Natural Remedies for Carpal Tunnel Syndrome

Thinking about carpal tunnel surgery? Think again!!!

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Natural therapies, including nutritional supplements, manual manipulation, acupuncture and low- level laser therapy, can go far in helping a person avoid surgical interventions, especially if done together as a program under the guidance of an experienced clinician.

Evidence-Based Therapies Far Less Expensive Than Surgery

Carpal tunnel syndrome (CTS) is the most common neuro-compressive disease in the world (1) and the average cost of a surgery for CTS is $4,000 - $12,000.(2) Thankfully, decades of research have shown benefits from several different individual types of therapies, which are much less invasive than surgical options and the majority of patients respond well to nutritional and conservative physical medicine approaches. Unfortunately, many patients are not made aware of them by conventional doctors and miss out on the opportunity for synergistic healing techniques.

Nutritional Supplements for CTS

The efficacy of vitamin B6 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.(3-5) 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.(6) And since a number of other B vitamins also have beneficial properties for nerves, the clinical use of vitamin B6 in exclusion may inherently havve limited outcomes. For it is well documented that the neurotropic B vitamins thiamine (B1), pyridoxine (B6), and cobalamin (B12) are key players, which maintain the neuronal viability in different ways. "... [T]hey constantly protect nerves against damaging environmental influences. While vitamin B1 acts as a site-directed antioxidant, vitamin B6 balances nerve metabolism, and vitamin B12 maintains myelin sheaths. ... The presence of vitamins B1, B6, and B12 paves the way out to the following important regeneration by supporting the development of new cell structures. Furthermore, vitamin B1 facilitates the usage of carbohydrates for energy production, whereas vitamin B12 promotes nerve cell survival and remyelination".(7)

One study aimed to 'neuroprotection', i.e. to limiting and correcting the nerve damage, used a combination of other nutritional supplements and showed they outperformed a multivitamin B-Complex preparation alone.(8) This study used daily alpha-lipoic acid (ALA), an antioxidant and fatty acid naturally occurring in humans, and gamma-linolenic acid (GLA), an omega-6 polyunsaturated fatty acid that the body cannot manufacture. They compared these against a group treated using a multivitamin B preparation (Vit B6, Vit B1, Vit B12) for 90 days among 112 subjects with moderately severe CTS. The results showed a significant reduction in both symptoms scores and functional impairment from the ALA/GLA group, while the multivitamin grou, p experienced a slight improvement of symptoms and a deterioration of functional scores. Electromyography (EMG) showed a statistically significant improvement with ALA/GLA, but not with the multivitamin product while other assessment tools showed significant efficacy of ALA/GLA in improving symptoms and functional impairment, while in the multivitamin group the improvement was significant, but less marked than in the ALA/GLA group.

Manual Manipulation and 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. One older case report described manipulative treatment for a 42 year old female patient with CTS symptoms. (9) The patient was evaluated using EMG, orthopedic and grip strength tests. All were found to be positive for CTS before treatment was begun. Manipulation of the cervical spine, right elbow, and right wrist was performed three times per week for 4 weeks. Following the treatment period, grip strength had improved, orthopedic tests were negative, and there was significant improvement in the EMG studies. Other more recent research has also shown benefits from osteopathic manipulative treatment. (10, 11)

There have also been multiple published cases of improvement for patients treated with myofascial release and self-stretching techniques.(12) 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.

Other studies of manual manipulation show benefits from soft tissue and joint mobilization of the forearm, wrist, and hand, but not from the spinal manipulation alone. (13,14)

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! (15) 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". (16) 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.

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, including CTS.

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. It should be noted that lasers used to cut tissue require 1,000 milliwatts(mW) of heat and the beginning of any ‘danger zone’ is around 500mW. The device used for LLLT at Northeast Natural Medicine, LLC is less than 5mW and therefore unable to produce enough heat to cause any tissue damage.

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. (17) 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.

Though some patients may ultimately require surgical interventions, it is a shame that often times a person may not be aware of less invasive means to help alleviate their symptoms and maintenance techniques which could help them avoid such expensive and undertakings.

References

1. 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

2. 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.

3. 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.

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

5. 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.

6. 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.

7. Baltrusch, Simone. “The Role of Neurotropic B Vitamins in Nerve Regeneration.” BioMed research international vol. 2021 9968228. 13 Jul. 2021, doi:10.1155/2021/9968228.

8. 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.

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

10. 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.

11. 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.

12. 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.

13. Rozmaryn, LM et al. “Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome.” Journal of hand therapy : official journal of the American Society of Hand Therapists vol. 11,3 (1998): 171-9. doi:10.1016/s0894-1130(98)80035-5

14. O'Connor, D et al. “Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome.” The Cochrane database of systematic reviews vol. 2003,1 (2003): CD003219. doi:10.1002/14651858.CD003219.

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

16. 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

17. 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.

18. *** image credits Jackson R, Beckman J, Frederick M, Musolin K, Harrison R. Rates of Carpal Tunnel Syndrome in a State Workers’ Compensation Information System, by Industry and Occupation — California, 2007–2014. MMWR Morb Mortal Wkly Rep 2018;67:1094–1097.

The content and any recommendations in this article are for informational purposes only. They are not intended to replace the advice of the reader's own licensed healthcare professional or physician and are not intended to be taken as direct diagnostic or treatment directives. Any treatments described in this article may have known and unknown side effects and/or health hazards. Each reader is solely responsible for his or her own healthcare choices and decisions. The author advises the reader to discuss these ideas with a licensed naturopathic physician.