What is Carpal Tunnel Syndrome
Carpal Tunnel Syndrome (CTS) occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. The median nerve runs into the hand to supply sensation to the thumb, index finger, long finger and half of the ring finger. The nerve also supplies a branch to the muscles of the thumb, the thenar muscles. The carpal tunnel itself is a narrow, rigid passageway of ligament and bones at the base of the hand containing the median nerve and tendons. Thickening can occur here from irritated tendons or other swelling that narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist, radiating all way up the arm. The carpal tunnel is an opening into the hand that is made up of the bones of the wrist on the bottom and the Transverse Carpal Ligament (TCL) is on the top. Through this opening, the median nerve and the flexor tendons run into the hand. The median nerve lies just under the TCL. The flexor tendons allow us to move the hand, such as when we grasp objects. The tendons are covered by a material called tenosynovium, which very slippery and allows the tendons to glide against each other as the hand is used to grasp objects.
Any condition which causes irritation or inflammation of the tendons can result in swelling and thickening of the tenosynovium. This is a condition called tenosynovitis. As all of the tendons begin to swell and thicken, the pressure begins to increase in the carpal tunnel because the bones and ligaments that make up the tunnel are not able to stretch in response to the swelling. Increased pressure in the carpal tunnel begins to squeeze the median nerve against the TCL. Eventually, the pressure reaches a point when the nerve can no longer function normally. This is when pain and numbness in the hand will manifest.
Although painful sensations may indicate other conditions, CTS is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed or traumatised. There are many conditions, which can result in irritation and inflammation of the tenosynovium, and eventually cause CTS. Different types of arthritis can cause inflammation of the tenosynovium, or a fracture of the wrist bones may later cause CTS if the healed fragments result in abnormal irritation on the flexor tendons.
Symptoms often are gradual over time with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. You could experience a sharp, piercing pain that shoots up through your wrist and arm, or a cramping sensation could be present. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists, (this is where splints are useful at night). A person with CTS may wake up feeling the need to "shake out" the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch since the nerves are not registering due to being impeded by compression.
CTS is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rarely a problem with the nerve itself. It can be due to a congenital predisposition - the carpal tunnel is simply smaller in some people than in others. Other contributing factors include trauma or injury to the wrist such as sprain or fracture causing swelling; overactivity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; repetitive strain injury (RSI); fluid retention during pregnancy/menopause; or the development of a cyst or tumour in the canal. In some cases no cause can be identified. Since there is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause CTS, there is some disbelief in medical circles and work environments as to the validity of the case presented. Repeated motions performed in the course of normal work or other daily activities can result in repetitive motion disorders such as bursitis and tendonitis.
Writer's cramp, a condition in which a lack of fine motor skill coordination and ache and pressure in the fingers, wrist, or forearm is brought on by repetitive activity, is not a symptom of CTS.
Commonsense and basic logic here with regard to how the person has used their body over time, for example, through repeated forceful movements or carrying or lifting extremely heavy items, indicate "wear and tear" on the part of the body being repeatedly over used.
Women are three to four times more likely to contract CTS than men. Anatomically, this could be due to the carpel tunnel being smaller in women than men, or that men have more physical strength in their forearms and wrists. A higher percentage of women perform keyboard work, particularly as touch typists. This task, in itself, is not a "normal" task for our hands and arms to perform at speeds of 80/90 words a minute for many years. The dominant hand is often affected first due to more overuse generating pain. This is also apparent in using a computer mouse, a repetitive clicking movement that puts more strain on the dominant hand. Anyone experiencing metabolic disorders such as diabetes that can directly affect the body's nerves will be more susceptible to developing CTS.
In the early stages of CTS, a splint is used to decrease the symptoms, especially the numbness and pain occurring at night. It may also help control the swelling of the tenosynovium and reduce the symptoms of CTS. If this fails to control symptoms a cortisone injection into the carpal tunnel may be suggested. This medication will decrease the swelling of the tenosynovium and may give temporary relief of symptoms. But cortisone is a toxic drug and must be used sparingly. If all of these treatments fail to control the symptoms of CTS, surgery will be required to reduce the pressure on the median nerve. Avoidance of any heavy use of the hand for four weeks after surgery is essential. Pain and numbness will be present initially and will improve over time, but tenderness in the area of the incision can be present for several months. Some people may opt for surgical intervention; they may also have left the problem too long and created further damage and weakness with surgery being their only option. However natural therapies can assist with many cases of CTS.
How Can Natural Therapies help?
Two therapies that can be helpful are Acupuncture and Bowen Therapy. Both are excellent in freeing up inflammation and relieving pain and discomfort. Since the area is highly inflamed, a sports massage would be quite painful, but could be used later once inflammation and much of the pain has been released with either of these modalities, thereby aiding strength.
Naturopathic support is recommended for any nutritional deficiencies, in particular minerals, and individual cases need to be assessed. Specific mineral supplements are given to increase strength and integrity of the cells, tissues, muscles and ligaments. These include calcium, magnesium, silica, boron, selenium, ideally in all rounded formulation. Topical liniments that penetrate deeply into the nerves can help to nourish and give supporting strength to the underlying nerves that are often impeded and pinched during CTS or other injuries weakening the nerves. Dietary changes may be needed, together with assessment of any pharmaceutical medication, in particular any thyroid medication since calcium levels may be affected.
Homeopathic and herbal remedies may be required depending on the individual situation, for example, hormonal imbalance (after pregnancy, menopause), hypo/hyperthyroid, pituitary imbalance, reducing the inflammatory process, malnutrition, nerve and adrenal exhaustion.
Any imbalance of the body must be addressed to encourage efficient healing - it's not just about treating the arms and neck. Splints or support gloves that extend up the forearm are also recommended at night and when performing any light tasks. But, contrary to some types of treatment, patients are encouraged to move their arms and hands to encourage blood flow throughout the day without splints or support gloves, only applying them for specific tasks. Patients are highly recommended to cease normal to heavy tasks that could have brought on the condition or weakened the CTS. Postural assessment is also important and lifestyle habits may need to be addressed and changed.
Excellent results have been achieved with both Bowen Therapy and Acupuncture by incorporating relevant remedies to support underlying weaknesses and deficiencies. Patient compliance is important to assist in overall recovery.
One CTS sufferer I treated with Bowen Therapy improved by 95% within six weeks. She was very compliant and made necessary changes to her work and home activities, including taking relevant remedies, since she was on thyroid medication and presented with an imbalance of calcium. Another habitual symptom she had was grinding her teeth, which can (in some cases), reflect a mineral imbalance. She continued receiving Bowen Therapy every four weeks for maintenance along with taking relevant remedies I prescribed.
Another case took a little longer to see positive results since the young woman was not as compliant. In this case, she wore a glove support and splint at night, and due to her having young children and a busy home life, I recommended she wear her support when doing light household tasks, and remove it when she was sitting relaxing and occasionally through the day to allow gentle movement. Recommending light massage up her arms during these relaxation times encouraged blood flow to the nerves and tissues.
A great challenge is encouraging people to understand that gentle holistic therapies like Bowen and acupuncture are very effective in helping resolve this problem with no need for surgery. Of course, you may have a chronic case present whereby the person has let the injury deteriorate to the point where some surgery may be required, so then Bowen therapy and acupuncture can help speed up healing and strength.
Appropriate exercises must always be given to clients so they can become involved with their recovery and strengthen the body.
It is so easy to forget that you have a problem with your hand or arm since we tend to take for granted how often we use them during the course of the day. By supporting them, or even tying a temporary sling around the weak arm, you remind yourself that you must allow it time to rest and heal. People who continue to perform the same tasks at work while strapped are not allowing healing to take place; the support should not be used as a means to continue doing what probably caused the CTS in the first place. Rest is paramount to healing. A change of attitude and lifestyle may be what you need to address here. Often there is no need for surgery - a sufferer just needs to be patient since the body has an incredible ability to heal itself with the correct support.
Sydney-based Lyn Craven is a practitioner of naturopathy, nutrition, medical herbalism, Bowen therapy, Reiki energy healing and meditation, and is a corporate health presenter/consultant with 19 years' experience in natural therapies. Lyn has recently created a Meditation CD for anxiety, stress and self healing.
Lyn Craven is a practitioner of Naturopathy, Bowen Therapy, Energy/Reiki therapist, meditation teacher and Corporate Health Consultant. She is also a health researcher/writer and has produced a meditation CD assisting people to manage anxiety and stress. She runs a private practice in Sydney and can be contacted on +61403 231 804