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 juicy nutrition info.
What are the symptoms of Carpal Tunnel Syndrome?
- Finger tingling at night that interferes with your sleep
- Your hand “falls asleep” frequently and feel like you need to "shake it out"
- Inner wrist pain while grasping or pinching a object
- Pain and burning that travel from inner wrist up your forearm
- Weakness in the muscles of the thumb and hand
- Accidentally dropping objects
Pain and parasthesias (tingling/numbness) can 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, the palm area below these fingers, as well as the skin around the finger nails to the middle knuckle crease on the back side of the fingers. These pain and parasthesia symptoms can radiate up into the inner forearm, and less frequently travel above the elbow up into the axilla (armpit). (1)
What causes Carpal Tunnel Syndrome?
CTS occurs from combination of factors that increase pressure on the median nerve as it travels through a narrow passageway called the carpal tunnel. The carpal tunnel is located about 2 cm from the inner wrist crease, at the base of your hand on the palm side. The underside of the tunnel is created by a curved alignment of small carpal bones and the top of the tunnel is secured by a strong thick band called the transvers carpal ligament. The median nerve lies just under this thick ligament. The carpal tunnel also contains nine tendons that are linked to the fingers and thumb to create movement. Repetitive finger and thumb movements cause some friction against the nerve, however, the biggest issue with CTS is the position of the wrist while the fingers and thumb are grasping and pinching. When the wrist is bent far down or way back while the finger/thumb tendons are moving, there is more pressure on the median nerve.
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 finger pattern noted above. The outer half of the ring finger and the small finger will feel normal because they receive sensory input from the ulnar nerve that travels outside of the carpal tunnel.
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 difficult to move, 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 progress, people begin to feel some tingling during the day, especially during or after activities involving hand grasping. In untreated and chronic cases of CTS, the muscles in the palm that power the thumb don't receive the same level of stimulation from the nerve and can begin to atrophy. Hand weakness makes it difficult to grasp small objects. Some people with very severe CTS cannot differentiate hot and cold by touch and may accidentally burn their fingertips. (2)
CTS symptoms are often provoked by activities that involve repetitive bending (flexing or extending) of the wrist, working with the arms held 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 vibration while using 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 posture from a rounded back while using a computer or sitting slumped in a chair causes chest compression, decreased breathing and decreased circulation. All of these factors and aggravators decrease how well the nerve can transmit signals (conductivity) for sensation and muscle activation.
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. There are a number of lifestyle factors that increase one’s risk for developing CTS: 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)
While there are mechanical and physical forces involved in compression of the median nerve, another common cause of swelling in the carpal tunnel are underlying medical conditions that cause systemic inflammation. 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 carpal tunnel, obesity, kidney failure and lymphedema. (2)
How is CTS diagnosed?
CTS is diagnosed through reviewing medical history and a physical examination with specific tests called “provocative manuevers”. If these provoke symptoms, a doctor will likely order a "Nerve Conductions Velocity Study" to measure the conduction speed of your nerve impulses. This will will rule out or confirm the presence and severity level of CTS.
What are the traditional treatments 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 and contrast baths (alternating heat and cold) to decrease swelling.
Doctors may prescribe pain medication or 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. Muscle weakness and/or atrophy are signs of chronic long-term median nerve compression and surgery will likely be advised to prevent further damage. A "Carpal Tunnel Release" is one of the most common hand surgeries performed and it is often recommended to be done before any muscle weakness occurs.
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). Omega 3 fatty acids are anti-inflammatory.
2) Walnuts, flax seeds, chia seeds, hemp seeds: These contain an excellent source of ALA (alpha-linoleic acid), which is a precursor for the creation of 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: Multiple studies have proven the effectiveness of taking B6 for carpal tunnel (as well a trigger finger and arthritis). I typically advise my patients and clients with CTS to take 50 mg of activated B6 (the P5P form), 3 times a day (for a total of 150 mg per day) for 1-3 months, then decrease to 50 mg per day for another 1-3 months. It can take 6 weeks for symptoms to start disappearing and up to 12 weeks for definite improvement.
One study concluded: "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)
"Vitamin B6 is needed for normal function of nerve cells and is the most frequently used and well-known nutritional treatment for CTS. It has been reported that people with CTS are frequently deficient in vitamin B6, and yet other doctors have not found a link. At very high levels vitamin B6 can damage sensory nerves, leading to numbness in the hands and feet as well as difficulty in walking. It is believed that vitamin B6 is usually safe in amounts of 200-500mg per day." (7)
It is important to speak with your doctor (and Nutritional Therapist) about taking higher doses of B6. “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.” (8)
3) Curcumin: The curcumin content in turmeric is only 3% by weight. So if you’re not keen on eating turmeric regularly, it can be beneficial to take a more concentrated form of curcumin as a supplement. It is best taken with a meal containing fat, along with some black pepper for best absorption. “Turmeric 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.” (9)
Conclusion
I enjoy working with clients who have carpal tunnel syndrome to provide Hand Therapy advice AND Nutritional Therapy advice! 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. If you would like to order supplements for 15% of MRSP, you can scroll to the bottom of any of my website pages and click on Fullscript. Wellevate was bought by Fullscript and accounts will be shifted in spring 2023.
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Please note"carpal tunnel blog post". I would greatly appreciate your support!
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References
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
8) Ryan-Harshman M, Aldoori W. Carpal tunnel syndrome and vitamin B6. Can Fam Physician. 2007;53(7):1161-1162.
9) Savage E. The 9 Best Turmeric Supplements of 2020, According to a Dietician. July 2020