Carpal Tunnel Syndrome is so common that nearly everyone has heard of it. There have been many times in my work as an OT/CHT when patients arrive for their first session and tell me about their hand problems followed by the question “Is this Carpal Tunnel?” It has become a catch-all phrase. I’d like to clear up what Carpal Tunnel Syndrome actually is, share the basics of treatments that Hand Therapists typically provide, and then add some superpower info about how to address this condition from the inside out with Nutritional Therapy. You can scroll down to the bottom section if you want to jump to the good juicy nutrition info 😊
What are the symptoms of Carpal Tunnel Syndrome?
- Your hand feels like it “falls asleep” frequently and you may drop objects
- Wrist pain and finger tingling at night that interferes with your sleep
- Pain and burning that travels up your arm
- Weakness in the muscles of the thumb and hand
Pain and parasthesias (tingling/numbness) may be focused just at the wrist or involve what feels like the entire hand but is actually a specific sensory pattern that includes the thumb, index, middle and inner half of the ring finger, as well the palm area below these finger, and around the finger nails to the middle knuckle crease on the back side of the hand. The pain and parasthesia symptoms can radiate up into the forearm, and less frequently be felt above the elbow up into the armpit/shoulder area. (1)
What causes Carpal Tunnel Syndrome?
CTS is result of a combination of factors that increase pressure on the median nerve and the nine tendons (the nerve neighbors) inside the carpal tunnel. The median nerve runs the length of your arms and ends in the hands. At the wrist level the nerve has to go through a narrow passageway called the carpal tunnel. To be more specific, the tunnel is not located at the wrist crease, it is about an inch away near the base of your hand on the palm side. The tunnel is surrounded by bones on the underside and is secured on top by a strong thick ligament. The median nerve lies just under this thick ligament. As the nine tendons inside the tunnel move and glide to create finger movement, this causes friction against the nerve but the bigger issue with CTS is the position of the wrist as the fingers are grasping and pinching. When the wrist is bent far down or way back, there is more pressure at the carpal tunnel.
When the median nerve gets irritated and compressed it cannot conduct its electrical nerve signals as efficiently. This causes the strange and uncomfortable sensations of tingling or numbness into the specific pattern noted above. The outer half of the ring finger and the small finger will feel normal because they receive sensory input from a different nerve outside of the carpal tunnel (the ulnar nerve).
The symptoms often appear in one or both hands at night. The dominant hand is usually affected first and produces the most intense symptoms because it is used more frequently. Some people with CTS say their fingers feel swollen and useless, even though little or no swelling is apparent. A person with CTS may wake up feeling the need to “shake out” the hand or wrist. As symptoms worse, people begin to feel tingling during the day, especially with activities involved hand grasping. In untreated and chronic cases, the muscles at the base of the thumb may waste away. Hand weakness makes it difficult to grasp small objects and people report feeling. Some people with very severe CTS cannot determine between hot and cold by touch and may accidentally burn their fingertips (2).
While there are mechanical/physical forces involved in the compression, the most common cause of swelling in the carpal tunnel is an underlying medical condition that causes systemic inflammation. Which is why Nutritional Therapy can be helpful but more on that later…
The most frequent conditions linked with CTS are: Type 2 diabetes, underactive thyroid gland, overactive pituitary gland, high blood pressure, fluid retention from pregnancy or menopause, autoimmune disorders (such as rheumatoid arthritis), fracture or trauma to the wrist, development of a cyst or tumor in the canal, obesity, kidney failure and lymphedema (2)
CTS symptoms are often provoked by activities that involve repetitive flexing or extending the wrist, raising and working with the arms overhead, along with repetitive gripping and pinching. Driving, reading, typing, holding a phone, and gardening/weeding are common aggravating activities.
The most intense compression to the nerve comes from repetitive gripping and pinching with the wrist in a bent (flexed) position. Hyper-extending the wrist to push heavy objects or pushing down into the palm repeatedly also causes compression. Prolonged exposure to vibrations from using hands tools or power tools is especially aggravating. Using a keyboard or mouse with the wrist in a extended position while resting the inner wrist down on a firm surface can be irritating to the nerve. Poor computer posture (ergonomics) are also an issue when working with a rounded back or sitting slumped in a chair because this causes chest/armpit compression, decreased circulation and decreased breathing which all decrease the conductivity of the nerve.
Who is at risk for CTS?
CTS is most frequently diagnosed between the ages of 30 to 60. Women are 3 times more likely to develop CTS than men. Certain medical conditions, as noted above, increase risk. There are a number of lifestyle factors that increase one’s risk: smoking, high salt intake, a sedentary lifestyle and a high body mass index. People employed in certain occupations that that involve repetitive wrist movements may be at higher risk: manufacturing, assembly line work, construction work, keyboarding, massage therapists, hairdressers. (3)
How is CTS diagnosed?
CTS is diagnosed using a combination of your history, a physical examination with specific tests called “provocative manuevers”. A doctor will likely order nerve conduction studies that measure the conduction speed of your nerve impulses to confirm the presence and severity level of CTS.
What is the traditional treatment for CTS?
Occupational Therapists advise patients to wear wrist splints at night to prevent flexed wrist posturing, teach proper wrist/arm ergonomics during work and home activities, instruct specific stretching exercises to decreases muscle tension, and educate patients about the use of cold/ice to decrease swelling. (I offer Hand Therapy Consultations to provide personalized home programs that include Nutritional Therapy recommendations as well)
Doctors may prescribe mild pain medication and other medications to reduce inflammation and treat underlying conditions such as Type 2 Diabetes. A doctor can provide a steroid injection into the carpal tunnel area to reduce inflammation and may recommend surgery if there is muscle weakness (which is usually a sign of chronic long-term median nerve compression).
How can Nutritional Therapy help CTS?
You’re likely heard the phrase “You are what you eat”. The food that we eat (and drink) creates our body structure, our organ function and affects all body systems including digestion, circulation, nerve conduction and the level of inflammation in the body. What we eat has the power to increase inflammation or decrease it. Which is why food can be used as natural medicine to help reduce and prevent inflammatory health conditions like carpal tunnel syndrome.
Here are the best foods recommended for reducing inflammation and easing the symptoms of CTS (4).
1) Salmon, tuna, sardines and fatty fish: These fishes are rich sources of two kinds of healthy omega 3 fats (EPA and DHA).
2) Walnuts, flax seeds, chia seeds, hemp seeds: These contain an excellent source of ALA (alpha-linoleic acid), which is a precursor to creating Omega 3 fatty acids.
3) Tumeric: This is a strong flavored spice that is often used in Indian curries. It contains an anti-inflammatory chemical called curcumin which can offer pain relief. The anti-inflammatory properties are enhanced when used in combination with black pepper and ginger.
4) Brightly colored fruits and vegetables: These are helpful for reducing inflammation because they are high in anti-oxidants. Aim to get a rainbow of vegetables into your meals each day!
5) Pineapple: contains an enzyme called bromelain that improves digestion and is a good source of vitamins.
6) Spinach, avocados, bananas, chicken, pistachios, seeds: What do these foods all have in common? They are high in vitamin B6, which is involved in more than 150 enzyme reactions. B6 is closely linked with the functions of our nervous and immune systems. (5)
What supplements are helpful for CTS?
1) Fish Oil / Marine Algae Oil: If you don’t like eating fish but you want the Omega 3 benefits, you can take a fish oil supplement. If you’re vegetarian, you can take a marine algae oil supplement.
2) Vitamin B6: Studies have shown that taking 150-200 mg per day for 12 weeks can be helpful, then decrease to 50-100 mg per day.
One study: “Conclusion: The present study suggests that vitamin B6 treatment improves clinical symptoms and sensory electrodiagnostic results in CTS patients and thus is recommended for CTS treatment”. (6)
Another study reported: “Vitamin B6 at less than 200 mg per day is not likely to cause any adverse effects, but patients should be monitored for changes in symptoms, particularly when high doses are taken over long periods.” (7)
3) Curcumin: The curcumin content in turmeric is only 3% by weight. So if you’re not keen on eating turmeric regularly, it could be beneficial to supplement with a more concentrated form of curcumin as a supplement. It is best taken with a fatty meal along with some black pepper for best absorption. “Tumeric supplements may have interactions with certain medications and may be contraindicated for certain conditions so always speak with your health care provider if you’re thinking of adding a supplement to your routine.” (8)
If you would like learn about my favorite brands and supplement dosage recommendations, I would be happy to provide you with a Comprehensive Nutrition Consultation to tailor the amounts to what your body needs. You can order supplements with a 15% discount off of MRSP by clicking the Wellevate or Fullscript link at the bottom of my website pages. I enjoy working with individual clients to clarify their health goals and support their progress in reaching them!
1) Mayo Clinic Staff. Carpal Tunnel Syndrome. February 2020.
2) National Institute of Neurological Disorders and Stroke. April 2020.
3) Healthline Editorial Team. Carpal Tunnel Syndrome. March 2019.
4) Black R. 6 Best Foods for Carpal Tunnel Syndrome. February 2016.
5) McCulloch M. 9 Signs and Symptoms of Vitamin B6 Deficiency. June 2018.
6) Talebi M, Andalib S, Bakhti S, Ayromlou H, Aghili A, Talebi A. Effect of vitamin b6 on clinical symptoms and electrodiagnostic results of patients with carpal tunnel syndrome. Adv Pharm Bull. 2013;3(2):283-288
7) Ryan-Harshman M, Aldoori W. Carpal tunnel syndrome and vitamin B6. Can Fam Physician. 2007;53(7):1161-1162.
8) Savage E. The 9 Best Tumeric Supplements of 2020, According to a Dietician. July 2020