Natural treatments for carpal tunnel syndrome

• DEFINITION: Treatment of the compression of the median nerve of the wrist.
• PRINCIPAL PROPOSED NATURAL TREATMENTS: None
• OTHER PROPOSED NATURAL TREATMENTS: Acupuncture, Arnica, bromelain, ergonomic workspace, laser therapy, magnet therapy, physical therapy, proteolytic enzymes, reset, splinting, turmeric, vitamin B₆, vitamin B₁₂, yoga

Introduction

Carpal tunnel syndrome (CTS) is a common and often disabling condition that is most often associated with data entry and general computer use. CTS can, nonetheless, affect anyone who performs repetitive hand motions. CTS occurs in women more often than men and is a relatively common temporary pregnancy complication because of fluid retention. It also occurs frequently among people with rheumatoid arthritis or diabetes.

CTS is caused by compression of the median nerve. As it travels to the hand, the median nerve passes through an opening in the wrist called the carpal tunnel. Constant, repetitive hand motion may aggravate the ligaments and tendons encased in the tunnel, causing them to swell. As the tunnel walls close in, they compress the median nerve. This causes tingling and numbness in the thumb, index finger, middle finger, and half of the ring finger. The discomfort of CTS often wakes people during the night and eventually makes it difficult to grasp small objects.

Most instances of CTS are job-related. Paying attention to proper ergonomics is essential for preventing CTS. This might involve repositioning a computer keyboard or taking breaks more often. Conventional medical treatment for more stubborn CTS cases is variable in its success. Splinting the affected hand, especially at night, may help reduce symptoms. Nonsteroidal anti-inflammatory medications, such as ibuprofen or naproxen, may help slightly. Surgery is considered the ultimate treatment, but corticosteroid injections may be equally or slightly more effective. Sometimes, a person with work-related CTS may have no choice but to change vocation.

Proposed Natural Treatments

There is no meaningful supporting evidence for natural treatments for carpal tunnel syndrome. Those that have been scientifically evaluated to some extent include vitamin B₆, yoga, and magnet therapy.

Vitamin B₆. Late in the twentieth century, researchers noted that people with CTS seemed deficient in vitamin B₆. This led to the widespread use of vitamin B₆ as a CTS remedy. However, a more recent study found no association between CTS and vitamin B₆ deficiency. Even if vitamin B₆ deficiency were common in CTS, this is not proof that taking vitamin B₆ supplements can reduce symptoms.

A few studies have investigated the effectiveness of vitamin B₆ for CTS. Most were poorly designed and involved few people. The small, randomized, double-blind, placebo-controlled studies that do exist found no evidence that vitamin B₆ effectively treats CTS. One study enrolled only fifteen people and found no significant difference after ten weeks among those taking vitamin B₆, placebo, or nothing. Another study involving thirty-two people found some benefits, but these were fairly minor. There was no improvement in nighttime pain, numbness, or tingling, or in objective measurements of median nerve function. Some benefit, however, was seen in the relatively less important symptoms of finger swelling and discomfort after repetitive motion.

Because vitamin B₆ has not been proven effective and may be harmful in high doses, it is not recommended for treating CTS.

Yoga. Hatha yoga, a system of stretching and balancing exercises, has been tried for CTS. In one study, forty-two persons with CTS were randomly assigned to receive either yoga instruction or a wrist splint for eight weeks. The results indicated that yoga was more effective than the wrist splint.

However, this study has a serious flaw: Participants in the control group were simply offered the wrist splint and given the choice of using it or not. It would have been preferable for them to have received an option such as fake laser acupuncture or, even better, phony yoga postures. Numerous studies show that when people believe they are receiving an effective treatment, they report improvement, regardless of the nature of the treatment.

Magnet therapy. In the one reported double-blind, placebo-controlled study of magnet therapy for CTS, thirty people with CTS received treatment with either a real or a fake static magnet. Dramatic, long-lasting benefits were seen with the magnet treatment. However, identical dramatic and long-lasting benefits were seen with placebo treatment too. This study underscores the need for a placebo group in studies; had there not been one in this trial, magnet therapy would have shown itself quite effective for CTS. In two more small, randomized trials, researchers again found no differences between the treatment and the placebo groups. Both groups experienced an improvement in symptoms.

Other treatments. Bromelain and other proteolytic enzymes are sometimes recommended for treating CTS, but there is no evidence that they are effective. In a double-blind, placebo-controlled study of thirty-seven people undergoing surgery for CTS, an ointment made from the herb Arnica (combined with homeopathic Arnica tablets) proved slightly more effective than the placebo for relieving pain after surgery.

People who have a stroke that renders one hand paralyzed may develop CTS from overuse of the remaining functional hand. One poorly designed study found preliminary evidence that mecobalamin, a form of vitamin B₁₂, might provide some benefit. Another study failed to find low-level laser therapy helpful for CTS.

Patients may look to various types of non-invasive treatments to assist with CTS. Some are relatively simple and inexpensive to implement. For example, a splint can be attached to the wrist and worn at night while sleeping. Keeping the wrist straight during this period will assist as well. Another simple remedy is to employ both heat and cold measures. A wrist can be soaked in ice for a recommended period of 10 to 15 minutes. This can be done once or twice an hour. A hand can instead be submerged in warm water heated between 92 and 100 degrees Fahrenheit. Another simple measure is gently shaking the hand, alleviating pressure on the median bone. Also, the position of a keyboard on a desk can be slightly changed periodically, and the placement of the hand and wrist can be varied. Simply taking a break from one’s work to concentrate on brief exercises and resting the arm and hand may relieve CTS symptoms. A physical therapist may use massage techniques or ultrasound therapy to promote mobility, reduce pain, and decrease inflammation. Acupuncture may also help to reduce CTS symptoms. Finally, anti-inflammatory herbs like turmeric may relieve CTS symptoms, but more study is necessary. 

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