• Numbness, tingling, and/or burning pain in the first three fingers of the hand, particularly at night
• Appearance or worsening of symptoms caused by flexing of the wrist for 60 seconds and relieved by extending the wrist
Carpal tunnel syndrome (CTS) is a common, painful disorder caused by compression of the median nerve, which passes between the bones and ligaments of the wrist. Compression of this nerve causes weakness; pain in gripping; and burning, tingling, or aching that may radiate to the forearm and shoulder. Symptoms may be occasional or constant and usually occur most at night. CTS is more prevalent among women and occurs frequently between the ages of 40 and 60. It occurs most often in pregnant women, women taking oral contraceptives, menopausal women, or patients on hemodialysis due to kidney failure.1 These groups tend to have a greater need for vitamin B6.
CTS also occurs in people who perform repetitive strenuous work with their hands (e.g., carpenters), and it may occur in people who do repetitive lighter work (e.g., typists and keyboard operators). It may also follow injuries of the wrist. More frequently, however, there is no history of significant trauma.
Any factor that causes the carpal tunnel to get smaller or its contents to swell can lead to carpal tunnel syndrome. Common causes include:2
• Increased volume of canal contents/edema (inflammation of the carpal tunnel tendons, obesity, pregnancy, oral contraceptives)
• Trauma (fracture, repetitive wrist flexion)
• Abnormal anatomy (cysts, fatty tumors, bone spurs)
• Metabolic conditions (diabetes, hypothyroidism)
• Inflammatory conditions (rheumatoid arthritis, gout, connective tissue disease)
Many cases of CTS respond on their own in a month or two. Surgery for CTS should definitely not be considered before more conservative treatment has been tried for six months, and should be reserved for cases that are persistent (not resolving after one year) or deteriorating (worsening clinically, along with nerve conduction studies showing deterioration). To prevent permanent nerve damage, however, surgery should not be delayed beyond three years after first onset of symptoms. Open carpal tunnel release surgery is one of the most commonly performed outpatient surgeries and is less expensive than the newer endoscopic procedures. A detailed review reported no difference in long-term results between the procedures, but pain is reduced the first two weeks following the endoscopic surgery compared with open procedures.3 Surgery with early mobilization allowing movement of the hand and wrist versus immobilization,4 surgery with oral homeopathic arnica and topical arnica ointment,5 and surgery with controlled cold therapy all showed benefits over surgery alone.6
Cross Section of Carpal Tunnel
The most recommended initial treatment is four weeks in a neutral wrist splint worn full-time. Splinting is most effective when started within three months of onset of CTS. Specialized splints have not been proven more effective than a good-quality, well-fitted over-the-counter splint.7,8
Alternating Hot and Cold Water Treatment
Inflammation and swelling are present in many cases of CTS. Alternating hot and cold water treatment (contrast hydrotherapy) provides a simple, efficient way to increase circulation to the area and reduce swelling. Immersion of the hand past the wrist in hot water for three minutes, followed by immersion in cold water for 30 seconds, repeated three to five times, will increase local circulation, thereby increasing local inflow of nutrients, increasing elimination of waste products, and decreasing pain.
The increased incidence of CTS since its initial description in 1950 parallels the increased presence of dietary compounds, drugs, and environmental toxins that block the action of vitamin B6 (hydrazine dyes such as yellow dye #5; drugs such as isoniazid, hydralazine, dopamine, penicillamine, and oral contraceptives; and excessive protein). Several clinical studies demonstrated the efficacy of vitamin B6supplementation for CTS; the initial dose was 50 mg initially, increased to 200 to 300 mg.9–11 Even greater effect was seen when B6 and B2 (riboflavin) were given together,11 possibly owing to riboflavin-dependent enzymes that convert pyridoxine to its active form, pyridoxal-5-phosphate (P5P). While two studies failed to show that B6 was better than a placebo,12,13 given the safety profile and possible effectiveness of B12 it is definitely worth trying in the treatment of CTS. We recommend dosages no greater than 100 mg per day, however. If B6 does not produce results within a few weeks, P5P should be tried at 10 mg per day.
Celadrin is a proprietary mixture of cetylated fatty acids that has been shown to affect several key factors that contribute to inflammation. Studies have assessed both the oral and the topical use of Celadrin in the treatment of osteoarthritis (see the chapter “Osteoarthritis”). Although there are no studies of Celadrin in CTS, we feel that the topical application of Celadrin cream may help when CTS is associated with inflammation. Apply to the affected area twice per day.
A randomized controlled study comparing an oral steroid (prednisolone 20 mg for two weeks, then 10 mg for two weeks) vs. eight sessions of acupuncture over four weeks showed acupuncture to be as effective as the steroid in CTS symptom control. In addition, acupuncture improved muscle function but prednisolone did not.14 Another acupuncture study demonstrated a positive response in 35 of 36 patients (14 of whom were previously treated unsuccessfully with surgery).15
• Any factor that causes the carpal tunnel to get smaller or its contents to swell can lead to carpal tunnel syndrome.
• Surgery for CTS should definitely not be considered before six months of more conservative treatment.
• The most recommended initial treatment is four weeks in a neutral wrist splint worn full-time.
• Alternating hot and cold water treatment (contrast hydrotherapy) provides a simple, efficient way to increase circulation to the area and reduce swelling.
• Several clinical studies demonstrated the efficacy of vitamin B6 supplementation for CTS.
• Identify and reduce causes of strain and vibration, and prevent repeated trauma.
• Full-time splinting in a neutral position as a first step.
• Acupuncture can be helpful.
• Contrast hydrotherapy: immerse hand past the wrist for three minutes in hot water; this is followed by a 30-second immersion in cold water. Repeat three to five times per day.
Follow the general recommendations given in the chapter “A Health-Promoting Diet.”
• A high-potency multiple vitamin and mineral formula as described in the chapter “Supplementary Measures”
• Vitamin B6 (pyridoxine): 50 to 100 mg per day; if no response, try 10 mg P5P per day
• Fish oils: 3,000 mg EPA + DHA per day
• One of the following:
Grape seed extract (>95% procyanidolic oligomers): 100 to 300 mg per day
Pine bark extract (>95% procyanidolic oligomers): 100 to 300 mg per day
Some other flavonoid-rich extract with a similar flavonoid content, super greens formula, or another plant-based antioxidant that can provide an oxygen radical absorption capacity (ORAC) of 3,000 to 6,000 units or more per day
• Celadrin: Apply a cream containing Celadrin to the affected areas twice per day.