Carpal Tunnel Syndrome: Symptoms and Treatment
Our hands were just not designed for the kind of repetitive work we do these days, especially the hours we spend typing. (Sewing, knitting, and guitar playing are other culprits.) And so we have an explosion of carpal tunnel syndrome, a painful wrist and hand condition.
The condition is a form of nerve damage rather than a muscle, ligament, or joint problem. Picture a strand of cooked thin spaghetti. Now imagine threading that spaghetti through a rubber tube-and then squeezing the tube. The result: squished spaghetti. In carpal tunnel syndrome, the spaghetti is the median nerve, one of two nerves that transmit feeling in the hand. The tube is the carpal tunnel, a channel at the front of the wrist. The bottom of the channel is composed of the bones of the wrist, while the “roof” is composed of the carpal ligament.
Anything that squeezes or inflames the carpal tunnel-ranging from injury to medical conditions like rheumatoid arthritis-puts pressure on the nerve, causing pain, numbness, or tingling. Medical conditions that lead to fluid buildup, like pregnancy, hypothyroidism, and diabetes, increase pressure on the nerve from inside the tunnel.
Luckily, about 80 percent of carpal tunnel syndrome cases improve with nonsurgical methods like those described below. The rest, however, may need surgery.
Do This Now
To alleviate the pain of carpal tunnel syndrome, do the following.
- Give yourself an ice massage. Freeze a couple of inches of water in a Styrofoam cup and peel off the top of the cup, exposing the edge of the ice but leaving the bottom of the ice covered so you can hold it. Grasp the bottom part of the cup and rub the exposed ice over your wrist. Massage for 10 minutes several times a day during flares.
- After icing, perform the range-of-motion exercises described in “Stretches for Carpal Tunnel Syndrome” (page 319) to stretch your hand and wrist.
- When performing repetitive actions (like using a computer mouse), set an alarm to beep every 15 minutes. Get up, stretch, flex your hands and wrists, ball up your hands and squeeze tightly, then release. Repeat several times before resuming your activity.
- Wear a wrist splint at night to keep your wrist in a neutral position.
- Take 500 milligrams bromelain. Make sure the strength is at least 2,000 milk clotting units (MCU) or 1,200 gelatin dissolving units (GDU) per 500-milligram dose. Then take the same dose twice a day for three more days. Take it between meals, not with food, or the enzyme will spend itself dissolving your food.
Why It Works
Ice reduces the swelling that squishes the median nerve. The stretching exercises mobilize the tissue lining the carpal tunnel so the nerve slides more freely and blood flows better, which improves toxin removal and nutrient delivery.
Taking frequent breaks can help prevent further inflammation. If you have a bad case of carpal tunnel syndrome, you may need to stop the offending activity altogether for a couple of weeks.
The splints, available in drugstores or medical supply stores, are designed to keep the wrist in a neutral position, that is, not bent or turned in one direction or another. This relieves pressure on the carpal tunnel and, in turn, on the median nerve. Splinting works best when started within the first three months of symptoms.
If you have severe carpal tunnel syndrome, you may need an individually molded splint that’s easier to wear during the day. Don’t wear it for more than three hours at a time during the day, however, without taking an hour break, or you could permanently damage function in your fingers or other parts of your wrist.
Bromelain, a protein-digesting enzyme derived from pineapple, combats inflammation in the carpal tunnel from inside your body. Use it during an acute flare to reduce pain and swelling.
Herbs and Supplements
Fish oil. Although there are no studies on the use of fish oil for carpal tunnel syndrome, we recommend it because of its strong anti-inflammatory effects. Also, since it’s fat soluble, it can penetrate nerve tissue well (nerve tissue contains a lot of fat). Take 1,500 to 3,000 milligrams fish oil daily. It’s also good for your heart.
Willow bark extract. A supplement derived from the original source for aspirin, willow bark extract can reduce carpal tunnel pain if used regularly (unlike aspirin, it doesn’t pose a risk of stomach upset, so you can use it longer-term). Use a standardized extract like Asalixx (available online at bionoricausa.com or by calling 800-264-2325) and take one or two pills twice a day.
Pyridoxine. Although the evidence is mixed on its benefits, our clinical experience shows good results with high doses of vitamin B6, which is important for nerve function. We find it can improve pain after movement, although it doesn’t work well at improving pain at night. Start with 50 milligrams a day as part of a B complex, increasing to 100 milligrams of B6 a day if you don’t see any improvement after four weeks. Don’t exceed 200 milligrams a day.
Capsaicin cream. This cream contains the same compound that gives hot peppers their heat. It interferes with the transmission of pain signals. Use the 0.025% concentration (the lowest) because the skin on the inside of the wrist is so thin and sensitive.
Anti-inflammatory diet. Follow the anti-inflammatory diet to reduce the inflammation that contributes to pressure of the carpal tunnel on the median nerve.
Ultrasound therapy. This treatment, in which sound waves are directed to the carpal tunnel, can significantly improve symptoms when given daily for at least two weeks.
Surgery. Surgery for carpal tunnel syndrome is recommended only for people who don’t improve with the other treatments available, have persistent severe symptoms, or show evidence that the median nerve is significantly impaired, affecting their ability to use their hand.
Typically, the surgeon removes the carpal tendon, releasing pressure on the nerve. This can be done with an open incision, or endoscopically, using a small instrument inserted through a small puncture in the wrist. Which procedure is best is controversial, with most reviews finding the endoscopic form is worse when it comes to reversing nerve damage but better at improving grip strength. Plus, it results in less scarring. Another review found no difference in benefits between the two. Bottom line: Discuss with your surgeon which procedure is best for you.
Acupuncture. The 1997 National Institutes of Health Consensus panel on acupuncture agreed that available evidence at the time suggested acupuncture might be a good treatment for carpal tunnel syndrome. More recently, a small study found that laser acupuncture (using lasers instead of needles on pressure points) along with transcutaneous electric nerve stimulation (TENS), which emits low electrical pulses through the skin onto the nerve, resulted in less pain and greater improvement than a sham treatment. In fact, a computer typist and handyman who hadn’t been able to work returned to work and remained in good condition for a year or longer.
Arnica ointment. Although there are no trials on its use for carpal tunnel syndrome, our experience finds that massaging this homeopathic ointment or gel onto the wrist before attempting difficult activities and at night helps with pain.
Yoga. You might not think of yoga when it comes to your wrists, but one study published in the Journal of the American Medical Association found eight weeks of twice-weekly yoga classes and relaxation therapy worked better than splinting or no treatment in improving carpal tunnel syndrome. The participants performed 11 poses designed to strengthen, stretch, and balance each joint in their upper body. Tell your teacher about your condition, and ask her to provide you with exercises appropriate for you.
Steroids. Both oral and injectable steroids are used in the short term to reduce swelling and pain in carpal tunnel syndrome. Prednisone is the most commonly prescribed oral steroid. It usually works within four weeks. You may also receive steroid injections into the opening of the carpal tunnel, with or without an anesthetic like lidocaine, which provides temporary relief. Injections seem to work best if you splint the wrist for several days afterward. Neither injections nor oral steroids should be used for long-term relief, however, because of potentially serious side effects.
Watch your weight. Because carpal tunnel syndrome is associated with obesity and diabetes, maintaining a healthy weight can reduce your risk.
Take frequent breaks from repetitive motions like typing or using a computer mouse (the mouse is actually more dangerous to the carpal tunnel than the keyboard). You can even get computer programs that remind you to do this.
Squeeze a small ball several times a day with each hand. This helps maintain strength and flexibility in the arms and hands.