What are natural treatments for carpal tunnel syndrome?

Introduction

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

CTS is caused by compression of the median nerve. On its way 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. In some cases, a person with work-related CTS may have no choice but to change vocation.

Proposed Natural Treatments

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

Vitamin B
6
. Late in the twentieth century, researchers noted that people
with CTS seemed to be deficient in vitamin B
6. This led to
widespread use of vitamin B6 as a CTS remedy. However, a more recent
study found no association between CTS and vitamin B6 deficiency. In
any case, even if vitamin B6 deficiency were common in CTS, that by
itself would not prove 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 two (albeit small) randomized, double-blind, placebo-controlled studies that do exist found no evidence that vitamin B6 effectively treats CTS. The first study, which enrolled only fifteen people, found no significant difference after ten weeks among those taking vitamin B6, placebo, or nothing. The second study, involving thirty-two people, did find 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 recommend for treating carpal tunnel syndrome.

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. Experience from numerous studies shows 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 that there were 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 the treatment of 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 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.

Bibliography

Carter, R., C. B. Aspy, and J. Mold. “The Effectiveness of Magnet Therapy for Treatment of Wrist Pain Attributed to Carpal Tunnel Syndrome.” Journal of Family Practice 51 (2002): 38-40.

Colbert, A. P., et al. “Static Magnetic Field Therapy for Carpal Tunnel Syndrome.” Archives of Physical Medicine and Rehabilitation 91 (2010): 1098-1104.

Hui, A. C., et al. “A Randomized Controlled Trial of Surgery vs. Steroid Injection for Carpal Tunnel Syndrome.” Neurology 64 (2005): 2074-2078.

Irvine, J., et al. “Double-Blind Randomized Controlled Trial of Low-Level Laser Therapy in Carpal Tunnel Syndrome.” Muscle and Nerve 30 (2004): 182-187.

Jeffrey, S., and J. Belcher. “Use of Arnica to Relieve Pain After Carpal-Tunnel Release Surgery.” Alternative Therapies in Health and Medicine 8 (2002): 66-68.

Ly-Pen, D., et al. “Surgical Decompression Versus Local Steroid Injection in Carpal Tunnel Syndrome.” Arthritis and Rheumatism 52 (2005): 612-619.