Carpal Tunnel Introduction

Carpal Tunnel Syndrome (CTS) is a painful condition caused by compression of the median nerve within the small space, or carpal “tunnel,” of the wrist. The carpal tunnel is a narrow space formed by the wrist (carpal) bones, transverse carpal ligament, the median nerve, and specific tendons. Carpal Tunnel causes numbness, weakness, tingling, and/or burning pain in, primarily, the first three fingers of the hand. These symptoms may, however, may radiate into the thumb, hand, forearm and shoulder. Carpal Tunnel is the most common peripheral compression neuropathy and repetitive stress injury (RSI) in the United States.

Carpal Tunnel is most common in people who perform repetitive tasks with their hands, such as factory assemblers and frequent computer users. This repetitive movement causes inflammation and swelling of the soft tissues surrounding the carpal tunnel. Inflamed tendons are the usual culprit. They press on the median nerve, which causes the aforementioned numbness and pain.

Carpal tunnel syndrome can also be the result of an underlying joint or bone disease (arthritis, osteoarthritis, rheumatoid arthritis), certain hormonal or metabolic changes (pregnancy, menopause, thyroid imbalance), and changes in blood-sugar levels (type 2 diabetes). It may also result from certain conditions and injuries of the wrist. These may include sprains, breaks, or other direct trauma which causes wrist swelling and inflammation. Carpal Tunnel is most common in women between the ages of 40 and 60.

According to the U.S. National Center for Health Statistics (1):

• Carpal tunnel syndrome affects over 2 million people in the United States.

• Approximately 260,000 carpal tunnel release surgeries are performed each year, with nearly 47 percent of these being work-related.

• Carpal tunnel syndrome accounts for the highest average in number of days missed at work, when compared to all other work-related injuries or illnesses.

Carpal tunnel symptoms are often similar to other health conditions or problems. Carpal Tunnel sufferers may experience some or all of the following symptoms:

• Pain in the wrist that radiates into the hand and sometimes the forearm and shoulder

• Numbness, tingling, and/or burning pain in the hand and first three fingers

• Weakness in the hand and difficulty making a fist.

• Pain or numbness may be worse at night.

The severity of the compression, or entrapment, of the median nerve is determined by both clinical and electrodiagnostic testing. If carpal tunnel syndrome is caught and treated in the early, mild, or more moderate stages, the following treatment can be very successful:

• Stopping the repetitive movement that causes carpal tunnel syndrome

• Splinting the wrist to relieve pressure on the median nerve

• The use of anti-inflammatories such as aspirin and NSAIDS

• Steroid injections (such as methylprednisolone) into the carpal tunnel

More severe cases may require surgery to relieve the entrapment of the median nerve, and associated complications.

Vitamin B6 and Vitamin B2

Carpal tunnel syndrome patients are often deficient in vitamin B6 (2). Numerous studies have found that vitamin B6 supplementation may be effective in treating carpal tunnel syndrome (3-6). Other studies report that B6 effectiveness is enhanced by taking it with vitamin B2, which assist in the conversion of vitamin B6 into its more active form (7). Conversely, one study concludes that there is no correlation between vitamin B6, carpal tunnel syndrome, or the paralleled mprovements in carpal tunnel syndrome symptoms (8). Nevertheless, many experts agree that given its safety and the positive clinical studies, vitamin B6 supplementation should still be considered.

Bromelain

Bromelain, a protein-digesting enzyme complex derived from pineapple, has been shown to be helpful in treating inflammatory conditions, like carpal tunnel syndrome. In study, bromelain has accounted for many therapeutic benefits, such as in the reduction of swelling, increased healing time, and a reduction in post-operative pain. (9, 10).

Boswellia

The gum resin of Boswellia serrata (boswella) has been found to have anti-inflammatory effects that may be useful in treating carpal tunnel syndrome (11).

Curcumin (turmeric)

Curcumin, the yellow pigment of Curcuma longa (turmeric), has been shown to have anti-inflammatory and antioxidant effects, which may be useful in treating carpal tunnel syndrome (11-13). One study indicated that curcumin’s anti-inflammatory properties may be as effective as the more commonly used non steroidal anti-inflammatory drugs (NSAIDs). (14)

1. Facts About Carpal Tunnel Syndrome: http://www.mmhs.com/clinical/adult/english/arthritis/carpal.htm

2. Fuhr, J.E., Farrow, A., Nelson, H.S., Jr. Vitamin B6 levels in patients with carpal tunnel syndrome. Arch. Surg. 1989 Nov; 124(11):1329-30.

3. Ellis, J., Folkers, K., Levy, M., Takemura, K., Shizukuishi, S., Ulrich, R., Harrison, P. Therapy with vitamin B6 with and without surgery for treatment of patients having the idiopathic carpal tunnel syndrome. Res. Commun. Chem. Pathol. Pharmacol. 1981 Aug; 33(2): 331-44.

4. Ellis, J., Folkers, K., Watanabe, T., Kaji, M., Saji, S., Caldwell, J.W., Temple, C.A., Wood, F.S. Clinical results of a cross over treatment with pyridoxine and placebo of the carpal tunnel syndrome. Am. J. Clin. Nutr. 1979 Oct; 32(10): 2040-6.

5. Ellis JM et al. “Response of vitamin B6 deficiency and the carpal tunnel syndrome to pyridoxine,” Proc Natl Acad Sci USA 1982 (79): 7494-8.

6. Kasdan, M.L., Janes, C. Carpal tunnel syndrome and vitamin B6. Plast. Reconstr. Surg. 1987 March; 79(3): 456 62.

7. Folkers, K., Wolaniuk, A., Vadhanavikit, S. Enzymology of the response of the carpal tunnel syndrome to riboflavin and to combined riboflavin and pyridoxine. Proc. Natl. Acad. Sci. U.S.A. 1984 Nov; 81(22): 7076-8.

8. Franzblau A, et al. The relationship of vitamin B6 status to median nerve function and carpal tunnel syndrome among active industrial workers. J Occup Environ Med. May1996;38(5):485-91.

9. Pizzorno JE and Murray MT, eds. Encyclopedia of Natural Medicine, revised 2nd edition, CA: Prima Publishing, 1998: 316

10. Maurer HR. Bromelain: biochemistry, pharmacology and medical use. Cell Mol Life Sci. 2001 Aug;58(9):1234-45.

11. Ammon HP, et al. Mechanism of Anti-inflammatory Actions of Curcumin and Boswellic Acids. J Ethnopharmacol. 1993;38:113.

12. Ammon HP, et al. Pharmacology of Curcuma longa. Planta Med. Feb1991;57(1):1-7.

13. Satoskar RR et al., “Evaluation of anti-inflammatory property of curcumin (diferuloy methane) in patients with postoperative inflammation,” Int J Clin Pharmacol Ther Toxicol 1986 (24): 651-4.

14. Srivastava KC, et al. Curcumin, A Major Component of Food Spice Turmeric (Curcuma longa) Inhibits Aggregation and Alters Eicosanoid Metabolism In Human Blood Platelets. Prostaglandins Leukot Essent Fatty Acids. Apr1995;52(4): 223-27.

15. Life Extension eds., Disease Prevention and Treatment, 4th ed. Florida: Life Extension Media, 2003.

16. Stoppard M. Family Health Guide, New York: DK Publishing, 2002.