Health Update: Carpal Tunnel

By Dr. Joseph Cilea

Carpal Tunnel Syndrome or CTS, is the most common of the peripheral nerve conditions where the median nerve is compressed or pinched at the wrist.  The resulting symptoms of numbness/pain in the wrist, index, third, and forth fingers, multiple sleep interruptions, frequent shaking and flicking of the hand/fingers, difficulty in gripping or pinching such as buttoning a shirt, threading a needle, lifting a coffee cup, frequent dropping of objects, the inability to perform work duties – especially fast, repetitive work tasks can have a devastating effect on a person’s quality of life.

While treatments traditionally have involved activity modification, night splints, anti-inflammatory medication, and in advanced/severe cases surgery, a recent study comparing different vitamin approaches reports promising results with the use of alpha-lipoic acid (ALA) and gamma-linolenic acid (GLA).  This combination was described as a logical early stage treatment aimed at “neuroprotection” or, to limit and correct nerve damage caused by CTS.  The doses utilized for 90 days in 112 subjects with moderately severe CTS were 600 mg/day of ALA and 360 mg/day of GLA.

This combination was compared against a commonly recommended multiple vitamin B complex that included 150 mg of B6, 100 mg of B1, and 500 mcg of Vit B12 per day for the same 90 day period.  Questionnaires regarding CTS symptoms and function and electromyography (EMG) were utilized to track the outcomes in the study.  The ALA/GLA treated group was statistically significantly improved when compared to the other B-complex vitamin approach.  This included significant improvements in both symptom scores and functional impairment compared to only a slight improvement in the vitamin B group.  Similarly, EMG was significantly improved in the ALA/GLA and unchanged in the vitamin B group.

Because there are many contributing causes of CTS, a multi-dimensional treatment plan will usually yield the best long-term results.  Because repetitive motion / cumulative trauma are often associated with the onset and perpetuation of CTS signs and symptoms, ergonomic issues must be addressed.  This includes perhaps a period of time when slower “light duty” work is necessary and consideration for workstation modifications, when feasible.  Because most people do not ‘run to the doctor’ with the early signs of CTS, over time, many CTS patients develop abnormal movement patterns by minimizing hand/wrist motions. Instead, they start to shrug the shoulder and lean the body to one side.  Hence, management addressing neighboring joint problems at the elbow, shoulder, and neck is needed.  A condition called “double-crush” where the nerve is pinched in more than only at the wrist but also at the elbow, shoulder, and/or neck results in a significantly worse CTS presentation.  These patients require treatment at all areas involved, not just at the wrist if long-term, satisfying results are to be obtained.

Metabolic conditions including diabetes mellitus, hypothyroid, obesity, pregnancy, the use of birth control pills, and others also contribute or, can even by themselves cause CTS.   Chiropractic has traditionally viewed the body as a whole, treating the person from the ground upwards paying attention to posture, leg length, pelvic tilt, shoulder and head tilt.  The use of manipulation of not only the wrist and hand, but also the elbow, shoulder, neck and back has yielded the best results rather than focusing only on the hand/wrist.  The traditional use of night splints, work station/ergonomic modifications, as well as diet and exercise are also commonly addressed by chiropractors when managing CTS patients. We take pride in providing quality, evidence-based care and appreciate the opportunity to do so when patients choose our clinic for their care and we realize there are many healthcare options available. The first step is to get an accurate diagnosis utilizing appropriate diagnostic testing.

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