Written by Karyn Siegel-Maier (c) 2008

Overview

Carpal Tunnel Syndrome (CTS) refers to a condition in which the median nerve, which extends from the underside of the forearm to the wrist, has become compressed at the wrist. In fact, the term gets its name from the narrow channel this nerve passes through—the carpal tunnel. The channel itself is quite rigid, being surrounded by bone on three sides and ligament on the last. However, the nerve that travels through it is responsible for allowing a range of intricate motion to the thumb and first three fingers of the hand. Since the ulna nerve governs the little finger, it is immune to the impact of the median nerve’s compression. Therefore, the pinky can serve as a clue when attempting to diagnose CTS.


What Causes Carpal Tunnel Syndrome?

CTS can occur due to a variety of combination of factors but, generally, thickening of the fibrous tissue inside the carpal tunnel triggers compression of the median nerve. Largely, this inflammation is ultimately caused by repetitive motion involving the hands and wrists. However, injury, arthritis, diabetes, thyroid or pituitary disorders, or cysts may also give rise to CTS symptoms. In addition, some people simply have a smaller carpal tunnel than others, making them more susceptible to this condition.

While CTS is characterized by inflammation of the tissue inside the carpal tunnel, it is not classified as an inflammatory disease because the immune system is not involved. However, inflammatory mediators, such as interluekin-6 and prostaglandin-2, can often be found in this tissue in those afflicted with CTS. In contrast, both people with and without CTS share a common inflammatory mediator being present in this tissue-- interleukin-1. Taken together, these facts suggest that there is an increase of these mediators involved for people prone to CTS. This increase translates to greater amounts of fluid and particles from the blood collecting in the tissue of the carpal tunnel, not only causing compression on the nerve but also promoting the development of fibroblasts and scar tissue.


Symptoms and Diagnosis

CTS develops gradually, with initial signs varying with each individual. Common symptoms, which may affect one or both hands, include:

  • Tingling, aching or burning sensation in the hand, specifically affecting the thumb and fingers, but sparing the little finger.
  • Pain in the wrist, possibly radiating from the arm and to the hand.
  • Diminished grip strength and/or experiencing difficulty grasping or holding onto objects.
  • Loss of feeling in one or more fingers.


Diagnosis

Generally, diagnosis is made from a review of symptoms. However, the following are some tools with which diagnosis of CTS may be confirmed:


  • Tinel's test, in which pain or numbness is checked for by tapping lightly on the wrist over the carpal tunnel.
  • Electromyography, in which electrodes are introduced into specific muscles via a needle to measure electrical impulses.
  • Nerve conduction studies to measure the rate of electrical impulses in the carpal tunnel.


Additional tests (x-rays, MRI, ultrasound, etc.) may also be performed, in addition to a physical examination to look for discoloration, disfigurement or other indications that may suggest an underlying condition other than CTS, such as tendonitis or diabetes.

Risk Factors

Engaging in certain occupations or hobbies may increase the likelihood of developing CTS. For instance, people who work with vibrating power tools, on an assembly line, operate computer software or type heavily for several hours a day are at increased risk.

Other risk factors include:

  • Gender Women are three times as likely to develop CTS than men, possibly because their carpel tunnels are often smaller in size.
  • Medical conditions Individuals with arthritis, that have thyroid disorders, or metabolic disorders, such as diabetes, are at higher risk.

Natural Prevention and Management of Carpal Tunnel Syndrome

There is no certain way to guarantee that CTS won’t occur. However, there are some simple precautionary measures that can be taken to help prevent CTS and/or minimize its symptoms and progression.

  • Ergonomics Proper equipment and workstations that are designed to help keep the wrists in a natural position can be of great help. Ideally, the wrists should be kept at elbow level.
  • Posture Maintaining proper posture can help reduce compression on the nerves serving the arms and hands when the shoulders are kept straight and back.
  • Frequent breaks Take a few moments from work or hobby tasks periodically to rest the hands and wrists.
  • Stretching Gently stretching the arms, hands and fingers out in front of you can help to reduce stiffness and improve blood flow to these areas.
  • Splints The use of splints or braces during the workday or while sleeping an night can help to keep the wrists straight and reduce pressure on the carpal tunnel. This is especially beneficial while sleeping since fluids are redistributed and collect in the upper portion of the body while in a reclining position.

Recommended Supplements in the Treatment of Carpal Tunnel Syndrome

  • Omega-3

Omega-3 fatty acids help to improve symptoms of CTS by reducing oxidative stress and serum levels of cytokines, inflammatory mediators found in higher levels in people with CTS. Omega-3 is also beneficial for people with elevated pressure on the carpal tunnel due to the presence of arthritis.


  • Vitamin B6

Some studies indicate that vitamin B6, taken in conjunction with other B vitamins, may help to reduce pain associated with CTS, although it may take a few months to experience any benefit.

Herbs Used in the Treatment of Carpal Tunnel Syndrome

Ginger

Several studies have shown that extracts of ginger help to reduce inflammation by reducing levels of cytokines.


Curcumin


Derived from the root of the spice turmeric, curcumin provides antioxidant properties. Collectively, the components known as curcuminoids, offer anti-inflammatory benefits since these agents inhibit the production of leukotrienes. It is also believed that this anti-inflammatory action is due to the presence of alpha r-turmerone.


Pineapple

Bromelain, an enzyme obtained from the pineapple plant, reduces levels of prostaglandin E2, thromboxane A2, and fibrogen, leading to reduced inflammation.

Safety Precautions

Omega-3

  • Check with your doctor if you are currently taking warfarin (Coumadin) due to an increased risk for bleeding.
  • Do not take two weeks before or after any surgical procedure.


Ginger

  • Check with your doctor if you are currently taking warfarin (Coumadin) due to an increased risk for bleeding.
  • Do not take if you have a history of gallstones or bile duct obstruction.


Curcumin

  • Check with your doctor if you are currently taking warfarin (Coumadin) due to an increased risk for bleeding.
  • Do not take if you have a history of gallstones, bile duct obstruction or gastroesophageal reflux disease (GERD).


Bromelain

  • Bromelain increases intestinal absorption of certain antibiotics (i.e., tetracyclines), and may increase blood and urine levels of these drugs.
  • Bromelain may interfere with chemotherapy medications, such as 5-flouroacil and vincristine.

References

1. Sud V, Freeland AE. Biochemistry of carpal tunnel syndrome. Microsurgery 2005;25(1):44–6. Review.

2. Nielsen AA, Jorgensen LG, et al. Omega-3 fatty acids inhibit an increase of proinflammatory cytokines in patients with active Crohn's disease compared with omega-6 fatty acids. Aliment Pharmacol Ther 2005 Dec;22(11–12):1121–8.

3. Miggiano GA , Gagliardi L. [Diet, nutrition and rheumatoid arthritis]. Clin Ter 2005 May-Jun;156(3):115–23. Review.

4. Aufiero E, Stitik TP, et al. Pyridoxine hydrochloride treatment of carpal tunnel syndrome: A review. Nutr Rev 2004 Mar;62(3):96–104. Review.

5. Holm G, Moody LE. Carpal tunnel syndrome: Current theory, treatment, and the use of B6. J Am Acad Nurse Pract 2003 Jan;15(1):18–22. Review.

6. Jurna I. [Analgesic and analgesia-potentiating action of B vitamins]. Schmerz 1998 Apr 20;12(2):136–41.

7. Bengmark S. Curcumin, an atoxic antioxidant and natural NF{kappa}B, cyclooxygenase-2, lipooxygenase, and inducible nitric oxide synthase inhibitor: A shield against acute and chronic diseases. JPEN J Parenter Enteral Nutr 2006 Jan-Feb;30(1):45–51.

8. Maurer HR. Bromelain: biochemistry, pharmacology and medical use. Cell Mol Life Sci 2001;58:1234-45.