Condition - Carpal Tunnel Syndrome
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome (CTS) is a common condition that affects the nerves of the hand. It causes pain or weakness in the hand, and numbness and tingling sensation in the hand and fingers. Symptoms of CTS can range from mild to severe.
What is the Carpal Tunnel?
The carpal tunnel is a small narrow passageway in the palm side of your wrist through which tendons that you use to move your fingers and wrist pass. The median nerve also passes through the tunnel, and controls sensations to the palm side of the thumb and fingers (except the little finger), as well as movement of the fingers and thumb.
In CTS, the median nerve is compressed (squashed) where it runs through the carpal tunnel at the wrist. Compression can occur because the space in the carpal tunnel reduces, or because tendons running through the same route increase in size. When the median nerve is compressed it can cause pain or aching, and tingling or numbness in the affected hand.
What are the Symptoms of Carpal Tunnel Syndrome?
Most people begin to notice symptoms of CTS at night, which either causes them to awaken, or is present when they awaken in the morning. Vigorously shaking the hands and arms often brings temporary relief. The classic symptoms of CTS include pain, numbness, burning feeling, and tingling (pins and needles) in the thumb, index finger, middle finger, and the side of your ring finger nearest your thumb.
As the condition progresses, you may also start to feel tingling during the day, and pain in the hand and wrist that may radiate up the arm. Over time, weakness can develop in some of the small hand muscles controlling the thumb, which may result in clumsiness and weakness of the affected hand, making it difficult to grip objects. This may eventually lead to muscle wasting at the base of the thumb.
Conventional treatment for CTS involves resting the affected hand, and the use of corticosteroid tablets (e.g. prednisolone) or steroid injections into, or near to, the carpal tunnel. If symptoms are severe, your doctor may suggest that you have carpal tunnel release surgery, which is often performed as an outpatient procedure using regional or general anaesthesia, and involves cutting the carpal ligament to increase the space in the carpal tunnel in order to take pressure off the median nerve in the wrist.
Some research suggests that ultrasound therapy (treatment method using sound waves) may be beneficial in the longer-term management of CTS.
Causes of Carpal Tunnel Syndrome
CTS can be due to a congenital predisposition where the carpal tunnel is simply smaller in some people than in others.
You are also more likely to develop CTS if you’re:
Female: the risk of CTS is approximately three times higher among women than men.
Obese: obesity is linked to a higher than average incidence of CTS.
Pregnant or going through the menopause: this may be due to fluid retention associated with pregnancy or menopause, which places additional pressure on the carpal tunnel.
You may also develop carpal tunnel syndrome if you have:
Nerve damage from a lack of vitamin B12, diabetes, Lyme disease, or other conditions that damage nerves.
A condition that reduces the space in the carpal tunnel, including fatty lumps, cysts, tumour, swelling of nerve capsules or arteries, or fluid retention.
Trauma or injury to the wrist and surrounding tissues that results in swelling.
Over activity of the pituitary gland.
Rheumatoid arthritis in the wrist joint.
Mechanical problems in the wrist joint.
Genetics may also play a part. CTS is more common in those with short stature and a family history of the condition.
Wrist shape may also be associated with the occurrence of CTS. A study at Imam Khomeini Hospital in Iran showed that a square shaped wrist pre-disposes an individual to CTS.
There is not enough clinical data to determine whether activities that involve repetitive forceful hand movements increase an individual’s predisposition to the condition.
Vitamin B6 (pyridoxine). There is some evidence to suggest that pyridoxine may be of benefit for nerve compression injuries, by supporting normal pain levels. Avoid very high doses (200 mg or more per day), as this can actually cause symptoms of neuropathy.
Vitamin B2 (riboflavin). Some studies suggest that low levels of riboflavin in the blood may be associated with CTS. Furthermore, riboflavin is necessary for the conversion of inactive vitamin B6 (pyridoxine) to its active form (pyridoxal 5’-phosphate).
Vitamin B12. CTS may be caused by nerve damage resulting from a lack of vitamin B12.
B-vitamin (B Complex). The B-vitamins are important for normal nerve function.
Fish oil. A study reported in the Clinical Journal of Pain suggests that omega 3 fatty acids (including EPA and DHA) may be of benefit in the management of patients with neuropathic pain (pain triggered by nerve injury) caused by CTS. Omega 3 fatty acids may help to support the natural production of anti-inflammatory substances in the body and keep levels of the inflammation-creating enzymes, 5-lipoxygenase and COX-2, within a normal healthy range. Fish oil is a good source of omega 3 fatty acids.
Conjugated linoleic acid (CLA) is a type of omega 6 fatty acid found in red meats and dairy products. Studies suggest that this fatty acid may help support anti-inflammatory processes by reducing levels of certain inflammatory substances, and keeping levels of the inflammation-creating enzymes, 5-lipoxygenase and COX-2, within a healthy range.
Devil’s claw root. Chemicals called harpagosides may help to support normal anti-inflammatory processes. Flavonoids are plant-based chemicals with potent antioxidant properties that help to mop up free radicals naturally produced by the inflammatory process. Devil’s claw root is a source of harpagosides and flavonoids.
Boswellia. Boswellic acids may help support anti-inflammatory processes by keeping levels of the inflammation-creating enzyme (called 5-lipoxygenase) within a normal healthy range. Boswellic acids are components of Boswellia.
Quercetin & Bromelain. Quercetin is a type of plant-based chemical, also known as a flavonoid, which provides the body with antioxidant protection. Bromelain is a mixture of proteinases (enzymes that help breakdown proteins) derived from pineapple stem. Both quercetin and bromelain may help support anti-inflammatory processes by reducing levels of certain inflammatory substances.
Ginger (Zingiber officinale) may help support normal anti-inflammatory processes.
Cat’s claw (Uncaria tomentosa) is a vine that grows in the Amazon rainforest The bark of cat’s claw is a source of oxindole alkaloids.
Antioxidants. CTS has been associated with ischaemia (reduction in blood supply and oxygen) of the median nerve, resulting in the generation of free radicals and oxidative stress, which can cause further nerve damage. Antioxidants help to mop up these free radicals.
Alpha-lipoic acid. This is an antioxidant that may help support healthy microcirculation to the nerves.
Add turmeric and fresh ginger to your foods and drinks. Turmeric is rich in polyphenolic compounds, known as curcuminoids, which give turmeric its bright yellow colour. Curcumin, the main curcuminoid found in turmeric, may help support anti-inflammatory processes.
Include onions in the diet. Onions are a rich source of chemicals including thiosulfinates and cepaenes, and research suggests that these may help support anti-inflammatory processes.
Eat a variety of brightly coloured fruits and vegetables that are rich in antioxidants, including red grapes, apples, berries (blueberries, blackberries, bilberries, and blackcurrants), and green tea. These are also good sources of flavonoids including quercetin.
Eat foods high in B-vitamins. Good dietary sources of B-vitamins are: animal products (meat, poultry), fish, nuts, dairy products, legumes, whole grains, wheat germ, spinach, broccoli, asparagus, potatoes, bananas, dried apricots, dates and figs.
The increased use of vegetable oils and soft margarine coupled with declining fish consumption has substantially increased our intake of omega 6 polyunsaturated fatty acids relative to our intake of omega 3 polyunsaturated fatty acids. A high omega 6:omega 3 ratio may increase levels of certain inflammatory substances. Replace vegetable oils (including margarines and vegetable shortening) with extra-virgin olive oil, cold-pressed flaxseed oil, cold-pressed walnut oil, and fish oil (via consumption of cold-water oily fish: sardines, mackerel, anchovies and salmon; and fish-oil supplements).
Avoid foods that contain trans-fatty acids including hydrogenated fats and oils (read the food labels).
Reduce your intake of animal fats. If you eat meat, favour free-range and grass-fed meat (these are actually good sources of omega 3 fats and conjugated linoleic acid).
Nuts and seeds have natural anti-inflammatory properties. Walnuts, in particular, are likely to provide many health benefits, and are a good source of omega 3 fats.
Eliminate fried foods, and processed/refined foods including white bread, pasta, and sugar.
Increase your intake of soluble fibre. A new study from the University of Illinois suggests that soluble fibre reduces inflammation by increasing the production of an anti-inflammatory protein called interleukin-4. Good sources of soluble fibre are fruits (like apples and strawberries), vegetables (such as carrots), nuts, seeds, rolled oats, oat bran, oatmeal, barley, legumes (beans, peas, and lentils), and flax seeds (preferably organic and cold milled).
According to a study from the Harvard School of Public Health, a diet rich in cooked vegetables and olive oil may help to reduce pain and swelling. The researchers suggested that cooked vegetables and olive oil contain fats (polyunsaturated fats and monounsaturated fats) that are used by the body to make hormone-like substances that may help to block pain and swelling. They are also rich in antioxidants that could have beneficial effects.
Reduce the number of tasks requiring highly repetitive, forceful movements of the hand and wrist, which can leave the tendons inflamed and swollen.
Acupuncture may help alleviate the symptoms of CTS. A recent randomised study reported in the November 2010 issue of the Journal of Pain, involving 77 patients with mild-to-moderate CTS, showed that short-term acupuncture treatment resulted in significant long-term improvements in CTS compared to subjects receiving treatment with steroids.
Yoga has been shown to reduce pain and improve grip strength.
Massage may help relieve symptoms.
Wrap ice packs around your wrists for 5 minutes every few hours to reduce pain and inflammation.
Use of wrist splints may help to keep the wrist straight and reduce pressure on the compressed nerve.
Sleeping with the wrists flexed can contribute to the nighttime symptoms.
While at work, the following tips may help to reduce pain:
a. Try to keep your wrists in a neutral position when using the computer, and not bent forward or back.
b. Leave your desk and stretch at least once every hour. In between, take shorter breaks and rest your hands in your lap, palms up.
c. Adjust the height of your chair so that your forearms are level with your keyboard, and use a suitable wrist support.
Loose weight if you're overweight or obese. There is a link between excess body weight and a higher than average incidence of CTS. Furthermore, excess abdominal visceral fat has been linked to systemic inflammation, and high-intensity exercise training may be effective at reducing abdominal visceral fat.