What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist's carpal tunnel. It is the most common neuro-compressive disease in the world, accounting for 90% of all neuropathies. (1)  And did you know gender can be a risk factor for carpal tunnel syndrome? One study in China found women could be four times more likely to get the condition! (2)

 

The core symptoms of CTS include:

  • pain

  • tingling

  •  numbness in the hand or wrist

  • weakness

The pain of CTS may be felt in one or more areas including the wrist, palm, or forearm in the vicinity of compression. Loss of strength may occur, and opposition of the thumb and atrophy of the opponens pollicis muscle may develop, as well as loss of fine motor skills. Mild CTS often presents with intermittent symptoms while severe CTS may result in permanent loss of sensation and even paralysis of the thumb.

The 'carpal tunnel' itself is formed by the seven carpal bones on one side and the transverse carpal ligament (also called the 'anterior annular ligament' or 'flexor retinaculum') on the other. The transverse carpal ligament is attached to several bones in the wrist including the pisiform, hamate, scaphoid and the trapezium. Through this tunnel pass multiple tendons of the forearm, but superficial to  the tendons lies the median nerve, which is just below the transverse carpal ligament. This ligament acts to prevent malfunctions and ruptures of the flexor tendons. With contraction of the flexors of the wrist and fingers, especially with the wrist in flexion, the tendons in the carpal tunnel move in such a way that the median nerve is trapped against the transverse carpal ligament, placing compressive force against it.

CTS can have varying underlying contributing causes and these may have to be addressed quite differently. However, a largely unifying consideration is that any condition that increases the volume of the structures within the carpal tunnel or causes a narrowing of the tunnel itself can result in impingement on the median nerve.  Conditions that may lead to narrowing in the tunnel are often trauma and injury-based, but not always.  That is why known mechanisms which can contribute to CTS are as varied as fluid retention, fat deposition, carpal synovitis, inflammation, tenosynovitis, or other space-occupying lesions.  Thus documented risk factors include being overweight or obese, smoking, wrist injury, diabetes mellitus, hypertension, hypothyroidism, and rheumatic disease. (2)

naturpathic doctor near me

Why use integrative medicine
to treat Carpal Tunnel Syndrome?

Often the cause for CTS, or far less invasive treatment options, may not be identified by conventional practitioners or surgeons with an eye on having a procedure.  With an average cost of a surgery for CTS being $4,000 - $12,000, (3) they may be only considering the gross structural environment without regard for finer contributing factors. Among CTS cases, some researchers have found decreased nutrient levels, such as vitamin B6, while others have seen evidence of collagen dysplasia or inflammation.  Integrative and natural medicine have a lot to offer for treating inflammation and promoting recovery.  Long before expensive surgical options should be considered, attention should be given to less invasive techniques, and trying to restore balance and proper function. 

natural treatment for carpal tunnel syndrome

Support for patients with Carpal Tunnel Syndrome

Manual Manipulation & Stretching for CTS

Physical manipulation of subluxations, or partial dislocations, of the carpal bones in the wrist is another way to achieve relief for CTS. These techniques, as well as separation of the larger bones in the forearm, namely the distal radius and ulna, may relieve pressure in the carpal tunnel, thereby relieving impingement of the median nerve.  Successful case reports have been published in the literature, sometimes conducting manipulation of the cervical spine, elbow, and wrist three times per week for 4 weeks and had improvements documented using EMG, orthopedic and grip strength tests. (4,5,6)  

 

There have also been multiple published cases of improvement for patients treated with myofascial release and self-stretching techniques.(7) Such patients have been assessed with EMG and MRI in addition to the common clinical examination. Often patients were instructed to do frequent (three to five times daily) self-stretching and at the completion of treatment, MRI demonstrated increased dimensions in the carpal tunnel and nerve conduction studies showed multiple types of improvement.

Low-Level Laser Therapy for CTS

For decades, low-level laser therapy (LLLT) has been applied in the treatment of many musculoskeletal and neurologic conditions and received U.S. Food and Drug Administration (FDA) approval for the treatment of several conditions, including CTS.(8)  Low level lasers received FDA classification of 3A, which shows the FDA has determined they pose a “non-significant risk” factor. This is consistent with findings by agencies throughout the world, as no study has ever reported adverse effects from treatment. 

 

A meta-analysis from 2016 reviewed seven randomized clinical trials on the topic of LLLT for CTS, for a total of 270 wrists in the laser group and 261 wrists in the control group. (9) There findings were impressive! Hand grip (at 12 weeks) was stronger in the LLLT group than in the control group and there was better improvement in the visual analog scale (VAS) (at 12 weeks) in the LLLT group. They also found the sensory nerve action potential (SNAP) (at 12 weeks) was better in the LLLT group.

Acupuncture for CTS

In a study of acupuncture treatment of CTS, a positive response was demonstrated in 35 of 36 patients, 14 of whom were previously treated unsuccessfully with surgery! (10)  Other studies compared 24 treatment sessions of either acupuncture or electro-acupuncture over 6 weeks and found multiple improvements including "symptomatology, grip strength, electrophysiological function, and physical provocation sign".(11)  These studies and others are often using wrist acupoints PC-7 (Daling) and PC-6 (Neiguan) along the pericardial meridian, which is along the median nerve tract.  The efficacy of acupuncture as a treatment for mild-to-moderate CTS was even just reviewed recently in a 2021 systematic review of randomized controlled trials which found not only was it effective but "... unlike conventional medicine which has serious side effects, [manual acupuncture] showed no serious side effects in papers that reported adverse effects". (12)

Nutritional Supplements for CTS

Many nutritional supplements have been shown to have beneficial qualities for supporting nerves and nervous system function, with several used specifically in the treatment of CTS.  The most notable is vitamin B6, where supplementation in the treatment of CTS has been widely discussed in the literature. Many studies have been done that fall on both sides of the fence, pro and con.(13-15) However, clinical evidence on vitamin B6's nerve regenerative function was found from a human study in patients with CTS, in which vitamin B6 treatment increased the conduction velocity of sensory nerves and thus reduced clinical symptoms.(16) And since a number of other B vitamins also have beneficial properties for nerves, the clinical use of vitamin B6 in exclusion may inherently have limited outcomes instead of using combination therapies.  Meanwhile, research with some fatty acids have, in some trials, shown benefits for people with CTS that were superior to those using only a vitamin B complex.(17)

So if you are seeking guidance, support or treatment for CTS, consider contacting our clinic at the number above.

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References:

  1. Sevy JO, Varacallo M. Carpal Tunnel Syndrome. [Updated 2022 Sep 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448179/

  2. Guan W, Lao J, Gu Y, Zhao X, Rui J, Gao K. Case-control study on individual risk factors of carpal tunnel syndrome. Exp Ther Med. 2018;15(3):2761-2766. doi:10.3892/etm.2018.5817

  3. Elite Insurance Partners LLC d/b/a MedicareFAQ. https://www.medicarefaq.com/faqs/does-medicare-cover-carpal-tunnel-syndrome-surgery/ Accessed on 08-01-2022.

  4. Valente, R, and H Gibson. “Chiropractic manipulation in carpal tunnel syndrome.” Journal of manipulative and physiological therapeutics vol. 17,4 (1994): 246-9.

  5. Schreiber, Adam L et al. “Two novel nonsurgical treatments of carpal tunnel syndrome.” Physical medicine and rehabilitation clinics of North America vol. 25,2 (2014): 249-64. doi:10.1016/j.pmr.2014.01.008.

  6. Burnham, Taylor et al. “Effectiveness of osteopathic manipulative treatment for carpal tunnel syndrome: a pilot project.” The Journal of the American Osteopathic Association vol. 115,3 (2015): 138-48. doi:10.7556/jaoa.2015.027.

  7. Sucher BM.“Myofascial manipulative release of carpal tunnel syndrome: documentation with magnetic resonance imaging.” The Journal of the American Osteopathic Association vol. 93,12 (1993): 1273-8.

  8. Erchonia Corporation. How Does Laser Therapy Work for Pain? The Science Behind the Effective Treatment.  https://www.erchonia.com/blog-news/how-does-laser-therapy-work-for-pain-the-science-behind-the-effective-treatment/ Accessed 11-25-22.

  9. Li ZJ, Wang Y, Zhang HF, Ma XL, Tian P, Huang Y. Effectiveness of low-level laser on carpal tunnel syndrome: A meta-analysis of previously reported randomized trials. Medicine (Baltimore). 2016 Aug;95(31):e4424. doi: 10.1097/MD.0000000000004424. PMID: 27495063; PMCID: PMC4979817. 

  10. Chen, GS. The effect of acupuncture treatment on carpal tunnel syndrome. Am J Acupunct 1990;18:5-9.

  11. Ho, Chien-Yi et al. “Clinical effectiveness of acupuncture for carpal tunnel syndrome.” The American journal of Chinese medicine vol. 42,2 (2014): 303-14. doi:10.1142/S0192415X14500207.

  12. Huh, Jeong Ho et al. “Effect of Manual Acupuncture for Mild-to-Moderate Carpal Tunnel Syndrome: A Systematic Review.” Journal of pharmacopuncture vol. 24,4 (2021): 153-164. doi:10.3831/KPI.2021.24.4.153.

  13. Folkers K, Ellis J. Successful therapy with vitamin B6 and vitamin B2 of the carpal tunnel syndrome and need for determination of the RDA's for vitamin B6 and B2 disease states. Ann N Y Acad Sci 1990;585:295-301.

  14. Ellis JM, Folkers K. Clinical aspects of treatment of carpal tunnel syndrome with vitamin B6. Ann N Y Acad Sci 1990;585:302-320.

  15. Folkers K, Wolaniuk A, Vadhanavikit S. Enzymology of the response of carpal tunnel syndrome to riboflavin and to combined riboflavin and pyridoxine. Proc Nat Acad Sci U S A 1984;81:7076-7078.

  16. Talebi M., Andalib S., Bakhti S., Ayromlou H., Aghili A., Talebi A. Effect of vitamin b6 on clinical symptoms and electrodiagnostic results of patients with carpal tunnel syndrome. Advanced Pharmaceutical Bulletin. 2013;3(2):283–288. doi: 10.5681/apb.2013.046.

  17. Di Geronimo G, Caccese AF, Caruso L, Soldati A, Passaretti U. Treatment of carpal tunnel syndrome with alpha-lipoic acid. Eur Rev Med Pharmacol Sci. 2009 Mar-Apr;13(2):133-9. PMID: 19499849.

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