding the treatment of this health condition using Traditional Chinese Medicine is available through the link above.

Clinical Lab Assessment

Some of the following laboratory testing can provide information necessary for diagnosis and treatment. In addition, the tests listed may also give insight to functional metabolism and functional nutrient status in the body.

Thyroid Profile

There is an increased risk of carpal tunnel syndrome in untreated hypothyroid conditions (30) and a connection between thyroid function and carpal tunnel syndrome seems evident. (31)

Clinical Notes

Omega-3 fatty acids: Although there are no clinical trials that have explored the use of omega-3 fatty acids for the treatment of carpal tunnel syndrome, an understanding of the anti-inflammatory activity of these compounds suggests that they might provide some benefit in the treatment of this condition. Linolenic acid, which is the parent compound in the omega-3 family of fatty acids, gets converted into eicosapentaenoic acid (EPA). EPA in turn, is the precursor for the production of the series 3 prostaglandins (PGE3), which have substantial anti-inflammatory activity. (32) , (33) Products that provide ample amounts of omega-3 fatty acids include flaxseed oil, which contains linolenic acid, and fish oils, which contain eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

When taking omega-3 fatty acid supplements, it is advisable to also take at least 400 IU of natural vitamin E per day.

References

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  4. 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.
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