Definition

A painful condition of the wrist, characterized by compression or irritation of the median nerve, which supplies feeling and movement to parts of the hand.


Symptoms

Wrist pain (usually a burning pain); pins and needles in the thumb, index finger, and half of the middle finger; numbness and weakness gripping. Symptoms are usually worse at night and can be relieved by repetitively shaking out hands.


Etiologic Considerations — Primary

Repetitive strain

Computer use, typing, sewing, vibration tools, cleaning.

Trauma

Wrist sprains/strains/fractures.

Wrist conditions/space occupying lesions: tumors, flexor tenosynovitis, ganglions.


Etiologic Considerations — Secondary

Pregnancy • Recent menopause • Hypothyroid • Overactive pituitary gland • Rubella • Renal dialysis • Acromegaly • Amyloidosis • Diabetes • Obesity • Rheumatoid arthritis • Congenitally narrowed carpal tunnel • Alcoholism • Idiopathic • Other factors: lack of aerobic fitness


Discussion

Carpal tunnel syndrome (CTS) is a very common malady in today’s society. The most common presentation is a middle-aged woman who wakes during the night with pins and needles in the fingers (specifically the thumb, index finger, and half of the middle finger). Shaking of the hands will help the symptoms settle and allow sleep to return, but in most cases the sufferer will wake several times. While these symptoms are largely pathognomonic, a full assessment and diagnosis is essential. Similar symptoms can arise from compression of the nerves in the neck with disc bulging, shoulder (thoracic outlet syndrome), or the elbow in pronator syndrome.

When a medical condition is called a syndrome you know immediately that there is no specific cause, it is rather a collection of symptoms and signs due to multiple reasons. CTS is a condition of adults and very rarely develops in children. Women are much more likely to be affected, likely due to the smaller size of the carpal tunnel. This tunnel is formed by the carpal bones as the arch and the strong transverse carpal ligament as the main support, holding the bones into a concavity. Repetitive activities, such as typing, exercise the tendons of the flexor muscles that share the carpal tunnel, leading to hypertrophy and irritation of the median nerve. Conditions that lead to inflammation in the wrist can cause CTS; arthritis and rheumatoid arthritis being common offenders, but also fractures and sprains can be at fault. During late pregnancy and hypothyroidism, hormonal changes can lead to fluid retention; this excess fluid compresses the nerve.

The traditional medical model of addressing this problem involves direct injection of corticosteroids or surgery. Corticosteroids are a powerful anti-inflammatory medication; when injected into the carpal tunnel they can temporarily ease the wrist pain, but the relief is temporary, and the tendons and ligaments are weakened as a side effect. The surgical treatment involves severing the transverse carpal ligament to open the carpal tunnel. This can be effective but should only be considered is the condition has not responded to an intensive 8 weeks of conservative treatment as outlined below, or if severe nerve damage and muscle wasting is present.

This book is focused on the natural approaches to common medical problems. In the authors’ experience, it is most important to find and treat the under underlying cause of the problem rather than mask the pain with steroids or rely on expensive surgery. If the underlying cause is arthritis or thyroid disease, then these must be treated first. More likely, the cause will be some aggravating daily task that is done repetitively on a daily basis. It may take some trial and error to identify, but if you can find it and modify your activities, you can prevent surgery in most cases.


Treatment

Activity modification: This is the most important intervention for carpal tunnel syndrome in most people. If you are constantly irritating the nerve during the day, it is vital to find some way to stop the aggravating activities (the underlying cause). Otherwise the symptoms will linger, and treatment will be ineffective. If you expect any outside intervention or treatment to resolve this problem and do not change the lifestyle factors causing the damage, the tissue will not have time to recover.

Identify all repetitive daily activities that involve clenching the first or flexing the fingers. Try to modify your desk, office, or work to reduce the aggravating activities and rest the wrist. If you can do this effectively, you will allow the wrist time and opportunity to heal naturally.

Physical therapy: Gently mobilizing the wrist is the mainstay of physical therapy. Stretching the carpal tunnel eases the pressure and irritation of the median nerve.

Biscuit-breaking technique. The practitioner grasps the patient’s wrist, palm down and gently pulls with the fingers up and out while pressing down with the thumbs. This is the same action as breaking a biscuit or cracker with the hands. This technique stretches the carpal tunnel.

Similar action except pressing the thumbs outward, as the fingers press up and in. Imagine breaking a biscuit toward yourself, opening the wrist and carpal tunnel.

Massage therapy has no proven benefit. CTS is often associated with a high BMI (Body Mass Index) so an aerobic exercise program should be started. Swimming, cycling, or running are good options.

Ergonomics: When using a computer, ensure the wrist is straight; any flexion or extension will compress contents of the carpal tunnel.

Splints: CTS splints keep the wrist in a straight position and rigidly stop wrist flexion and extension. These can be very useful the rehabilitation of CTS, and they can the purchased at most pharmacies. They should be worn at night for at least 2 to 6 weeks.

Ultrasound: There is some evidence that ultrasound will help relieve CTS. It should be applied for 5-minute sessions, 5 days a week for 2 weeks minimum.

Vitamin B6 supplementation: Several studies have shown CTS can be associated with B6 deficiency. It is unclear if supplementation will help CTS symptoms, but if deficiency is present, it should be corrected to improve general health. Eat foods high in vitamin B6, such as chickpeas, beef liver, yellowfin tuna, salmon, or wholegrain cereals. If dietary intake is insufficient, take one B-complex vitamin supplement daily. It can take 6 weeks to take effect. High intake from food sources has not been shown to be dangerous, but B6 supplementation over 100 mg per day can be toxic (less for children).

Wrist stretching: These stretches help open the wrist and stretch the flexor muscles and wrist ligaments.

Perform the stretches as depicted and hold for 30 seconds. Repeat 3 times a day.

Finger stretch. Spread fingers wide and hold for 5 seconds. Repeat 3 times a day.

Tendon Glide Exercises: These exercises may prevent the need for surgery. Begin with your hand open in the “stop” position. After each exercise, return to this position for 2–3 seconds.

Slowly bend the fingers until the tips just touch the pads of the palm. Hold for 2–3 seconds then return to position 1.

Clench the fist and hold gently for 2–3 seconds then return to the open hand position.

From the starting position, bend your fingers from the knuckle, keeping the fingers straight. Hold for 2–3 seconds then return to the starting position.

Bend the fingers forward to grab the heel of the palm. Hold again for 2–3 seconds. Complete the whole series five times in quick succession, repeat three times per day.

Suitable Treatments
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Excerpts from Better Health Through Natural Healing 3rd Edition

First published in 1985, Better Health through Natural Healing has become one of the most successful and authoritative resources of its type, with more than 1.5 million copies sold worldwide. Since the original publication of this comprehensive guide, alternative therapies have become more and more accepted by the mainstream, and patients and practitioners of the wider medical community are embracing complementary medicine as an effective treatment option for a range of medical conditions.

The book is available at the West End clinic, exclusively in Australia.


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