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Carpal Tunnel Syndrome

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Carpal tunnel syndrome (CTS) is a relatively common disorder characterized by pain, tingling, numbness, or changes in sensation in the hands, wrists, or fingers. CTS results from irritation or compression of the median nerve, which travels from the wrist into the hand through a canal called the carpal tunnel.

Several integrative interventions, including B vitamins and acetyl-L-carnitine, may decrease the pain caused by CTS and improve hand function.

Causes and Risk Factors for CTS

  • Repetitive use and trauma, including occupations that use jackhammers, chainsaws, and assembly line work. Studies on links between prolonged computer keyboard or mouse use and CTS have been inconclusive.
  • Obesity
  • Diabetes and metabolic syndrome
  • Menopause, pregnancy and female hormones, as the age of peak incidence is 40‒60 years old

Symptoms of CTS

  • Pain, numbness, and tingling in the wrist and first three fingers of the affected hand
  • Forearm pain may occur
  • Hand or wrist weakness may also be present

Diagnosis of CTS

  • Positive Tinel’s sign; a tingling sensation when tapping on the carpal tunnel
  • Positive Phalen’s maneuver; numbness and tingling when wrist is flexed
  • Nerve conduction tests to detect delayed median nerve conduction rates
  • Ultrasound of the wrist joint, carpal tunnel, and median nerve

Conventional Treatment for CTS

  • Injectable corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), and lidocaine patches are considered conservative treatment for mild-to-moderate CTS
  • Carpal tunnel release surgery when conservative treatment fails
  • Massage and manual manipulation techniques have improved CTS symptoms and splinting may be recommended

Novel and Emerging Strategies for CTS

  • Sonographically guided percutaneous needle release may provide similar results to minimally invasive surgery with lower risk and recovery time
  • Low-level laser therapy may improve various symptoms and be as effective as surgical treatment for mild-to-moderate CTS
  • Microwave heat treatment, using microwaves to heat skin, significantly improved hand function and decreased pain

Dietary and Lifestyle Considerations

  • General aerobic exercise such as walking, swimming, and bicycling may be useful for reducing CTS symptoms.
  • Better workplace ergonomics may help reduce some of the mechanical factors that precipitate job-related CTS.

Integrative Interventions

  • B vitamins: CTS patients may be deficient in vitamin B6 and B12, and studies have found improvement in CTS symptoms, including less pain and better nerve conduction, with vitamin B6 and B12 supplementation.
  • Alpha-lipoic acid combinations: Clinical trials using alpha-lipoic acid combined with other therapies (including curcumin and gamma-linolenic acid) have significantly improved CTS symptoms and function scores.
  • Acetyl-L-carnitine: In an uncontrolled study, 1097 subjects with peripheral nerve dysfunction, including 109 subjects with CTS, were treated with intramuscular acetyl-L-carnitine daily for 10 days followed by oral acetyl-L-carnitine daily for an additional 20 days. Symptoms were rated as improved by 83% of investigators and 84% of subjects.
  • Serratiopeptidase: Serratiopeptidase was given twice daily for six weeks in a clinical trial and was associated with significant clinical improvement in 65% of CTS subjects. Significant improvement in median nerve conduction velocity was also noted.
  • Omega-3 fatty acids: Omega-3 fatty acids may be useful in treating CTS as molecules derived from them may block pain receptors involved in neuropathic pain.