Carpal tunnel syndrome (CTS) is the most common compressive neuropathy affecting 3-6% of the adult population, most commonly women between the ages of 45 and 54. In the United States, an incidence of 1-3 per 1,000 people and a prevalence of 50 per 1,000 individuals has been reported. Causing pain, numbness, and tingling in the hand and wrist, CTS is one of the most common hand conditions requiring surgery and is considered an occupational hazard. (1, 2)
Traditionally, treatment options for CTS have focused on medication, splinting, or surgery. Medical costs related to the diagnosis and treatment of CTS have been estimated between 13,000-40,000 dollars per medical case annually (1). There has been a growing recognition of the benefits of an integrative approach to managing this condition that combines conventional medical treatments with complementary therapies and lifestyle modifications. This article will explore the various components of an integrative approach to treating carpal tunnel syndrome, helping individuals with CTS experience improved symptom relief and functional outcomes.
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What Is Carpal Tunnel Syndrome?
CTS is a condition that affects the hand and wrist and occurs when the median nerve becomes compressed or squeezed as it passes through the carpal tunnel. The carpal tunnel is a narrow, rigid passageway in the wrist composed of bones and a ligament called the flexor retinaculum. The median nerve runs from the forearm into the hand and provides sensation to the thumb, index, middle, and half of the ring fingers and controls some of the muscles at the base of the thumb. (2, 3)
Causes and Risk Factors for Developing Carpal Tunnel Syndrome
The primary cause of CTS is the swelling or inflammation of the tissues within the carpal tunnel, leading to compression of the median nerve. Compression can arise from increased compartmental pressure related to an inflammatory response to extensive use, trauma to the wrist, or an underlying inflammatory process. (1)
All of the following have been identified as risk factors associated with CTS (4):
- Anatomic Factors: wrist fractures, dislocations, and arthritis can deform the small bones in the wrist, narrowing the space within the carpal tunnel
- Sex: CTS is more common in women. This may be because the carpal tunnel area is relatively small in women compared to men, but hormonal fluctuations during pregnancy and menopause can also increase the risk of CTS.
- Chronic illnesses, such as diabetes and rheumatoid arthritis, increase the risk of nerve damage and have an inflammatory component that can put pressure on the median nerve.
- Obesity
- Workplace Factors: frequent, repetitive, small, and grasping movements or those that require prolonged flexing of the wrist (such as typing) can exacerbate pressure on the median nerve and worsen nerve irritation and damage.
Symptoms of Carpal Tunnel Syndrome
Symptoms of CTS can range from mild to severe, usually beginning slowly and progressively worsening with time if left untreated. Nighttime symptoms are often the first reported symptoms when people sleep with their wrists curled, which increases pressure on the median nerve. (5)
Common CTS symptoms include (5):
- Numbness and tingling ("pins and needles") in the thumb, index finger, middle finger, and half of the ring finger of the affected hand. These sensations often occur during activities that involve bending the wrist.
- Hand weakness makes it difficult to perform tasks requiring fine motor skills, such as buttoning a shirt, handling small objects, and writing. Reduced grip strength can also make an individual more prone to dropping objects.
In most cases, these symptoms come and go for months without worsening and will vary based on the time of day, activity, or wrist position. As the condition worsens, symptoms may become more severe and constant. In the most severe cases, muscles at the base of the thumb will atrophy and visibly appear smaller in size. (6)
How Is Carpal Tunnel Syndrome Diagnosed?
CTS is diagnosed in a patient with characteristic symptoms and physical exam findings. A complete physical examination of the upper extremity should be performed to rule out other causes of symptoms; inspect for tenderness, swelling, warmth, and discoloration; and test for sensation and muscle strength. Tests specific to CTS, including the Tinel sign and Phalen maneuver, are usually performed as positive findings increase the likelihood of CTS. (3, 7)
Adjunctive tests and imaging are not required to diagnose CTS but can help confirm the diagnosis, reveal underlying causes, determine the severity, and plan surgery if needed. Routine laboratory tests, including a CBC, CMP, HbA1c, and CRP, and X-rays can reveal fractures, arthritis, and diabetes contributing to the condition. (7
Electrodiagnostic tests, including a nerve conduction study and electromyography, and diagnostic imaging, like ultrasonography and MRI, are typically reserved for confirming the diagnosis of CTS in atypical cases and excluding other conditions. (3, 7)
Conventional Treatment for Carpal Tunnel Syndrome
Conventional treatment strategies for CTS aim to improve symptoms and hand and wrist function. Management is based on disease severity; in mild to moderate cases, a trial of conservative treatment usually improves symptoms within 2-6 weeks. Conservative treatment encompasses non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections for pain and inflammation reduction; rest and wrist splinting; physical and occupational therapy to improve hand and wrist flexibility, strength, and function; and activity modification to avoid or minimize activities that exacerbate CTS symptoms. (7)
Surgical decompression should be considered when conservative therapy does not elicit an improvement in symptoms after six weeks. This outpatient procedure involves cutting the carpal ligament to enlarge and release pressure within the carpal tunnel. Carpal tunnel release provides a positive and lasting outcome in 70-90% of cases. Most patients experience improvement in symptoms within one week of surgery and can return to normal activities two weeks post-op. Some patients, especially those with severe CTS, may take up to one year to fully recover. The most common complications of surgery are painful scarring and pain adjacent to the site of ligament release. (7)
Integrative Approaches to Carpal Tunnel Syndrome
Incorporating ergonomic modifications, acupuncture, physical therapy, manual therapies, and botanical medicine, integrative medicine seeks to alleviate pain, improve nerve function, reduce inflammation, and enhance hand and wrist health. This integrated approach focuses on symptom management, preventing nerve damage and muscle atrophy, and empowering patients to participate actively in their healing process.
Ergonomics and Workplace Modifications
Although there is insufficient evidence to suggest a causal relationship between computer work and CTS, there is speculation that an association exists between the two. Therefore, ergonomic workplace modifications are often recommended to relieve pressure from the median nerve and provide temporary symptom relief. Adjusting the workstation layout and equipment can reduce strain on the wrist and minimize CTS symptoms. One small study found that using an ergonomic keyboard for 12 weeks reduced hand pain. Ergonomic changes include properly positioning the keyboard, mouse, and chair and using wrist supports, adjustable desks, and ergonomic devices designed to support neutral wrist positions.
Acupuncture and Acupressure for Carpal Tunnel Syndrome
A recent 2023 meta-analysis concluded that acupuncture may be considered as a safe adjunctive therapy to conventional treatment strategies to benefit patients in improving symptom severity and functional status. Some studies have reported positive outcomes with acupuncture and electroacupuncture in relieving pain, reducing inflammation, and improving hand function by stimulating the release of natural pain-relieving chemicals called endorphins.
Manual Therapies (e.g., Chiropractic Care, Osteopathy) For Carpal Tunnel Syndrome
Manual therapy is a hands-on approach performed by healthcare professionals, such as physical therapists, chiropractors, or massage therapists, to target specific structures in the hand and wrist and promote healing and symptom relief. Studies increasingly show the positive effects of manual therapy interventions, including osteopathic manipulation and massage, on symptoms and physical function in patients with CTS.
Exercise and Stretching Routines for Carpal Tunnel Syndrome
Physical therapy and stretching exercises are easy to learn, can be done at home, and can be combined with other therapeutic modalities to relieve symptoms. They encourage the normal movement of the median nerve through the carpal tunnel and improve the wrist's range of motion and hand function. Although the evidence for these techniques is limited, smaller studies suggest short-term benefits with physical therapy and self-stretching (8-10).
Yoga for Carpal Tunnel Syndrome
Yoga can be a beneficial complementary therapy for individuals with CTS because it promotes relaxation, flexibility, and strength in the wrists. Recommendations to incorporate yoga into an integrative CTS treatment plan are based on a small study conducted in 1998 that concluded a yoga-based regimen was more effective than wrist splinting or no treatment in relieving signs and symptoms of CTS.
Herbal Remedies and Essential Oils for Carpal Tunnel Syndrome
An integrative approach to pain management often incorporates natural and botanical supplements. Medicinal herbs and essential oils commonly used to treat neuropathic pain include turmeric, lavender, chamomile, ginger, frankincense, and capsaicin. (11-14)
Developing an Integrative Treatment Plan for Carpal Tunnel Syndrome
Developing an integrative treatment plan involves a collaborative effort between healthcare providers and patients. Establishing open and transparent communication between an individual and their healthcare team helps doctors obtain a clear medical history to facilitate a shared decision-making process. Personalization of the treatment plan should be based on the severity of CTS and the patient's needs, preferences, and health goals. Educating patients about CTS, its causes, symptoms, and available treatment options empowers them to make informed decisions, implement and comply with treatment strategies, and attend regular follow-up appointments. Scheduled follow-up appointments allow healthcare providers to assess treatment progress and make necessary adjustments to improve health outcomes.
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Summary
This article discussed carpal tunnel syndrome and explored the benefits of integrating complementary therapies and lifestyle modifications with conventional medical treatments to manage its symptoms and prevent complications. Incorporating therapies like physical therapy, acupuncture, and botanical medicine has value in alleviating pain, improving nerve function, and enhancing hand and wrist health. Ultimately, an integrative approach to CTS empowers individuals to participate in their health actively and promotes a comprehensive, collaborative strategy for managing this prevalent health condition.
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