Pamela A. Popper, Ph.D., N.D.

Wellness Forum Health

The carpal tunnel is a canal located on the palm side of the wrist which is made of bones and connective tissue. It protects the median nerve to the hand and the tendons that facilitate bending the fingers.

Carpal tunnel syndrome, CTS, is one of the most common peripheral neuropathies, involving about one million American adults each year.[1] CTS involves compression or pinching of the nerve in the carpal tunnel, which results in numbness, tingling, and pain. The thumb, index, middle, and ring finger are most commonly affected, but symptoms can sometimes extend above the wrist into the forearm. People with carpal tunnel syndrome can experience discomfort while holding on to something like a phone or magazine, and sometimes accompanying weakness causes a tendency to drop things.

Women are more likely than men to develop carpal tunnel syndrome and there are many causes, including fracture or dislocation of the wrist.  It is widely believed that carpal tunnel syndrome is caused by repetitive motions performed in the workplace, such as computer use, and this can be a contributing factor. But many studies have looked at the association between computer use and carpal tunnel syndrome, with mixed and inconclusive results. One meta-analysis showed that only 8.29% of CTS cases were job-related.[2] Most of the time, the condition is caused by being overweight, by health conditions that cause damage to the nerves, such as diabetes[3], and conditions that cause inflammation, such as rheumatoid arthritis and other autoimmune diseases, gout, osteoarthritis, and chronic kidney insufficiency.

One meta-analysis of 58 studies including 1,379,372 subjects showed that being overweight or obese increased the risk of CTS significantly. The risk of CTS increased by 7.4% for each one-unit increase in body mass index. There was no difference in the association between men and women and was consistent regardless of study design.[4]

Diagnosis can be difficult due to variations in symptoms and the difficulty some patients have in even describing symptoms.  Nerve conduction tests are considered the gold standard for diagnosis, but are not definitive.  In one study of over 2400 Swedish subjects, 14.9% reported symptoms of CTS but only 4.9% had a positive nerve conduction test, and 18.0% of patients with no symptoms had a positive test.[5]

NSAIDS, corticosteroids and surgery are often recommended to treat CTS.  The problem with drugs is that they do not address the underlying cause, and the problem with surgery is that most cases of CTS are caused by being overweight and health issues like type 2 diabetes. Surgery also has a high risk of complications such as infection, increased pain, numbness and tingling, and scar tissue buildup which results in the need for a second surgery.

Adopting a program of dietary excellence, combined with exercise results in weight loss and has been proven to successfully treat diabetic neuropathy, one known cause of CTS.[6] [7]

Yoga has been shown to be more effective than wrist splinting for relieving symptoms of CTS.[8] Sine yoga postures stretch muscles and improve joint function, yoga practice is a reasonable alternative for resolving carpal tunnel

Manual physical therapy is another non-surgical alternative.  In one study, researchers compared pain and function for 111 women randomized to have surgery or manual physical therapy. Patients receiving physical therapy reported bigger decreases in pain at one month and 3 months, and at the end of the year results were the same as for those patients undergoing surgery.[9]  Specific exercises called carpal tunnel decompression exercises have also been shown to work, and patients can be taught to do these regularly at home or at the office.[10] Since less invasive approaches are always better in health care, a strong argument can be made for physical therapy and exercise instead of surgery.

Other alternative treatments include the use of heat[11], ultrasound[12], and laser[13] therapies.

In summary, non-drug and non-surgical alternatives are effective both for reducing symptoms and for resolution of CTS.

[1] Tanaka S, Wild DK, Seligman PJ, Behrens V, Cameron L, Putz-Anderson V. The US prevalence of self-reported carpal tunnel syndrome: 1988 National Health Interview Survey data. Am J Public Health. 1994;84(11):1846–8.

[2] Gerr F, Letz R. Risk factors for carpal tunnel syndrome in industry: blaming the victim? J Occup Med. 1992;34(11):1117–9

[3] Becker J, Nora DB, Gomes I, Stringari FF, Seitensus R, Panosso JS, et al. An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Clin Neurophysiol. 2002;113(9):1429–34

[4] Shiri R, Pourmeman M, Falah-Hassani K, Vikari-Juntura E. “The effect of excess body mass on the risk of carpal tunnel syndrome: a meta-analysis of 58 studies.”  Obesity Reviews December 2015;16(12):10-94-1104

[5] Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153–8

[6] Kristina Fiore “Vegan Diet Eases Diabetic Neuropathy Pain.” Medpage Today August 8 2014-11-30http://www.medpagetoday.com/MeetingCoverage/AADE/47120

[7] Crane M, Sample C. “Regression of diabetic neuropathy with total vegetarian (vegan) diet.” J Nutr Med. 1994;4:431-439

[8] Garfinkel M, Singhal A, Latz W, Allan D, Reshetar R, Schumacher H. “Yoga-based intervention for carpal tunnel syndrome: a randomized trial.” JAMA 1998 Nov 11;280(18):1601-1603

[9] Fernandez-de-Las Penas C, Ortega-Santiago R, de la Llave-Rincoin A et al. “Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: A Randomized Parallel-Group Trial.” J Pain. 2015 Nov;16(11):1087-94

[10] Seradge H, Bear C, Bithell D.” Preventing carpal tunnel syndrome and cumulative trauma disorder: effect of carpal tunnel decompression excercises: an Oklahoma experience.” J Okla State Med Assoc. 2000;93:150-153.

[11] Michlovitz S, Hun L, Erasala G, Hengehold D, Weingand K. “Continuous low-level heat wrap therapy is effective for treating wrist pain.”  Arch Phys Med and Rehab September 2004;85(9):1409-1416

[12] Ebenbichler G, Resch K, Nicolakis P et al. “Ultrasound treatment for treating the carpal tunnel syndrome: randomized “sham” controlled trial.”  BMJ 1998;316:731-735

[13] Padua L, Padua R, Morretti C, Nazzaro M, Toral J. “clinical outcome and neurophysiological results of low power laser irradiation in carpal tunnel syndrome.” Lasers Med Sci 1999;14:196-202