Carpal Tunnel Syndrome is a painful and disabling cumulative trauma disorder characterized by inflammation and swelling in the tendons that run through the narrow carpal tunnel in the wrist. One of the most common of repetitive motion injuries, the World Health Organization categorizes it as a work-related musculoskeletal disorder. Reportedly responsible for 30-40% of workers’ compensation claims in the early 1990s, it afflicts burgeoning numbers of office workers.
It is caused by excessive and unrelieved repetition of movements that in themselves appear innocuous, such as cutting vegetables or typing on a computer keyboard. In addition to high frequency of repetition and lack of rest periods, factors that increase risk of hand-wrist damage include awkward or unnatural working posture, use of excessive force in performing a task, and emotional stress.
Numbness, tingling, and pain in the base of the thumb and the first three fingers results from the compression of a nerve that shares the carpal tunnel. Treatment includes rest, exercises, wrist splints, anti-inflammatory medications, learning stress-reducing movement techniques, making adjustments to the individual’s workstation, and surgery to reduce pressure on the afflicted nerve.
Signs, symptoms & indicators of Carpal Tunnel Syndrome
Numb/tingling/burning extremities
Tarsal tunnel syndrome is similar to carpal tunnel syndrome. The main difference between tarsal tunnel syndrome and carpal tunnel syndrome is that tarsal tunnel occurs in the foot and carpal tunnel occurs in the hands and wrist.
Carpal Tunnel Syndrome could instead be
Neuritis/Neuropathy
Both carpal tunnel and tarsal tunnel symptoms involve nerve irritation as the nerve passes through the wrist or ankle joint.
Recommendations for Carpal Tunnel Syndrome
Artificial Sweetener Avoidance
Aspartame use has been reported to trigger Carpal Tunnel syndrome.
Progesterone
Progesterone and carpal tunnel syndrome are linked through the former’s diuretic action. The reason for the symptomatic numbness of carpal tunnel syndrome is that the nerve which travels from the arm to the hand passes through a narrow bony tunnel in the wrist and if the surrounding cells are swollen with water (often worse in the morning) the nerve is pinched.
Progesterone is an excellent natural diuretic, with none of the side effects of the synthetic forms. Maintaining adequate levels of progesterone is often an effective remedy.
There have been cases of too much progesterone causing carpal tunnel syndrome, so caution is advised.
MSM (Methyl Sulfonyl Methane)
According to Dr. Stanley Jacobs, MD, MSM can be helpful in most musculoskeletal pain and inflammatory conditions, such as Carpal Tunnel Syndrome.
Physical Therapy
Sometimes, strengthening the extensors can help when your flexors have been overworked. One exercise is done by wrapping a wide rubber band around the fingers of an affected hand, from your thumb to your pinkie. Spread your fingers, hold for a few seconds, then release. You can do the same on the other hand, if needed. I know several people who have remarked how much this has helped them.
A second exercise is to hold one end of an elastic exercise band in one fist, palm up, with the other end securely held under your foot. Slowly flex your wrist against the resistance. Repeat ten times. Now, grip the band with your palm facing down and do the same thing. Repeat with the other hand. You can also do this exercise using a very light dumbbell.
Physical Supports
Splinting your wrists at night may be all that’s needed to improve the numbness and tingling of early carpal tunnel syndrome.
A study found that wearing a custom-made wrist splint for six weeks could bring long-lasting relief. “This fairly innocuous, low-cost intervention dramatically improves the level of discomfort, not only in the short-term, but the relief lasts up to a year out,” said study author Dr. Robert Werner, the chief of physical medicine and rehabilitation at the Ann Arbor VA Medical Center in Michigan. [Archives of Physical Medicine and Rehabilitation, January, 2005]
Splinting devices are generally only worn at night. Some patients choose to wear a wrist splint all of the time. Compared with nighttime-only splint use, full-time use has been shown to provide greater improvement of symptoms and electrophysiologic measures; however, compliance with full-time use is more difficult. Other wrist support devices are worn during the day when engaged in repetitive use of the hands and fingers – as with work at a keyboard.
Splinting is probably most effective when it is applied within three months of the onset of symptoms.
Prolotherapy
If the diagnosis is incorrect, then surgery is less than likely to be successful.
“Unfortunately, many patients with elbow and hand pain have been misdiagnosed with Carpal Tunnel Syndrome. A typical Carpal Tunnel Syndrome patient will experience pain and numbness in the hand. Because most physicians do not know the referral pain patterns of ligaments, they do not realize that cervical vertebrae 4 and 5 and the annular ligament can refer pain to the thumb, index, and middle fingers. Ligament laxity can also cause numbness. Cervical and annular ligament laxity should always be evaluated prior to making a diagnosis of Carpal Tunnel Syndrome. Surgery for Carpal Tunnel Syndrome should not be done until an evaluation is performed by a physician who understands the referral problems of ligaments and is experienced in Prolotherapy.
Seldom do patients find relief from “Carpal Tunnel” complaints of pain in the hand and elbow with physical therapy and surgery because the diagnosis is wrong. The most common reason for pain in the elbow referring pain to the hand is weakness in the annular ligament, not from Carpal Tunnel Syndrome.
Several sessions of Prolotherapy will easily strengthen the annular ligament and relieve chronic elbow pain.” [Ross Hauser, MD]
Vitamin B6 (Pyridoxine)
Vitamin B6 100mg tid has been shown to offer relief of pain and other symptoms. If a lower dose is effective, this is probably the best approach, as high levels of B6 supplementation can cause nerve damage. [Neurology 1985;35: pp.1466-68] In most people, supplementation of up to 500mg of B6 daily is safe.
Key
| Strong or generally accepted link |
| May do some good |
| Likely to help |
| Highly recommended |
Glossary
Carpal Tunnel Syndrome
A common, painful defect of the wrist and hand. It is caused by pressure on the middle nerve in the carpal tunnel. The syndrome is seen more often in women, especially in pregnant and in menopausal women. Symptoms may result from a blow, swelling, a tumor, rheumatoid arthritis, or a small carpal tunnel that squeezes the nerve. Pain may be infrequent or constant and is often most intense at night.
Anti-inflammatory
Reducing inflammation by acting on body mechanisms, without directly acting on the cause of inflammation, e.g., glucocorticoids, aspirin.