Carpal tunnel syndrome (CTS) is an injury caused by a pinched nerve in the
wrist, resulting in pain and numbness in the index and middle fingers and
weakness of the thumb. The 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
Some easy-to-recognize signs and symptoms of CTS include the
Nighttime painful tingling in one or both hands, frequently causing
Feeling of uselessness in the fingers
A sense that fingers are swollen even though little or no swelling is
Daytime tingling in the hands, followed by a decreased ability to
Loss of strength in the muscle at the base of the thumb, near the
Pain shooting from the hand up the arm as far as the
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.
Who's Most At Risk?
People working with small hand tools in manufacturing and those using a
computer keyboard on a regular basis are especially at risk.
Women are more likely than men to develop CTS. It most commonly occurs in
people between the ages of 40 and 60. CTS is associated with health conditions
such as Lyme disease, rubella, pregnancy, and menopause. High caffeine, tobacco,
or alcohol intake are contributing risk factors.
What to Expect at Your Provider's Office
If you are experiencing symptoms of CTS, you should see your health care
provider. He or she can help guide you in determining which treatment or
combination of therapies will work best for you.
Your provider will perform a physical examination and some simple tests to
determine if there is a loss of sensation or some weakness in your thumb or
fingers. He or she may also perform more sophisticated diagnostic procedures
ranging from a nerve conduction study to electromyography (EMG). X rays or
magnetic resonance imaging (MRI) may be used to reveal the cause and the nature
of the injury.
Your 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 to 4 weeks, then at night only.
You can help prevent CTS or alleviate symptoms by making some simple changes
in your work and leisure habits.
Stretch or flex your arms and fingers before beginning work and at
Alternate tasks to reduce the amount of repetitive
Modify or change daily activities that put pressure on your
Modify your work environment. If you use a computer, have an
adjustable keyboard table and chair, and a wrist
Your provider may prescribe the following medications:
Anti-inflammatory drugs, such as ibuprofen, to reduce inflammation
(swelling, pain, and redness)
Corticosteroids, a type of steroid, injected at the site of the carpal
tunnel to reduce tendon swelling
Diuretics, if needed
Surgical and Other Procedures
Patients who do not improve with medication and splinting may require
surgery. Surgery provides complete relief in 95 percent of
Complementary and Alternative Therapies
A comprehensive treatment plan for CTS may include a range of complementary
and alternative therapies.
Use of vitamin B6 supplements (50 to 200 mg a day) for up to 3
months provides patients with pain relief and increased function in 85 percent
of cases. B-complex may be used as an adjunct to B6. The following
nutrients may have an anti-inflammatory effect: essential fatty acids (1,500 to
3,000 mg a day), and curcumin (250 to 500 mg) and bromelain (250 to 500 mg),
both taken between meals. Lipoic acid (100 mg twice a day) can help reduce
swelling. Modifying your diet to reduce or eliminate saturated fats and fried
foods will also decrease inflammation.
A combination of the following herbs in equal parts may decrease
inflammation, provide some pain relief, and enhance healing.
Cramp bark (Viburnum opulus)
St. John's wort (Hypericum perforatum)
Wild yam (Dioscorea villosa)
These herbs are available as dried extracts (pills, capsules, or tablets),
teas, or tinctures (alcohol extraction, unless otherwise noted). If you use the
teas, add 1 heaping tsp. of herb to 1 cup of water and steep for 10 minutes
(roots need 20 minutes). The recommended dose is 1 to 3 cups of tea per day or
30 drops of tincture three times per day.
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 three to five pellets of 12X to 30C every one to four
hours until symptoms clear up.
Apis mellifica for joints that are red, hot, or
Arnica montana, four times per day, for a bruised, beat-up
feeling, soreness, achy muscles after trauma or overuse; this treatment may be
especially effective if the gel or cream form is used
Guaiacum for CTS that is improved by the use of cold
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 three minutes followed by
one minute in cold water, and repeat three times. Do this two to three times
According the National Institutes of Health, acupuncture may be useful in
treating 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
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
Massage may help prevent or relieve symptoms, especially when rosemary and/or
St. John's wort oil are used.
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
If your wrist is placed in a splint or you receive corticosteroids, you'll
need ongoing evaluation by your health care provider until treatment is
completed. If you undergo surgery for CTS, a single follow-up visit is normally
all that is required.
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Review Date: March 2000
Reviewed By: Participants in the review process include: Gary Guebert, DC, DACBR,
(Chiropractic section October 2001) Login Chiropractic College, Maryland
Heights, MO; R. Lynn Shumake, PD, Director, Alternative Medicine Apothecary,
Blue Mountain Apothecary & Healing Arts, University of Maryland Medical
Center, Glenwood, MD; Joseph Trainor, DC, (Chiropractic section October 2001)
Integrative Therapeutics, Inc., Natick, MA; Marcellus Walker, MD, LAc,
(Acupuncture section October 2001) St. Vincent's Catholic Medical Center, New
York, NY; Leonard Wisneski, MD, FACP, George Washington University, Rockville,
MD; Terry Yochum, DC, Rocky Mountain Chiropractic Center, Arvada, CO; Ira Zunin,
MD, MPH, MBA, (Acupuncture section October 2001) President and Chairman, Hawaii
State Consortium for Integrative Medicine, Honolulu,
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