Carpal Tunnel Syndrome

What you need to know

Halt the hurting in your hands and wrists so you can get back to feeling well while you work. According to research or other evidence, the following self-care steps may help relieve CTS symptoms:

Add vitamin B6 to the mix
Soothe symptoms by taking 300 mg a day for no more than three months straight, and 50 to 100 mg per day after that

Slip on a splint
Reduce irritation by wearing a special wrist brace designed for carpal tunnel syndrome; use it during working hours and at night

Consider chiropractic care and physical therapy
Consult a qualified practitioner for manipulative, soft tissue, and other therapies to reduce symptoms and improve function

Make an appointment with an acupuncturist
See a qualified practitioner for treatments that may provide relief

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full carpal tunnel syndrome article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a condition characterised by pain, tingling, and numbness in the fingers and hand, sometimes radiating up into the elbow.

The painful sensations of CTS are caused by compression of the median nerve in the tunnel of bones in the wrist. In many cases, the condition results from long-term repetitive motions of the hands and wrists, such as from computer use. Although repetitive motion is often a culprit, it does not explain the frequent occurrence of CTS with non-motion-related conditions, such as pregnancy.

Product ratings for carpal tunnel syndrome

Rating	Nutritional Supplements	Herbs
	Vitamin B6
See also: Homoeopathic Remedies for Carpal Tunnel Syndrome
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Symptoms of CTS include recurrent numbness, tingling, weakness, or pain in one or both hands in a characteristic location defined by the median nerve, which is compressed as it passes through the carpal tunnel in the wrist. Symptoms are usually worse at night and after prolonged use of the hands. Some people may experience clumsiness in handling objects, with a tendency to drop things, and may also have a decreased ability to feel hot and cold.

Other therapies

Splints are often recommended to immobilize the wrist, theoretically protecting it from repetitive motion injury. A physical therapy programme of hand- and wrist-strengthening exercises, combined with the use of a wrist brace, is sometimes recommended. In more advanced cases, a surgical procedure called a “release” may be necessary. The procedure separates the ligaments covering the carpal tunnel in the wrist, which relieves painful pressure on the median nerve.

Vitamins that may be helpful

Some, but not all, studies have found vitamin B6 deficiency to be common in people with CTS.¹ Supplementation with vitamin B6 has reportedly relieved the symptoms of CTS,² but some researchers have not found this treatment to be beneficial.³ ⁴

A few studies report that people with CTS are helped when given 100 mg of vitamin B6 three times per day.⁵ ⁶ Although some researchers have found benefits with lesser amounts,⁷ ⁸ ⁹ ¹⁰ using less than 100 mg taken three times per day for a few months has often failed.¹¹ ¹² ¹³ Most doctors assume that people with CTS who respond to vitamin B6 supplementation do so because of an underlying deficiency. However, at least one group of researchers has found vitamin B6 to “dramatically” reduce pain in people with CTS who did not appear to be B6-deficient.¹⁴ Some doctors believe that B6 is therapeutic because it reduces swelling around the carpal tunnel in the wrist; this theory remains completely undocumented.

Very high levels of vitamin B6 can damage sensory nerves, leading to numbness in the hands and feet as well as difficulty in walking; supplementation should be stopped if these symptoms develop after beginning vitamin B6 supplementation. Vitamin B6 is usually safe in amounts of 200 to 500 mg per day,¹⁵ although occasional problems have been reported in this range.¹⁶ Higher amounts are clearly toxic.¹⁷ Any adult taking more than 200 mg of vitamin B6 per day for more than a few months should consult a doctor.

In order to be effective, vitamin B6 must be transformed in the body to pyridoxal-5’-phosphate (PLP). Some doctors have suggested that people who do not respond well to vitamin B6 supplements should try 50 mg of PLP three times per day. There is no clear evidence that using PLP provides any advantage in reducing symptoms of CTS.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Integrated approaches that may be helpful

Acupuncture may be useful in the treatment of CTS. In a preliminary trial, people with CTS (some of whom had previously undergone surgery) received either acupuncture or electro-acupuncture (acupuncture with electrical stimulation). Eighty-three percent of the participants in this trial experienced complete relief that lasted through two to eight years of follow-up.¹⁸ After reviewing all available scientific literature on the topic, a consensus conference convened in 1997 by the National Institutes of Health concluded that acupuncture for CTS “may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management programme.”¹⁹

Manipulative procedures may have a role in treating CTS by decreasing symptoms and improving function. A type of stretching treatment called myofascial release improved the symptoms of a patient with CTS in one published case report,²⁰ and similar treatments combined with specific wrist manipulations and self stretches were further tested in a small, preliminary trial.²¹ Participants in this study experienced a decrease in pain, numbness, and weakness, and their nerve function improved as well.

A small, preliminary trial assessed a chiropractic treatment programme consisting of exercises, soft tissue therapy, and manipulation of the wrist, the upper extremity, the spine, and the ribs.²² The treatment resulted in improvement in grip and thumb strength, muscle function, flexibility, and overall function, as well as a decrease in pain among people with CTS. In a follow-up study six months later, most of the improvement had been maintained.²³ A controlled clinical trial compared traditional medical and chiropractic care for CTS.²⁴ People with CTS received either standard medical care (ibuprofen and night-time wrist supports) or chiropractic care (manipulation of the wrist, elbow, shoulder, neck, and spine, as well as massage to the soft tissues). Ultrasound and night-time splints were also used in the chiropractic treatments. People in both groups improved significantly and similarly in terms of pain reduction, increased function, and improved finger sensation and nerve function, but the chiropractic group reported fewer side effects.

References

1. Fuhr JF, Farrow A, Nelson HS. Vitamin B6 levels in patients with carpal tunnel syndrome. Arch Surg 1989;124:1329–30.

2. Keniston RC, Nathan PA, Leklem JE, Lockwood RS. Vitamin B6, vitamin C, and carpal tunnel syndrome. J Occup Environ Med 1997;39:949–59.

3. Franzblau A, Rock CL, Werner RA, et al. The relationship of vitamin B6 status to median nerve function and carpal tunnel syndrome among active industrial workers. J Occup Environ Med 1996;38:485–91.

4. Smith GP, Rudge PJ, Peters TJ. Biochemical studies of pyridoxal and pyridoxal phosphate status and therapeutic trial of pyridoxine in patients with carpal tunnel syndrome. Ann Neurol 1984;15:104–7.

5. Ellis JM, Azuma J, Watanbe T, Folkers K. Survey and new data on treatment with pyridoxine of patients having a clinical syndrome including the carpal tunnel and other defects. Res Comm Chem Path Pharm 1977;17(1):165–77.

6. Ellis JM. Vitamin B6 deficiency in patients with a clinical syndrome including the carpal tunnel defect. Biochemical and clinical response to therapy with pyridoxine. Res Comm Chem Path Pharm 1976;13(4):743–57.

7. D’Souza M. Carpal tunnel syndrome: clinical or neurophysiological diagnosis. Lancet 1985;i:1104–5.

8. Driskell JA, Wesley RL, Hess IE. Effectiveness of pyridoxine hydrochloride treatment on carpal tunnel syndrome patients. Nutr Rep Internat 1986;34(4):1031–9.

9. Ellis JM. Treatment of carpal tunnel syndrome with vitamin B6. Southern Med J 1987;80(7):882–4.

10. Browning DM. Carpal tunnel syndrome: clinical or neurophysiological diagnosis? Lancet 1985;i:1104–5 [letter].

11. Smith GP, Rudge PJ, Peters TJ. Biochemical studies of pyridoxal and pyridoxal phosphate status and therapeutic trial of pyridoxine in patients with carpal tunnel syndrome. Ann Neurol 1984;15:104–7.

12. Amadio PC. Pyridoxine as an adjunct in the treatment of carpal tunnel syndrome. J Hand Surg 1985;10A(2):237–41.

13. Stransky M, Rubin A, Lava NS, Lazaro RP. Treatment of carpal tunnel syndrome with vitamin B6: a double-blind study. Southern Med J 1989;82(7):841–2.

14. Bernstein AL, Dinesen JS. Brief communication: effect of pharmacologic doses of vitamin B6 on carpal tunnel syndrome, electronencephalographic results, and pain. J Am Coll Nutri 1993;12:73–6.

15. Gaby AR. Literature review & commentary. Townsend Letter for Doctors and Patients.1990;Jun:338–9.

16. Parry G, Bredesen DE. Sensory neuropath with low-dose pyridoxine. Neurology 1985;35:1466–8.

17. Schaumburg H, Kaplan J, Windebank A, et al. Sensory neuropathy from pyridoxine abuse. N Engl J Med 1983;309(8):445–8.

18. Chen GS. The effect of acupuncture treatment on carpal tunnel syndrome. Am J Acup 1990;18:5–9.

19. NIH Consensus Conference. Acupuncture. JAMA 1998;280:1518–24.

20. Sucher BM. Myofascial release of carpal tunnel syndrome. J Am Osteopathic Assoc 1993;93:92–101.

21. Sucher BM. Palpatory diagnosis and manipulative management of carpal tunnel syndrome. J Am Osteopathic Assoc 1994;94:647–63.

22. Bonebrake AR, Fernandez JE, Marley RJ, et al. A treatment for carpal tunnel syndrome: evaluation of objective and subjective measures. J Manip Physiol Ther 1990;13:507–20.

23. Bonebrake AR, Fernandez JE, Dahalan JB, et al. A treatment for carpal tunnel syndrome: results of a follow-up study. J Manip Physiol Ther 1993;16:125–39.

24. Davis PT, Hulbert JR, Kassak KM, et al. Comparative efficacy of conservative and chiropractic treatment for carpal tunnel syndrome: a randomized clinical trial. J Manipulative Physiol Ther 1998;21:317–26.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires September 2008.

2007-09-01