Carpal Tunnel Syndrome
Description
Carpal tunnel syndrome (CTS), also called entrapment neuropathy, is a common painful disorder caused by compression of the median nerve as it passes between the bones and ligaments of the wrist.
CTS is found in individuals with a long history of strenuous repetitive use of the hands (e.g., carpenters and those in wheelchairs) or it may follow injuries of the wrist. More frequently, however, there is no history of significant trauma.
Causes
Primary Factors
Tenosynovitis
Overuse
Trauma Edema
Rheumatoid arthritis
Various sytemic diseases i.e. (leukemia, multiple myeloma, myxedema, acromegaly, and sarcoidososis)
The symptomatology is caused by pressure on the median nerve as it passes through the space formed by the wrist bones and the inelastic transverse carpal ligament (the carpal tunnel).
Predisposing Factors
CTS is more common in women. Factors predisposing women include:
Pregnancy
Taking oral contraceptives
Menopause
Patients on hemodialysis
People performing unaccustomed repetitive manual activity
All these conditions are associated with a pyridoxine deficiency or an increased need for pyridoxine.
Signs & Symptoms
Numbness
Tingling
Burning pain of the first three fingers of the hand, particularly at night.
Appearance or worsening of symptoms caused by flexion of the wrist for 60 seconds and relieved by extension.
Nutritional Supplements
Structure & Function:
Single Nutrients &
Joint Support
---------------------------------
General Supplements
---------------------------------
| Coenzyme Q10* | |
| Fatty acid (sunflower)* | |
| Folic acid* | |
| Manganese* | |
| Glucosamine Sulfate | 250-500 mg |
| Niacin* | |
| Thiamine* | |
| Vitamin B6 | 100-250 mg |
| Vitamin B12* | |
| Vitamin E* | |
| Zinc* |
* Please refer to the respective topic for specific nutrient amounts.
Note:
All amounts are in addition to those supplements having a Recommended Dietary Allowance (RDA). Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.
Pyridoxine
Vitamin B-6 deficiency is a common finding in carpal tunnel syndrome. In fact, except when due to direct trauma or systemic disease. A person's vitamin B-6 status can be determined through laboratory measurement of erythrocyte glutamic oxaloacetic transaminase (EGOT) activity or plasma pyridoxal phosphate.
Clinical and double blind studies have conclusively demonstrated vitamin B-6 supplementation (usually 50-100 mg/day) relieves all symptoms of CTS in patients with depressed EGOT levels. Typically 80% of those with the condition have abnormal EGOT levels. Even Phalen, who pioneered the surgical treatment for CTS agrees that in the future, pyridoxine (in doses of 100-200 mg/day) may be the treatment of choice for CTS. However, a therapeutic response may require up to 3 months of supplementation.
Note: All amounts are in addition to those supplements having a Recommended Dietary Allowance (RDA). Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.
Dietary Considerations
The increase in the incidence of carpal tunnel syndrome, since its initial description by Phalen in 1950, parallels the increase in the occurrence of vitamin B-6 antagonists in the environment during the same period.
Examples of B-6 antagonists include:
Hydrazine dyes (FD & C yellow #5)
Drugs (INH, hydralazine, dopamine and penicillamine)
Oral contraceptives
Excessive protein intake
Although no particular diet has been tested for the treatment of carpal tunnel syndrome, it is appropriate to avoid foods containing yellow dyes and limit protein consumption to 50 grams/day.
Homeopathic Remedy
Hypericum tinct.
It is also possible to replicate orthomolecular or allopathic medicine e.g. as vitamin B6 is recommended for this condition, a homeopathic preparation of pyridoxine may also be recommended.
Vitamin B6 is available in combination remedies (at 6X) as oral vials, or an injection solution in three forms:
Coenzyme compositum
Discus compositum
Ubichinon compositum
Treatment Schedule
Doses cited are to be administered on a 3X daily schedule, unless otherwise indicated. Dose usually continued for 2 weeks. Liquid preparations usually use 8-10 drops per dose. Solid preps are usually 3 pellets per dose. Children use 1/2 dose.
Legend
X = 1 to 10 dilution - weak (triturition)
C = 1 to 100 dilution - weak (potency)
M = 1 to 1 million dilution (very strong)
X or C underlined means it is most useful potency
Asterisk (*) = Primary remedy. Means most necessary remedy. There may be more than one remedy - if so, use all of them.
References
Boericke, D.E., 1988. Homeopathic Materia Medica.
Coulter, C.R., 1986. Portraits of Homeopathic Medicines.
Kent, J.T., 1989. Repertory of the Homeopathic Materia Medica.
Koehler, G., 1989. Handbook of Homeopathy.
Shingale, J.N., 1992. Bedside Prescriber.
Smith, Trevor, 1989. Homeopathic Medicine.
Ullman, Dana, 1991. The One Minute (or so) Healer.
Herbal Approaches
----------
Herbs
-----------
Bromelain
Lobelia
Passion flower
Turmeric
Note: The misdirected use of an herb can produce severely adverse effects, especially in combination with prescription drugs. This Herbal information is for educational purposes and is not intended as a replacement for medical advice.
Discussion:
Bromelain The proteolytic enzyme of Ananas comosus (pineapple) has well-documented efficacy in virtually all inflammatory conditions, regardless of etiology. The effect of orally-administered bromelain on the reduction of edema, bruising, healing time and pain following various injuries and surgical procedures, has been demonstrated in several clinical studies.
For example, Tassman's studies of patients undergoing oral surgery concluded while post-surgical medication alone is effective, a regimen of pre- and post-surgical medication is recommended. In a double-blind study of patients undergoing oral surgery, bromelain was found to be significantly superior to placebo: swelling decreased in 3.8 days with bromelain, compared with 7 days for the placebo; and the duration of pain was reduced to 5.1 days in the bromelain group, compared with 8.1 in the placebo.
Similar observations were made in studies of episiotomy cases. Bromelain reduced edema inflammation and pain, and pre-operative administration potentiated the effects. This is relevant since approximately 20% of patients with carpal tunnel syndrome will not respond to vitamin B-6 supplementation and will require surgical intervention.
There is also a nerve component, for which Lobelia and Passion flower are recommended.
During the acute inflammatory stage of CTS, herbs which limit the inflammatory process may be of assistance. However, since none have been specifically tested for efficacy in this condition, these recommendations have not been substantiated.
Turmeric (also known as Indian saffron), has been used in both Indian and Chinese medicine for the treatment of many forms of inflammation. Its efficacy is probably due to its well-documented anti-inflammatory properties and vitamin C content.
The volatile oil fraction has been demonstrated to possess anti-inflammatory activity in a variety of experimental models, where its effects were shown to be comparable to hydrocortisone and phenylbutazone. These anti-inflammatory effects are believed due to anti-histamine activity in early inflammation.
Even more potent in acute inflammation is the yellow pigment of turmeric, curcumin. Curcumin, or the alcoholic extract of the curcuma root, is used in several indigenous systems of medicine in the treatment of sprain and inflammation. This use seems to be substantiated by recent investigations that have sought to elucidate the mechanism of action of curcumin, although no clear-cut mechanism has been determined.
Curcumin is as effective as cortisone or phenylbutazone in models of acute inflammation, but only half as effective in chronic models. While phenylbutazone is associated with significant toxicity (ulcer formation, leukopenia, lymphocytopenia), curcumin displays no significant toxicity.
The more potent sodium curcuminate is produced in a poultice made from turmeric mixed with slaked lime, an ancient household remedy for sprains, muscular pain and inflamed joints.
Aromatherapy - Essential Oils
Carpal Tunnel, as well as other repetitive stress syndromes, may be treated using a selection from the following oils:
| Chamomile Essence, | Eucalyptus Essence, |
| Lavender Essence, | Peppermint Essence. |
Related Health Conditions
AbstractsReferences
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