| | | | Other Names | | | Carpal, Carpal Tunnel, CTS.
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| | | In many cases, carpal tunnel syndrome (CTS) results from long-term
repetitive motions of the hands and wrists, such as from computer use.
Although repetitive motion is often a culprit, it does not explain the
frequent occurrence of CTS with non-motion-related conditions, such as
pregnancy.
What are the symptoms of carpal tunnel syndrome?
Symptoms of CTS include recurrent numbness, tingling, weakness, or pain in
one or both hands in a characteristic location defined by the median
nerve, which is compressed as it passes through the carpal tunnel in the
wrist. Symptoms are usually worse at night and after prolonged use of the
hands. Some people may experience clumsiness in handling objects, with a
tendency to drop things, and may also have a decreased ability to feel hot
and cold.
Conventional treatment options: CTS is typically treated
with nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and
ibuprofen, oral diuretic medications, and injections of corticosteroids
into the wrist in order to reduce swelling. Splints are often recommended
to immobilize the wrist, theoretically protecting it from repetitive
motion injury. Sometimes a physical therapy program of hand- and
wrist-strengthening exercises and the use of a wrist brace is recommended.
In more advanced cases, a surgical procedure called a "release" may be
used to separate the ligaments covering the carpal tunnel in the wrist in
order to relieve the pressure on the median nerve.
Nutritional
supplements that may be helpful: Some, but not all, studies have found
vitamin B6 deficiency to be common in people with CTS.1 Supplementation
with vitamin B6 has reportedly relieved the symptoms of CTS,2 but some
researchers have not found this treatment to be beneficial.3
4
Several studies report that people with CTS are helped when given
100 mg of vitamin B6 three times per day.5 6 Although some researchers
have found benefits with lesser amounts,7 8 9 10 using less than 100 mg
taken three times per day for several months has often failed.11 12 13
Most doctors assume that people with CTS who respond to vitamin B6
supplementation do so because of an underlying deficiency. However, at
least one group of researchers has found vitamin B6 to "dramatically"
reduce pain in people with CTS who did not appear to be B6-deficient.14
Some doctors believe that B6 is therapeutic because it reduces swelling
around the carpal tunnel in the wrist; this theory remains completely
undocumented.
Very high levels of vitamin B6 can damage sensory
nerves, leading to numbness in the hands and feet as well as difficulty in
walking; supplementation should be stopped if these symptoms develop after
beginning vitamin B6 supplementation. Vitamin B6 is usually safe in
amounts of 200 to 500 mg per day,15 although occasional problems have been
reported in this range.16 Higher amounts are clearly toxic.17 Any adult
taking more than 200 mg of vitamin B6 per day for more than a few months
should consult a doctor.
In order to be effective, vitamin B6 must
be transformed in the body to pyridoxal-5'-phosphate (PLP). Some doctors
have suggested that people who do not respond well to vitamin B6
supplements should try 50 mg of PLP three times per day. There is no clear
evidence that using PLP provides any advantage in reducing symptoms of
CTS.
Are there any side effects or interactions? Refer to the
individual supplement for information about any side effects or
interactions.
Other integrative approaches that may be helpful:
Acupuncture may be useful in the treatment of CTS. In a preliminary trial,
people with CTS (some of whom had previously undergone surgery) received
either acupuncture or electro-acupuncture (acupuncture with electrical
stimulation). Eighty-three percent of the participants in this trial
experienced complete relief that lasted through two to eight years of
follow-up.18 After reviewing all available scientific literature on the
topic, a consensus conference convened in 1997 by the National Institutes
of Health concluded that acupuncture for CTS "may be useful as an adjunct
treatment or an acceptable alternative or be included in a comprehensive
management program."19
Manipulative procedures may have a role in
treating CTS by decreasing symptoms and improving function. A type of
stretching treatment called myofascial release improved the symptoms of a
patient with CTS in one published case report,20 and similar treatments
combined with specific wrist manipulations and self stretches were further
tested in a small, preliminary trial.21 Participants in this study
experienced a decrease in pain, numbness, and weakness, and their nerve
function improved as well.
A small, preliminary trial assessed a
chiropractic treatment program consisting of exercises, soft tissue
therapy, and manipulation of the wrist, the upper extremity, the spine,
and the ribs.22 The treatment resulted in improvement in grip and thumb
strength, muscle function, flexibility, and overall function, as well as a
decrease in pain among people with CTS. In a follow-up study six months
later, most of the improvement had been maintained.23 A controlled
clinical trial compared traditional medical and chiropractic care for
CTS.24 People with CTS received either standard medical care (ibuprofen
and nighttime wrist supports) or chiropractic care (manipulation of the
wrist, elbow, shoulder, neck, and spine, as well as massage to the soft
tissues). Ultrasound and nighttime splints were also used in the
chiropractic treatments. People in both groups improved significantly and
similarly in terms of pain reduction, increased function, and improved
finger sensation and nerve function, but the chiropractic group reported
fewer side effects.
References:
1. Fuhr JF, Farrow A,
Nelson HS. Vitamin B6 levels in patients with carpal tunnel syndrome. Arch
Surg 1989;124:1329-30.
2. Keniston RC, Nathan PA, Leklem JE,
Lockwood RS. Vitamin B6, vitamin C, and carpal tunnel syndrome. J Occup
Environ Med 1997;39:949-59.
3. Franzblau A, Rock CL, Werner RA, et
al. The relationship of vitamin B6 status to median nerve function and
carpal tunnel syndrome among active industrial workers. J Occup Environ
Med 1996;38:485-91.
4. Smith GP, Rudge PJ, Peters TJ. Biochemical
studies of pyridoxal and pyridoxal phosphate status and therapeutic trial
of pyridoxine in patients with carpal tunnel syndrome. Ann Neurol
1984;15:104-7.
5. Ellis JM, Azuma J, Watanbe T, Folkers K. Survey
and new data on treatment with pyridoxine of patients having a clinical
syndrome including the carpal tunnel and other defects. Res Comm Chem Path
Pharm 1977;17(1):165-77.
6. Ellis JM. Vitamin B6 deficiency in
patients with a clinical syndrome including the carpal tunnel defect.
Biochemical and clinical response to therapy with pyridoxine. Res Comm
Chem Path Pharm 1976;13(4):743-57.
7. D'Souza M. Carpal tunnel
syndrome: clinical or neurophysiological diagnosis. Lancet
1985;i:1104-5.
8. Driskell JA, Wesley RL, Hess IE. Effectiveness of
pyridoxine hydrochloride treatment on carpal tunnel syndrome patients.
Nutr Rep Internat 1986;34(4):1031-9.
9. Ellis JM. Treatment of
carpal tunnel syndrome with vitamin B6. Southern Med J
1987;80(7):882-4.
10. Browning DM. Carpal tunnel syndrome: clinical
or neurophysiological diagnosis? Lancet 1985;i:1104-5 [letter].
11.
Smith GP, Rudge PJ, Peters TJ. Biochemical studies of pyridoxal and
pyridoxal phosphate status and therapeutic trial of pyridoxine in patients
with carpal tunnel syndrome. Ann Neurol 1984;15:104-7.
12. Amadio
PC. Pyridoxine as an adjunct in the treatment of carpal tunnel syndrome. J
Hand Surg 1985;10A(2):237-41.
13. Stransky M, Rubin A, Lava NS,
Lazaro RP. Treatment of carpal tunnel syndrome with vitamin B6: a
double-blind study. Southern Med J 1989;82(7):841-2.
14. Bernstein
AL, Dinesen JS. Brief communication: effect of pharmacologic doses of
vitamin B6 on carpal tunnel syndrome, electronencephalographic results,
and pain. J Am Coll Nutri 1993;12:73-6.
15. Gaby AR. Literature
review & commentary. Townsend Letter for Doctors and
Patients.1990;Jun:338-9.
16. Parry G, Bredesen DE. Sensory
neuropath with low-dose pyridoxine. Neurology 1985;35:1466-8.
17.
Schaumburg H, Kaplan J, Windebank A, et al. Sensory neuropathy from
pyridoxine abuse. N Engl J Med 1983;309(8):445-8.
18. Chen GS. The
effect of acupuncture treatment on carpal tunnel syndrome. Am J Acup
1990;18:5-9.
19. NIH Consensus Conference. Acupuncture. JAMA
1998;280:1518-24.
20. Sucher BM. Myofascial release of carpal
tunnel syndrome. J Am Osteopathic Assoc 1993;93:92-101.
21. Sucher
BM. Palpatory diagnosis and manipulative management of carpal tunnel
syndrome. J Am Osteopathic Assoc 1994;94:647-63.
22. Bonebrake AR,
Fernandez JE, Marley RJ, et al. A treatment for carpal tunnel syndrome:
evaluation of objective and subjective measures. J Manip Physiol Ther
1990;13:507-20.
23. Bonebrake AR, Fernandez JE, Dahalan JB, et al.
A treatment for carpal tunnel syndrome: results of a follow-up study. J
Manip Physiol Ther 1993;16:125-39.
24. Davis PT, Hulbert JR, Kassak
KM, et al. Comparative efficacy of conservative and chiropractic treatment
for carpal tunnel syndrome: a randomized clinical trial. J Manipulative
Physiol Ther 1998;21:317-26.
Source: NOW Foods
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Please Note: This Traditional Use information is provided as a courtesy only. The products indicated above may be listed in error. This information is based on Traditional and Folklore Medicine which uses natural materials to support health. This information has not been evaluated or approved by the FDA and is not based on scientific evidence from any source. These statements have not been evaluated by the Food and Drug Administration (FDA). These products are intended to support general well being and are not intended to treat, diagnose, mitigate, prevent, or cure any condition or disease. If conditions persist, please seek advice from your medical doctor.
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