The carpal tunnel is the area in the wrist where the median nerve passes through a region of surrounding bone, ligaments, and connective tissue as it spreads its nerve fibers to different areas of the hand and fingers. Its nerve distribution includes the palm, thumb and first three fingers. Compression within this area causes nerve irritation or damage which manifests as pain, numbness and tingling to the affected areas. Current figures are that up to 10 percent of the US population suffers from Carpal Tunnel Syndrome (CTS) which can occur in one or both hands.
The causes of CTS normally occur from over-use injuries when the wrist is held in a semi-flexed position, i.e. working on computer keyboard. However, disease conditions can lead to CTS as well, including thyroid problems, diabetes, high blood pressure, autoimmune disorders, and fluid retention (pregnancy). The resulting inflammation from these conditions leads to swelling and increase pressure in the carpal tunnel putting pressure on the median nerve.
The symptoms of classic CTS are numbness, tingling and pain along the thumb and first 3 fingers, wrist pain that may travel up the arm, and worsening pain at night interfering with sleep. Diagnostic testing such as nerve conduction studies can be done to evaluate the speed of electrical impulses through the median nerve. Decreased conduction indicates CTS. Treatment of CTS usually involves anti-inflammatory medications to control inflammation and pain, wrist splints to keep hands in a neutral position, steroid injections into the wrist, and treatment of the underlying condition, i.e. low thyroid, diabetes. Surgical intervention is always an option, but should be used only as the last resort.
Unfortunately, individuals with Multiple Sclerosis can have nerve involvement of the median nerve which can lead to what appears to be CTS. If the median nerve is affected by dysfunction in the nervous system from MS than numbness and tingling in the palm and first three fingers, including the thumb can occur. Usually with MS the numbness and tingling would be one sided, or felt in other areas of the body – not just the hands. Also, because classic CTS occurs because of compression of the median nerve within the carpal tunnel someone with MS may not experience pain in the wrist, but instead just numbness and tingling, unless of course they also have an overuse injury too. Wearing wrist splints to keep the hands in a neutral position would not likely bring relief from median nerve involvement from MS that would be expected to occur if someone was truly suffering from classic CTS.
A quick way to diagnose true CTS is to perform a hand-flexing procedure called the Phalen’s maneuver. Place the back of your hands together with the wrists bent at a 75 degree angle. Hold this position for a few minutes. If you feel numbness, tingling, burning sensation and/or pain it may likely be CTS. To know for sure if CTS truly exists a nerve conduction study called electromyography (EMG) would need to be performed, but the Phalen’s maneuver is a good predictor.
There are a number of natural medicine options for CTS treatment. Certain supplements like B-complex vitamins (with 100mg of each major B-vitamin taken three times daily), as well as Zinc (50mg daily) and CoQ10 (100mg daily) can help. Also, plant based remedies of Bromelain and Boswellia can help reduce inflammation. Capsicum cream (usually available over-the-counter) applied to the wrist area two to three times daily can help with pain and inflammation. Vitamin C at 1000mg four times daily and Vitamin E at 200 IU daily may be helpful too. Finally, some individuals with CTS find that eating a ½ of a fresh pineapple daily for two to three weeks is beneficial. Pineapple is a natural source of bromelain.