Doctors have written about carpal tunnel syndrome (CTS) for more than 100 years, but it took the emergence of computer keyboards for the condition to achieve national prominence. In fact, any activity that constantly strains the wrist, from guitar playing to rowing, from assembly line work to knitting, can bring it on. Sometimes, however, carpal tunnel syndrome can begin without any apparent cause at all. Carpal tunnel syndrome usually starts as repeated local irritations swell the tendons and ligaments in the wrist. This then compresses the median nerve, which passes through a “tunnel” from the forearm to the hand. The combination of the inflamed tendons and the squeezed median nerve are responsible for the pain, tingling, numbness and weakness of the thumb and index and middle fingers characteristic of CTS. In addition, any of the following have been associated with this painful condition: an underactive thyroid, diabetes, rheumatoid arthritis, obesity, pregnancy, premenstrual syndrome (PMS), birth control pills, and menopause.
Although conventional medicine can be very helpful, I believe one of its options, namely surgery, should be the last resort. As many physicians are unaware of alternative therapies, let’s see if our WholeHealth Chicago suggestions can help keep you out of the operating room. No guarantees, of course, but nothing ventured . . .
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a painful disorder of the wrist and hand that affects some 5 million Americans. Carpal tunnel refers to a passageway in the wrist, composed of bones and ligaments, through which a major nerve system passes from the forearm into the hand. For a variety of reasons–repetitive strain, arthritis, bone dislocation or fracture, fluid retention, or a variety of systemic changes affecting the entire body, such as diabetes–the carpal tunnel can become narrowed. When this occurs, the median nerve, which controls feeling and movement in the hand, is compressed by surrounding tissue or excess fluid. As the nerve is constricted, it causes numbness, weakness, or pain. Often affecting the dominant hand (though possible in both hands), these symptoms may appear suddenly or gradually, and may last for only a few days at a time or persist for several months.
Women are far more susceptible than men are to carpal tunnel syndrome, in large part because more women perform the types of hand-intensive tasks (especially typing on computer keyboards) that put them at risk. The condition is also common among overweight women between ages 30 and 60 who have been pregnant. The sooner carpal tunnel syndrome is diagnosed, the easier it is to treat–and the better the prognosis. Left untreated, however, the condition can lead to a weakened grip and severe chronic pain in the forearm or shoulder.
Numbness, tingling, or burning in the hand, especially the thumb and first two fingers. (Usually only half of the ring finger is affected, if at all.)
Pain in the hand, wrist or arm. It’s often worse at night and usually severe enough to awaken you.
Shooting pains in the wrist and forearm that may extend as far as the shoulder and neck
Weakness in the hand that makes it difficult to grasp or pick up objects
A sensation of swelling in the fingers without any actual visible swelling
What Causes Carpal Tunnel Syndrome?
Carpal tunnel syndrome is often considered a modern-day ailment, a stress injury caused by too many tense hours spent at a keyboard. In fact, it was first diagnosed in the 1880s, long before computers reigned, and its rise has been attributed to several factors, including:
Activities that require prolonged repeated movements of the hands or fingers or bending of the wrist. This encompasses not only typing, but also knitting, sewing, drilling, carpentry, assembly-line work, playing a musical instrument and certain sports, such as tennis, squash, canoeing, and the use of rowing machines or other exercise equipment.
Injury or trauma that causes nerve damage in the wrist.
Hormonal changes due to pregnancy, birth control pills or menopause.
Diseases such as diabetes, hypothyroidism, rheumatoid arthritis, or Raynaud’s disease.
Treatment and Prevention
For carpal tunnel, acting quickly at the first hint of a symptom can often head off a full-blown irritation. The natural position of the working hand is with the wrist held straight or slightly bent and the thumb in a continuous line with the forearm. Using your hand with the wrist bent, either forward or back, places a stress on the nerves as they pass through the carpal tunnel. So to prevent CTS, your best bet is learning to work with your wrist and hand held straight.
If you must perform repetitive movements, like those required by a keyboard, take a break every hour and exercise both your hands and your wrists. In addition, always adjust the height of your chair until you’re positioned with your wrists in a straight line.
Conventional treatment usually begins with recommendations for rest, cold compresses, and wrist splints. The splints are usually worn for two to three weeks–especially at night when you may bend your wrist in your sleep. At the workplace, a good wrist splint allows you to continue your usual hand-related tasks. However, you may just have to discontinue certain troublesome actions for a week or two in order to allow time for the swelling to go down.
Your doctor may recommend an anti-inflammatory medication, usually aspirin, an NSAID or one of the new COX-2 inhibitors. If you don’t respond to this program, a course of intensive physical therapy, corticosteroid injections, or even surgery may be recommended.
Unfortunately, the ultimate conventional remedy, surgery, provides relief for troublesome symptoms in less than half of CTS patients. For this reason, WholeHealth Chicago physicians routinely recommend that surgery should only be pursued if there’s clinical evidence of damage to the radial or ulnar nerve with unremitting pain, numbness, and possible actual wasting of the muscles of the affected hand.
And we also feel it’s always a wise strategy to try a three- to six-month trial of noninvasive therapies before you think seriously about undergoing surgery. Conventional physicians are often unaware that a variety of alternative therapies have been shown to be quite helpful in treating CTS. These include osteopathic and chiropractic manipulation, acupuncture, massage, and magnet therapy.
Actually, you might consider one of the manipulative therapies, such as osteopathy or chiropractic, well before considering surgery. You’ve basically got a mechanical problem, i.e., a compressed nerve due to some local swelling. Gentle manipulation of the bones and soft tissue of the wrist by a health-care provider trained in the appropriate techniques may actually shift the fluids responsible for the swelling and release the entrapped nerve. Although such treatment may take several visits, you can really tell if you’re heading in the right direction because your pain should lessen and your grip strength improve.
There are also a number of specific lifestyle changes you can make, as well as several supplements that can help improve your circulation, reduce the inflammation and generally promote healthy nerve tissue.
Just a reminder: If you have a serious medical condition or are taking medication, it’s always a wise idea to talk to your doctor before beginning a supplement program.
How Supplements Can Help
Research has shown that people who don’t have enough vitamin B6 in their diet are more likely to feel the pain and numbness of carpal tunnel syndrome. This may be because vitamin B6 increases the brain’s production of a chemical that helps control pain. Some people have better results with pyridoxal-5-phosphate (P-5-P), a form of vitamin B6 that the body produces naturally. Studies have shown taking 100 mg of vitamin B6 three times a day will relieve the symptoms in approximately 50% to 60% of carpal tunnel cases within four to six weeks.
Vitamin B6 is much more effective when taken with bromelain, a natural anti-inflammatory enzyme found in pineapple.
To enhance the benefits of bromelain, take the herb turmeric, which is a member of the ginger family. Its anti-inflammatory effects are due to its active ingredient, a substance called curcumin. Although it’s safe to take over the long term, turmeric can be expensive, so you may want to cut the dosage in half once your symptoms subside. Ginger, too, will work as an anti-inflammatory, either in capsules, as a spice or as a tea.
Get supplement dosages and tips in our WholeHealth Chicago Supplement Recommendations for Carpal Tunnel Syndrome.
During flare-ups, over-the-counter anti-inflammatory pain relievers, such as aspirin and ibuprofen, can help reduce pain and swelling.
When lying down, elevate your affected arm with pillows.
To reduce pain and inflammation, apply a flexible ice pack (or even a bag of frozen peas) to your wrist for 10 minutes every hour.
When working with your hands, try to keep your wrists straight. Flexing or twisting them stresses the carpal tunnel.
Try to vary activities and rotate tasks so that your wrists are not constantly bent.
Take frequent breaks during any activity that requires repetitive hand motions. At least once an hour, flex your fingers and shake your hands.
When working at a computer keyboard, make sure your fingers are lower than your wrists. Don’t rest the heels of your hands on the keyboard or mouse pad.
While driving, avoid gripping the steering wheel too tightly.
To reduce stress on the wrist, lift objects with the entire hand, or better yet, with both hands.
Listen to your body. If your hands hurt during an activity, it’s time to stop.
Reduce the amount of salt in your diet. Salt promotes water retention, which can contribute to swelling.
Quit smoking. Smoking aggravates the condition by constricting the small blood vessels of the hand.
Beware of fingerless gloves, wrist rests, and other “therapeutic” devices. There’s no scientific evidence that they work. Some experts fear that because these devices can decrease circulation to the wrist or restrict movement, they may actually worsen the problem or transfer it to the shoulder.
If symptoms persist, your doctor may prescribe a wrist splint, diuretics to reduce water retention or injections of corticosteroids to reduce inflammation.
In cases of advanced nerve injury or muscle damage, surgery may be suggested.
When to Call a Doctor
If your fingers are stiff and painful
If wrist discomfort interferes with normal daily activities
If supplements and home remedies provide little or no relief from pain and numbness
If your fingers are numb and tingling
If you have a large amount of swelling in the wrist
If you can’t perform your tasks at work
From David Edelberg, M.D. at WholeHealth Chicago: To begin, it’s pretty universally agreed that a rest from the culprit activity, wrist splints and anti-inflammatory medications can help relieve your CTS symptoms. In addition, physical therapy can really aid in rebuilding the strength and improving the motion in your hand and wrist.
But many people with CTS seem unable to get rid of all their symptoms even after a course of conventional treatment. Or instead, they may manage a few good weeks, only to have the problem resurface again and again. It’s here that some nutritional supplements can help.
How to Take the Supplements
When your symptoms are acute, take all the supplements listed below in the doses recommended.
Most important of these is vitamin B6 –or pyridoxal-5-phosphate (P-5-P), an altered form of B6 that is produced by the liver acting on the B6 found in your food. How this B vitamin actually helps CTS is uncertain. Some–but by no means all–CTS sufferers are deficient in this nutrient. At any rate, B6can help reduce inflammation and maintain healthy nerve tissue.
The bromelain, an enzyme derived from pineapple, acts as an anti-inflammatory, and either of the herbs turmeric or ginger will enhance bromelain’s anti-inflammatory effect.
When your symptoms have improved, you can reduce the B6 to once a day or switch over to a B-complex vitamin combination containing 50 mg of B6. With no active inflammation, you can discontinue the bromelain and turmeric/ginger.
When you are finally symptom free, the amount of vitamin B in your high-potency multivitamin may be sufficient to keep CTS at bay. Just keep either B6or P-5-P handy in case you experience a flare-up.
Of special interest
If you also have osteoarthritis or back pain (ailments that can predispose you to CTS), try adding glucosamine sulfate (500 mg 3 times a day), which will help strengthen crucial ligaments and tendons throughout your body, including those in your hands, wrists, and forearms.
If you’re feeling particularly tense or stressed out, consider using the mild natural relaxant kava (250-500 mg 2 or 3 times a day, as needed). This nonaddictive herb can be quite useful because CTS becomes more of a risk when you’re holding your muscles tight and your body stiff with tension. Important:
We at WholeHealth Chicago strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.
Be aware that certain cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you’re taking medications. Key cautions are given in the listing below, but you need to see the WholeHealth Chicago Reference Library for a comprehensive discussion of each supplement’s cautions and drug/nutrient interactions. The Healing Path for Carpal Tunnel Syndrome provides more extensive therapeutic information about this condition.
For product recommendations and orders click here for the Natural Apothecary or call 773-296-6700 ext. 2001.
David Edelberg, MD