Carpal Tunnel Syndrome (CTS)

Carpal tunnel syndrome (CTS) is a potentially disabling condition that affects the wrists and hands, causing pain and other symptoms such as tingling and numbness.

The carpal tunnel is a space or channel within the wrist that’s surrounded by eight small carpal bones and the carpal ligament. Through the middle of this space run the tendons that attach the forearm muscles to the fingers, as well as a main nerve called the median nerve (this nerve divides into smaller branches in the palm).

If the tendons and ligaments in the tunnel become irritated and inflamed, it can put abnormal pressure on the median nerve. The result of this pressure may include pain, tingling and numbness in the hand, most usually in the thumb, the index finger, the middle finger and part of the ring finger. CTS may affect one or both hands – according to Patient, up to 73 percent of cases affect both hands, though not necessarily at the same time (i).

Sometimes the symptoms extend to other parts of the hand and the arm too, with some people also feeling pain and discomfort in their shoulder or neck. Plus you may experience a burning, prickling sensation similar to pins and needles.

Other symptoms that can affect those with CTS include the skin in the affected area becoming less sensitive to touch (hypoaesthesia), or becoming dry or swollen. The skin on your affected hand and fingers may also change colour, or you may develop muscle weakness in your fingers and/or thumb. This can lead to problems with your grip, and you may find yourself dropping things more often, or you may experience difficulties with things such as fastening buttons.

Who gets CTS?

Experts believe CTA is a fairly common condition affecting about five percent of people in Europe (i). Women are more likely to develop it than men; and while it can affect anyone of any age, it’s more common among middle-aged and older people(in people in their late 70s an equal number of women and men are affected) (ii). It’s also thought to be more widespread in people who are overweight or obese and can run in families. Women who are pregnant are also more likely to be affected (ii).

The symptoms tend to develop gradually, usually over a period of weeks, rather than suddenly. They also tend to be worse at night, which can have an impact on your sleep – though if your job involves writing, typing or other activities that involve hand and/or wrist movements, you may experience symptoms during the day too.

What causes CTS?

Carpal tunnel syndrome is caused by compression of the median nerve within the carpal tunnel in the wrist. But in most cases, there’s no obvious reason why this happens.

And while it’s widely thought the condition is often caused by occupational and recreational repetitive hand movements (CTS is considered to be a common form of repetitive strain injury, some experts now believe this theory is controversial.

However, most agree there are factors that may make you more susceptible to developing CTS, including the following:

Genetics

If other members of your family have or have had CTS, your risk of developing the condition is higher than it would be otherwise. According to Patient, around one in four people with CTS has a close relative – such as a parent, brother or sister – who also has the condition (ii). Currently, however, it’s not clear how or why CTS may run in families.

It’s also thought that short people are more likely to develop CTS than tall people (iii); those with a square-shaped wrist may also have a higher risk (iv).

Medical history

Certain health conditions are linked to CTS. If you have diabetes, for instance, you may be more likely to develop CTS than someone without diabetes. Other conditions that increase the risk of CTS include any form of arthritis that affects the wrist, as well as an underactive thyroid (hypothyroidism).

Some medicines may also cause CTS, including certain treatments for breast cancer.

Pregnancy

Many women experience CTS while they’re pregnant, though most find the symptoms disappear after their baby has been born. It is thought that CTS symptoms may be caused in such cases by the hormonal changes that happen during pregnancy, since these hormones can affect connective tissues and put pressure on the median nerve (v). CTS is also common in women around the time of the menopause, while some others find they experience symptoms at certain times during their monthly cycle. Discover more symptoms of pregnancy here.
 

Injury

Any injury to the hand or wrist – such as a sprain or a fracture – may damage the median nerve, causing CTS symptoms. Things that affect the space that is the carpal tunnel may also cause CTS, such as cysts, growths and swollen tendons (though these are fairly rare).

How is CTS treated?

If you have CTS caused by a medical condition – such as an underactive thyroid, for instance – treating that condition should also improve your CTS symptoms. If your symptoms get worse when you perform certain activities with your hands, it goes without saying that avoiding those activities might bring relief. According to Versus Arthritis, if you think your work may be causing your symptoms, you should discuss the problem with your supervisor or an occupational health nurse (or visit your local Jobcentre Plus and ask to be put in touch with a disability employment advisor) (v).

Depending on how mild your symptoms are, you may not need any treatment at all, since CTS symptoms disappear without treatment in up to one in four cases within a year or so (particularly in those under the age of 30) (ii).

Meanwhile, if you do need treatment for CTS, these fall into two categories: non-surgical and surgical. Your GP may recommend a non-surgical approach in the first instance. This may involve one or both of the following:

Wrist splints

Keeping your wrists as straight as possible can help relieve the pressure on the median nerve, and many people with CTS find wearing a wrist splint – which prevents the wrist bending – can be useful. According to the NHS, you normally wear the splint at night while you sleep, and it may take at least four weeks before you start to feel better (vi).

Wrist splints are available from larger pharmacies, or you can ask your GP to recommend a supplier. Your GP may also be able to advise you whether you need a resting splint – usually if your symptoms are worse at night – or a working splint, which holds your wrist slightly bent back and may be useful if your symptoms are triggered by certain activities.

Steroid injections

If you’ve tried a wrist splint and your symptoms haven’t improved, your GP may recommend corticosteroids to bring down the inflammation in your wrist. Usually, this means having the steroid medication injected directly into your wrist, rather than taking it in tablet form. This can be very effective, especially in cases where the nerve isn’t severely compressed. However, some people find their symptoms return within a year or so (a second injection may be given in some cases).

CTS surgery

If non-surgical methods haven’t been successful and you’re still experiencing symptoms, you may be advised to have carpal tunnel release surgery. This is performed under local anaesthetic, and you won’t usually have to stay in hospital overnight, as it’s carried out on an outpatient basis.

Once the anaesthetic has numbed your hand and wrist, the surgeon cuts the carpal ligament in your wrist to reduce the pressure on the nerve in the carpal tunnel. This may involve open surgery (making a cut to your wrist) or your surgeon may use keyhole surgery (this means the cut to your wrist or palm may be much smaller). You will be awake throughout the operation, which means your recovery time will be much shorter than if you had general anaesthetic.

According to the NHS, this usually cures carpal tunnel syndrome (vi), though there will always be a small risk of complications (your healthcare team will discuss these with you before you have your operation).

Exercises for CTS

There are ways you can help yourself if you have CTS. The Chartered Society of Physiotherapy recommends the following exercises to help ease your symptoms as well as prevent future injuries (vii):

Wrist bend (forward and back)

1. Rest your elbows on a table with your arms pointing up and your wrists straight.

2. Bend your wrists forward gently at a right angle, and hold for five seconds.

3. Straighten your wrists.

4. Bend your wrists backwards as far as comfortable and hold for five seconds.

5. Do three sets of 10 repetitions of the forward and backwards move.
    

Wrist lift

1. Put your hand on a table, palm facing downwards.

2. Lift up the fingers of the hand on the table.

3. Put your other hand on top of the hand on the table – place it sideways, across the knuckles of the bottom hand.

4. Push the top hand down while the fingers of the bottom hand try to keep pulling up (you should feel the muscles of your forearms contracting).

5. Repeat with the other hand on the bottom.

Wrist flex

1. Hold out one arm, keeping it straight with your palm facing down.

2. Bend the wrist gently so that your hand is pointing towards the ground.

3. Use your other hand to press the fingers that are pointing down back towards your body.

4. Hold for 15-30 seconds, then straighten your wrist.

5. With the same hand, bend the wrist gently the other way, so your fingers are pointing upwards. Use the other hand to gently pull the fingers back.

6. Hold for 15-30 seconds, then straighten your wrist again.

7. Repeat two more times, then swap hands. Do three complete sets with each wrist.

Finger bend

1. Hold both hands up with your fingers close together and pointing straight up.

2. Keeping the lower part of your fingers straight, bend both joints so that the tips of your fingers are pointing down.

3. Hold for five seconds.

4. Repeat two more times, then repeat the set 10 times.
    

Wrist stretch with weight

1. Hold a light weight such as a tin of beans in each hand.

2. Raise your arms to chest or shoulder height, keeping them straight and your palms facing down.

3. While gripping the weight, bend your wrists up slowly, then bend them back down again.

4. Do three sets of 10 repetitions.

5. When you feel comfortable with this exercise, try holding something slightly heavier in your hands while you do it, and keep increasing the weight gradually.
    

Hand squeeze

1. Squeeze a rubber ball in one hand.

2. Hold for five seconds.

3. Repeat two more times, then repeat the set 10 times.

4. Do the same with the other hand.

Natural relief for CTS

While there aren’t as yet any natural supplements clinically proven to help improve CTS, some may help relieve symptoms such as inflammation and swelling – which may trigger the development of CTS – as well as support nerve and muscle health.

Turmeric

A herb widely used in Indian cooking, turmeric adds colour and flavour to curry dishes and has long been used in the traditional Indian system of herbal medicine called Ayurveda. It contains an antioxidant substance called curcumin, which is widely thought to have anti-inflammatory properties (viii).

Fish oils

The omega-3 fatty acids found in fish oils are also believed to have an anti-inflammatory action, since they’re thought to affect the body’s production of prostaglandins, substances that play a key role in the production of inflammation (ix).

If you’re a vegetarian or vegan you can still benefit from an omega-3 supplement, thanks to the availability of products that contain the natural triglyceride (TG) form of omega-3, which is sourced from plant organisms called microalgae rather than fish oils.

Magnesium

A mineral that may be useful for general muscle health, magnesium is found naturally in the body (the average adult has about 25g), with just over half found in the bones and the rest in soft tissues. It’s needed for more than 300 different biochemical reactions, including muscle and nerve function. If you don’t have a sufficient level of magnesium in your body, one of the symptoms may be muscle cramps or twitches. However, there is evidence that many people in the UK don’t get enough magnesium in their diet. Studies meanwhile suggest that magnesium deficiency caused by a lack of the mineral in your diet may predispose you for chronic inflammatory stress (x).

B vitamins

The group of B vitamins – and especially vitamin B6 – is believed to help maintain healthy nerves. There is even some evidence to suggest those with carpal tunnel syndrome may be deficient in vitamin B6 (xi), with experts suggesting that a daily vitamin B6 supplement should be included in carpal tunnel syndrome treatment (xii).
 

PEA

Also known as palmitoylethanolamide, PEA is a type of fatty acid made naturally by the body and found in all cells, tissues and fluids including the brain (it’s also found in foods such as soya beans, peanuts, eggs, flaxseed and milk). Described as an endocannbinoid-like chemical that belongs to a family of fatty acid compounds called amides (xiii), PEA is an alternative to CBD, since both substances are thought to have similar properties including the ability to reduce pain and inflammation. However researchers suggest PEA is safer than CBD, since it has been studied more extensively and has a more robust safety profile (xiv) with no known side effects (xiii).

Your body naturally increases its production of PEA when your cells are damaged or threatened. But in certain situations – such as when your body is experiencing chronic inflammation – the level of PEA in your cells drops (xiii). When this happens, PEA supplements may be helpful. In fact one study suggests PEA supplements may help protect against inflammatory and neuropathic pain caused by moderate carpel tunnel syndrome (xv).


Meanwhile, natural therapies you could try include magnet therapy, since one study shows magnets may offer relief of CTS symptoms (xiii). Acupuncture may also help relieve CTS symptoms if you prefer natural methods, with one trials review suggesting it may be slightly better at improving symptoms than steroid injections (xiv).

For more information on a range of other health conditions like carpal tunnel syndrome, feel free to visit our dedicated health library.

 

References:

1. Available online: https://patient.info/doctor/carpal-tunnel-syndrome-and-median-nerve-lesions

2. Available online: https://patient.info/bones-joints-muscles/carpal-tunnel-syndrome-leaflet

3. Available online: https://oxfordbrc.nihr.ac.uk/genes-and-height-matter-for-carpal-tunnel-syndrome/

4. Shiri R. . A square-shaped wrist as a predictor of carpal tunnel syndrome: A meta-analysis. Muscle Nerve. 2015 Nov;52(5):709-13.Available online: https://www.ncbi.nlm.nih.gov/pubmed/26138327

5. Available online: https://www.versusarthritis.org/about-arthritis/conditions/carpal-tunnel-syndrome/

6. Available online: https://www.nhs.uk/conditions/carpal-tunnel-syndrome/

7. Available online: https://www.csp.org.uk/public-patient/rehabilitation-exercises/carpal-tunnel-syndrome

8. He Y. et al., Curcumin, inflammation and chronic diseases: how are they linked? Molecules. 2015 May 20;20(5):9183-213.Available online: https://www.ncbi.nlm.nih.gov/pubmed/26007179

9. Calder PC. Omega-3 fatty acids and inflammatory processes: from molecules to man. Biochem Soc Trans. 2014 Nov;17(6):1105-1115.Available online: https://www.ncbi.nlm.nih.gov/pubmed/28900017

10. Nielsen FH. Effects of magnesium depletion on inflammation in chronic disease. Curr Opin Clin Nutr Metab Care. 2014 Nov;17(6):525-30.Available online: https://www.ncbi.nlm.nih.gov/pubmed/25023192

11. Ellis. JM, Kishi. T, Azuma. J, et al. Vitamin B6 deficiency in patients with a clinical syndrome including the carpal tunnel defect. Biochemical and clinical response to therapy with pyridoxine. Res Commun Chem Pathol Pharmacol. 1976;13:743-757.

12. Holm. G., Moody LE., Carpal tunnel syndrome: current theory, treatment, and the use of B6. J Am Acad Nurse Pract. 2003 Jan 1;15(1):18-22. Available online: https://www.ncbi.nlm.nih.gov/pubmed/12613409

13. Colbert. AP, Markov. MS, Carlson. N, Gregory. WL, Carlson. H, ELmer. PJ, et al. Static magnetic field therapy for carpal tunnel syndrome: a feasibility study. Arch Phys Med Rehabil. 2010;91(7):1098-1104.

14. Sim. H, Shin. BC, Lee. MS, Jung. A, Lee. H, Ernst. E, et al. Acupuncture for carpal tunnel syndrome: a systematic review of randomized controlled trials. J Pain. 2011;12(3):307-314.

15. Clayton P. et al., Palmitoylethanolamide: A Natural Compound for Health Management. Int J Mol Sci. 2021 May;22(10): 5305. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157570/

16. Clayton P. et al., Palmitoylethanolamide: A Potential Alternative to Cannabidiol. J Diet Suppl. 2021 Nov;28;1-26. Available online: https://www.tandfonline.com/doi/full/10.1080/19390211.2021.2005733

17. Conigliaro R. et al., Use of palmitoylethanolamide in the entrapment neuropathy of the median in the wrist. Minerva Med 2011 Apr;102(2):141-7. Available online: https://pubmed.ncbi.nlm.nih.gov/21483401/

 

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Disclaimer: The information presented by Nature's Best 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. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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