Conditions

Carpal Tunnel Syndrome (CTS)

Carpal Tunnel Syndrome (CTS) is a repetitive strain injury, which develops over a period of time due to the repetition of stressful movements of the hand or wrists. It involves damage to the nerve that carries brain signals between the brain and the hands. This median nerve passes through the carpal tunnel that is created by the wrist bone and can become constrained if the tissues in the tunnel become swollen or inflamed.

CTS is commonplace among people who use computers extensively. Carpal tunnel syndrome can also be caused by strong, steady vibrations that shake the wrist (such as using a jackhammer or chainsaw). Other occupations that have been linked to CTS include assembly line workers, athletes, drivers, hairstylists, musicians, restaurant servers and writers.

Although CTS affects both sexes, women between the ages of twenty-nine and sixty-two seem to be affected more than any other segment of the population. People with square wrists (wrists that are roughly as deep as they are wide) are said to be more disposed to getting CTS than people whose wrists are wider than they are deep. Factors that increase the risk of CTS include menopause, obesity, Raynaud's disease, pregnancy, hypothyroidism, and diabetes mellitus.

Signs and Symptoms:

• Numbness
• Tingling
• Pain in the thumb, index and middle fingers
• Pain often increases at night
• Can affect one or both hands
• Muscle weakness (particularly in the thumbs)

Diagnosis:

The doctor will perform a physical examination to check for a loss of sensitivity in the thumb and all or some of the digits. There may be weakness on abduction or opposition of the thumb. In serious cases the atrophy may be present.

Your doctor may also order an electromyography (EMG). This procedure involves sending electrical impulses through the arm and measuring the speed at which they travel. Other tests your physician may order are - sedimentation rate tests, thyroid function studies, rheumatoid factor tests, and uric acid tests. Magnetic resonance imaging may help define cause and an X-ray or CT scan can help reveal heterotophic calcification.

Other diagnostic procedures are:

• Phalen's test- forearms are vertical while the wrists are fully flexed for 60 seconds; paresthesia or numbness are positive signs of carpal tunnel syndrome.
  
• Tinel's test- median nerve at the volar crease of the wrist is repeatedly tapped;
  
• Nerve conduction study- shows presence and extent of peripheral nerve pathology.

Treatment Options:

Treatment for carpal tunnel syndrome can range from pain management, splinting and/or surgical procedures.

Traditional Treatments:

Complementary and Alternative Therapies:

Alternative therapies can help where traditional treatments have failed. Many doctors today are looking to complementary and alternative therapies for alternatives to surgery.

Nutritional Supplementation:

• The antioxidants, especially vitamins C, D, and E, and selenium, are essential for the repair and healing of inflamed tissue.
• Take 1,000 mg of vitamin C
• 400 IU of vitamin E, twice a day (begin with 100 or 200 mg and gradually increase to recommended amount).
  Warning: If you have high blood pressure limit your intake of supplemental vitamin E to a total of 400 IU. If you are taking a blood thinner, consult your doctor before taking vitamin E.
• 400 IU of vitamin D
• 200 mg of selenium daily
• Take 300 to 500 mg of calcium and 200 to 250 mg of magnesium, twice daily, until your symptoms improve. This will help strengthen the nervous system.
• If your symptoms seem worse due to pregnancy, menstrual cycle or menopause, take 99 mg of potassium chelate, aspartate, or citrate twice daily as long as you have symptoms. This natural diuretic can gently reduce bloating and water retention due to hormonal changes.
• Vitamin B6 (pyridoxine) is effective in relieving nerve disorders and fluid retention. Take 50 to 75 mg twice daily until symptoms improve. Then gradually lower the dose by approximately 25 mg a week.
  Note: It's recommended that if you take any of the B vitamins individually you should also take a vitamin B complex at a different time of day.
• Bromelain may work as a surgical intervention for CTS with its ability to lessen swelling and inflammation. Take as directed.
  Grape seed extract contains powerful oligomeric proanthocyanidins that inhibit swelling and inflammation.

Alternative Therapies:

• An herbal combination of tumeric, devil's claw, capsicum, ginkgo, hawthorn and boswella can dramatically improve CTS when taken as directed.
• Butcher's broom can help relieve inflammation.
• Corn silk and parsley are natural diuretics that help keep swelling down.
• Marshmallow root soothes and softens tissue and promotes healing.
• Rhus toxicodendron, a homeopathic remedy, helps in any conditions where stiffness exists in a joint when it is first used. This substance is also helpful in soothing injuries caused by overuse of the joints.
• Wintergreen oil can aid in pain relief.
• Zhen Gu Shi, a potent Chinese liniment for inflamed joints, is good for easing CTS symptoms.

General Recommendations:

• Change positions frequently during repetitive motion activities.
• If you work at a keyboard, use a foam wrist rest and a rigid splint to keep your hands supported and in the proper position.
  Consider consulting an acupuncturist. Acupuncture has been shown to be very effective for CTS.
• Wrist manipulation by a sports chiropractic specialist can be a big benefit to CTS sufferers.
• Keep your workplace warm and dry.
• Avoid taking supplements that contain iron. They are suspected of aggravating pain and swelling in joints.
• Maintain your ideal weight and lose weight if necessary.

Warnings:

• If you have high blood pressure, limit your intake of supplemental vitamin E to a total of 400 IU.
• If you are taking a blood thinner, consult your doctor before taking vitamin E.