Chances are your checker at the grocery store wears a big, clunky wrist splint. If her arm is entombed in a Velcro-fastened binding extending from fingers to elbow, she’s got carpal tunnel syndrome (CTS). Not exactly velvet evening gloves, but these wrist wraps are the fashion statement of the twenty-first century.
CTS is a common, disabling condition. Most often associated with computer use, it can strike just about anyone who performs repetitive hand motions. CTS afflicts women more often than men. Pregnancy, rheumatoid arthritis, and diabetes are risk factors. This crippler is caused by compression of the median nerve, a major nerve supplying the arm and hand. This nerve generates sensation and movement in the hand. On its way through the wrist, the nerve navigates through a passage in the wrist called the carpal tunnel.
CTS is the most common type of repetitive stress injury. Continuous, repetitive wrist motion may irritate the ligaments and tendons encased in the tunnel, causing these structures to swell, squeezing the median nerve. Tingling and numbness in the thumb, index finger, middle finger, and half of the ring finger ensues. The individual’s hand will feel as if it has “gone to sleep.” The pain and discomfort of CTS is so severe that it often wakes people in the night. It can even eventually make it hard to grasp small objects. Without treatment, CTS may eventually manifest as permanent weakness, loss of sensation, or even thumb and finger paralysis.
CTS is a signal that the body is experiencing more strain than it was designed to handle. Activities that cause a person to repeatedly bend the wrist inward toward the forearm can increase the risk of CTS. Jobs that call for repeated strong wrist motions carry a comparatively high risk of CTS. Repetitive motion injuries are more frequent among office workers who do a lot of typing, those working at computers or cash registers, factory machine operators, and various musicians. Job injuries from repetitive stress, heavy lifting, and related conditions befall about 1 million workers each year and incur costs of $54 billion, according to a National Academy of Sciences report.
CTS is a noteworthy cause of missed workdays due to pain, causing an estimated 460,000 employee work-related injuries per year. Because most occurrences of CTS are job-related, paying attention to proper ergonomics is essential–repositioning the computer keyboard and taking more breaks, for example.
Treating carpal tunnel
The first step in conventional CTS treatment is splints, which support the wrist and prevent it from flexing inward, exaggerating nerve compression. Some people wear such splints at night whereas others need to wear the splints all day, especially while working. Nonsteroidal anti-inflammatory drugs are often used to decrease pain and swelling. In advanced CTS, steroids are injected into the wrist. The most serious cases of CTS may require surgery, cutting the ligament that crosses the wrist, to decrease the nerve compression.
If surgery becomes necessary, physical therapy is essential for speeding recovery. In one setting, a policy of initiating physical therapy the day after surgery reduced sick leave costs by 58 percent. A medical group investigation found that each single session of hand therapy cost $45, but it reduced lost work time by 8.6 days.
More than two decades ago, investigators noticed that people with CTS seemed to be deficient in vitamin B6, leading to pervasive use of B6 as a CTS remedy. Some more recent studies have affirmed this connection. But another extensive study suggests that CTS among active industrial workers is unrelated to vitamin B6 status.
Although many studies have been performed on B6 treatment for CTS, experts disagree on its effectiveness. In a twelve-year study conducted in Louisville, Kentucky, Morton Kasdan, M.D., found that 68 percent of his 494 CTS patients improved while taking daily B6.
B6 does seem to lower pain level. In a 1993 experiment with CTS patients, pain scores dropped. But that study suggests that vitamin B6 deficiency may not be a cause of CTS, in spite of the observed therapeutic effect. A typical recommended dose of vitamin B6 for CTS is 200 mg twice daily.
A National Institutes of Health panel reported that traditional acupuncture might be a useful treatment for CTS. Studies have shown that both laser acupuncture and electrical nerve stimulation can greatly reduce the pain associated with CTS. In one investigation, which included Chinese herbal medicines, acupuncture, moxibustion, and omega-3 fish oil capsules, more than 90 percent of the subjects reported no pain or pain that had been reduced by more than half. All patients were able to return to work, and most patients remained stable for up to two years.
Yoga has shown benefit for CTS in several studies. In one preliminary study, published in the Journal of the American Medical Association in 1998, a yoga-based regimen was more successful than wrist splinting in relieving some CTS symptoms.
Herbal pain relievers
Willow bark (Salix spp.). Willow is the main traditional pain reliever of European herbalism. It contains salicin and other related compounds (salicylates) that are the herbal predecessors of aspirin. Plant salicylates relieve pain, reduce fever, and curb inflammation. The American Herbal Pharmacopoeia says, “in modern herbal therapy, willow is predominantly used as an anti-inflammatory for symptomatic relief of gouty arthritis and as an analgesic for mild neuralgic pains, toothaches, and headaches.”
A 2000 Israeli study substantiated this benefit. The 191 pain sufferers took a willow extract, standardized to contain either 120 mg or 240 mg of salicin, each day. The herb turned out to be a great deal more effective than a placebo in this trial, with the higher dose being considerably more effective. In the high-dose group, the response was apparent after only one week of treatment. Use a tea brewed from up to 1 oz. (dry weight) of the raw herb per day or an extract containing 240 mg total salicin per day. Use willow for as long as necessary.
St. John’s wort (Hypericum perforatum). These days, St. John’s wort flowers are frequently used for mild to moderate depression. Yet this ancient medicine has also been known as a wound healer since 500 b.c. European and North American herbalists use the herb to treat mild painful conditions including arthritis and muscle inflammation. St. John’s wort helps nerves recover when they are damaged, inflamed, or strained, says Jill Stansbury, N.D., of the National College of Naturopathic Medicine. The herb is used to heal nerve pain and tingling, she says. The usual dose is 2 to 5 g of raw herb, 10 to 15 ml of tincture, or 900 mg of standardized extract (0.3 percent hypericin) per day.
Turmeric root (Curcuma longa). Turmeric is a mainstay in Ayurvedic herbal medicine, where it is widely used to benefit the musculoskeletal system. Curcumin, the pigment that gives this herb its characteristic yellow color, is an anti-inflammatory agent comparable to cortisone and phenylbutazone, the standard anti-inflammatory drugs. Curcumin is nonsteroidal, so it has none of the unwanted side effects of steroid anti-inflammatories.
Curcumin also treats pain directly–it depletes substance P, the pain receptor neurotransmitter, in the nerve endings. Research shows that curcumin and related compounds suppress pain through a mechanism similar to several drugs (COX-1 and COX-2 inhibitors) that reduce the levels of an enzyme that causes joint inflammation. For acute wrist inflammation, the dose can be as high as 1 ounce (4 tablespoons) per day. Stir the powder into water and swallow, or make it into a paste with honey or a bite of oatmeal. Standardized extract is also available. The dose is 1,500 mg of total curcumin content per day.
Pineapple fruit contains a proteolytic (protein-dissolving) enzyme, bromelain, which is often recommended for CTS. As a supplement, bromelain is usually derived from the stem of the plant, and is a mixture of several proteases that enhance muscle relaxation, inhibit blood platelet aggregation, and improve wound healing.
Naturopathic physicians suggest taking 250 to 1,500 mg of pure bromelain daily, between meals, to treat inflammatory conditions such as CTS. Of course, you can also use the fruit liberally in your diet.
According to traditional herbalists, applying comfrey externally can relieve pain, swelling, and inflammation. Use a poultice or commercially prepared cream.
In my experience, ginger (Zingiber officinale) works well, too. Slice the fresh roots lengthwise in thin, flat strips. Wrap the wrist with the strips, cover with a bandage, and leave overnight.
St. John’s wort excels as an external remedy. The plant’s yellow flowers contain red pigments that produce a beautiful, deep red oil. Prepared as an oily preparation, such as an ointment, St. John’s wort is one of the most popular European remedies for muscle pain, confirmed by Germany’s Commission E.
With our world becoming ever more dependent on the computer, we are going to see more cases of CTS. If you’re one of the unlucky victims, perhaps natural medicine is for you.