Carpal Tunnel Syndrome Health Article

Treatment

Carpal tunnel syndrome is initially treated with splints, which support the wrist and prevent it from flexing inward into the position that exacerbates median nerve compression. Some people get significant relief by wearing such splints to sleep at night, while others will need to wear the splints all day, especially if they are performing jobs that stress the wrist.

The activity which caused the condition should be avoided whenever possible. Also, the actions of making a fist, holding objects, and typing should be reduced. The patient's work area should be modified to reduce stress on the body. This may be achieved by correct positioning and with ergonomically designed furniture. Performing hand and wrist exercises periodically throughout the day can be beneficial.

Researchers found that the carpal ligament can be lengthened or released without surgery through osteopathic manipulation and weight loading. Combining the two gives additional benefit because manipulation lengthens the ligament at one end and weight loading increases the length at the other end. Patients can be taught a stretching exercise for self-manipulation of the ligament.

A National Institute of Health (NIH) panel concluded that traditional acupuncture may be a useful alternative or complementary treatment for carpal tunnel syndrome. Studies have shown that both laser acupuncture and microamp transcutaneous electrical nerve stimulation (TENS) can significantly reduce the pain associated with carpal tunnel syndrome. Both of these therapies are painless. Greater than 90% of the patients treated reported no pain or pain that had been reduced by more than half. Patients in this study were also using Chinese herbal medicines, deep acupuncture (including needle acupuncture), moxibustion, and omega-3 fish oil capsules. All patients were able to return to work and the pain of most patients remained stable for up to two years. Persons over the age of 60 years had a poorer response.

Some studies have shown that persons with carpal tunnel syndrome are deficient in vitamin B₆ (pyridoxine) and that supplementation with this vitamin is beneficial. Carpal tunnel syndrome should improve within two to three months by taking 100 mg three times daily. The patient should consult with his or her physician when taking high doses of this vitamin.

Chinese and homeopathic remedies include:

• arnica; 30c dose
• astra essence
• Rhus toxicodendron; 6c dose
• Ruta graveolens; 6c dose

Allopathic treatment

Ibuprofen or other nonsteroidal anti-inflammatory drugs may be prescribed to decrease pain and swelling. Diuretics may be used if the syndrome is related to the menstrual cycle. When carpal tunnel syndrome is more advanced, steroids may be injected into the wrist to decrease inflammation.

The most severe cases of carpal tunnel syndrome may require surgery to decrease the compression of the median nerve and restore its normal function. Such a repair involves cutting that ligament that crosses the wrist, thus allowing the median nerve more room and decreasing compression. This surgery is done almost exclusively on an outpatient basis and is often performed without the patient having to be made unconscious. Careful injection of numbing medicines (local anesthesia) or nerve blocks (the injection of anesthetics directly into the nerve) create sufficient numbness to allow the surgery to be performed painlessly, without the risks associated with general anesthesia. Recovery from this type of surgery is usually quick and without complications.

In 2002, researchers in the Netherlands reported that after studying about 80 patients over two years, surgery proved more successful than nighttime splints in freeing up compressed nerves of patients with carpal tunnel syndrome. Many patients in the splint group ended up choosing the surgery option after several months of wearing splints.

Expected results

Without treatment, continued pressure on the median nerve puts the patient at risk for permanent disability in the affected hand. Alternative medicines have been shown to reduce pain. Most people are able to control the symptoms of carpal tunnel syndrome with splinting and anti-inflammatory agents. For those who go on to require surgery, about 95% will have complete cessation of symptoms.

Prevention

Avoiding or reducing the repetitive motions that put the wrist into a bent position may help to prevent carpal tunnel syndrome. People who must work long hours at a computer keyboard, for example, may need to take advantage of recent advances in ergonomics and position the keyboard and computer components in a way that increases efficiency and decreases stress. Early use of a splint may also be helpful for persons whose jobs put them at risk of carpal tunnel syndrome.

BOOKS

Asbury, Arthur K. "Carpal Tunnel Syndrome." In Harrison's Principles of Internal Medicine. edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1998.

Crouch, Tammy. Carpal Tunnel Syndrome and Repetitive Stress Injuries. Berkeley, CA: Frog, 1995.