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Carpal tunnel syndrome (CTS) is an injury caused by a pinched nerve in the wrist. The injury causes pain and numbness in the index and middle fingers and weakness of the thumb. Carpal tunnel receives its name from the eight bones in the wrist, called carpals, which form a "tunnel" through which the nerve leading to the hand extends.
Signs and Symptoms
Signs and symptoms of CTS include:
What Causes It?
The carpal tunnel is filled with tendons (bundles of collagen fibers that attach muscle to bone) that control finger movement. Tasks requiring highly repetitive and forceful movements of the wrist can cause swelling around the tendons, resulting in a pinched nerve and producing CTS. Trauma, certain diseases, and pregnancy may also trigger CTS. On rare occasions, CTS may be genetic (some patients with CTS have carpal canals that are narrower than average).
Who's Most At Risk?
People working with small hand tools in manufacturing and those using a computer keyboard on a regular basis are at highest risk.
Women are 2 - 5 times more likely than men to develop CTS. It most commonly occurs in people ages 30 - 60. CTS is associated with health conditions, such as diabetes, hypothyroidism, rubella, pregnancy, connective tissues diseases, obesity, and menopause. High caffeine, tobacco, or alcohol intake are other contributing risk factors.
What to Expect at Your Provider's Office
If you have symptoms of CTS, you should see your health care provider. Your health care provider can help you determine which treatment or combination of therapies will work best for you.
Your health care provider will perform a physical examination and some simple tests to determine if you have lost any sensation or you have some weakness in your thumb or fingers. Your health care provider may also perform more sophisticated diagnostic procedures ranging from a nerve conduction study to electromyography (EMG). You may also get x-rays or magnetic resonance imaging (MRI) to reveal the cause and the nature of the injury.
Management of CTS is based on severity. Your health care provider may put your wrist in a splint or brace to keep your wrist from bending, and to minimize or prevent pressure on the nerve. You'll probably need to wear the splint full time for 3 - 4 weeks, then at night only. Putting ice on your wrist, massaging the area, and doing stretching exercises may also help.
You can help prevent CTS or alleviate symptoms by making some simple changes in your work and leisure habits, such as:
Your provider may prescribe the following medications:
Surgical and Other Procedures
Patients who do not improve with medication and splinting may need surgery. Surgery provides complete relief in 95% of patients.
Complementary and Alternative Therapies
A comprehensive treatment plan for CTS may include a range of complementary and alternative therapies.
Nutrition and Supplements
Supplements and complementary therapies should only be used under the supervision of a qualified practitioner. Some dietary supplements, herbs, or CAM treatments can potentially interfere with conventional medicines. Keep all providers informed regarding any therapies you may be considering.
Following these nutritional tips may help reduce symptoms:
You may address nutritional deficiencies with the following supplements:
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should speak with your health care provider before starting treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider remedies for the treatment of carpal tunnel symptoms based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for you.
An experienced homeopath can prescribe a regimen for treating CTS that is designed especially for you. Some of the most common acute remedies are listed below. An acute dose is 3 - 5 pellets of 12X to 30C every 1 - 4 four hours until symptoms clear up.
Contrast hydrotherapy -- alternating hot and cold water applications -- may offer relief from CTS symptoms. This approach decreases inflammation, offers pain relief, and enhances healing. Immerse your wrists fully in hot water for 3 minutes, followed by 1 minute in cold water, and repeat 3 times. Do this 2 - 3 times daily.
Castor Oil Packs -- Apply castor oil to a cloth, loosely wrap around wrist, and then cover with Saran Wrap. Apply a heating pad for 1 hour, or without using a heating pad, sleep with the application on the wrist. Do this for 4 - 5 nights per week until improvement occurs.
According to the National Institutes of Health, acupuncture may help treat CTS. Studies suggest that acupuncture restores normal nerve function and can provide long term relief of pain associated with CTS. Acupuncturists treat people with CTS based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of CTS, acupuncturists will often target the liver, gallbladder, and kidney meridians.
CTS is commonly treated by chiropractors. The methods most chiropractors use to treat CTS include manipulation of the wrist, elbow, and upper spine, ultrasound therapy, and wrist supports. Two studies support the use of chiropractic treatment for CTS.
In the first study, 25 individuals diagnosed with CTS reported significant improvements in several measures of strength, range of motion, and pain after receiving chiropractic treatment. Most of these improvements were maintained for at least 6 months.
A second study compared the effects of chiropractic care with conservative medical care (wrist supports and ibuprofen) among 91 people with CTS. Both groups experienced significant improvement in nerve function, finger sensation, and comfort. The researchers concluded that chiropractic treatment and conservative medical care are equally effective for people with CTS.
Massage may help prevent or relieve symptoms, especially in combination with rosemary or St. John's wort oil.
Most people's symptoms clear up within a few months with conventional treatment. If left untreated, CTS in advanced stages can become quite serious, involving a loss of sensation, muscle deterioration, and permanent loss of function.
If your wrist is placed in a splint or you receive corticosteroids, you'll be monitored by your health care provider until treatment is completed. If you have surgery for CTS, you may need only a single follow up visit.
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Review Date: 6/4/2012
Reviewed By: Reviewed by Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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