Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is a common and often disabling condition most often associated with data entry and general computer use, but it can affect anyone who performs repetitive hand motions. CTS occurs in women more often than men and is a relatively common temporary complication of pregnancy (due to fluid retention). It also occurs frequently among people with rheumatoid arthritis or diabetes.
CTS is caused by compression of the median nerve. On its way to the hand, the median nerve passes through an opening in the wrist called the carpal tunnel. Constant, repetitive hand motion may aggravate the ligaments and tendons encased in the tunnel, causing them to swell. As the tunnel walls close in, they compress the median nerve. This causes tingling and numbness in the thumb, index finger, middle finger, and half of the ring finger. The discomfort of CTS often wakes people during the night and eventually makes it difficult to grasp small objects.
Most instances of CTS are job-related. Paying attention to proper ergonomics is essential for preventing CTS. This might involve repositioning a computer keyboard or taking breaks more often. Conventional medical treatment for more stubborn CTS cases is variable in its success. Splinting the affected hand, especially at night, may help reduce symptoms. Nonsteroidal anti-inflammatory medications, such as ibuprofen or naproxen, may help slightly. Surgery is considered the ultimate treatment, but corticosteroid injections may be equally or slightly more effective.9-10 In some cases, a person with work-related CTS may have no choice but to change vocation.
Proposed Natural Treatments
There are no natural treatments for carpal tunnel syndrome that have any meaningful supporting evidence. Those that have been scientifically evaluated to any extent at all include vitamin B6, yoga, and magnet therapy.
Vitamin B 6
More than 25 years ago, researchers noted that people with CTS seemed to be deficient in vitamin B 6.2 This led to widespread use of B 6 as a CTS remedy. However, a recent study found no association between CTS and B 6 -deficiency.3 In any case, even if B 6 -deficiency were common in CTS, that by itself wouldn't prove that taking B 6supplements can reduce symptoms.
A few studies have investigated the effectiveness of vitamin B 6 for CTS. Most were poorly designed and involved few people. The two (albeit small) randomized, double-blind, placebo-controlled studies that do exist found no evidence that vitamin B 6 effectively treats CTS. The first study, which enrolled only 15 people, found no significant difference after 10 weeks among those taking vitamin B 6, placebo, or nothing at all.4 The second, involving 32 people, did find some benefits, but these were fairly minor.5 There was no improvement in nighttime pain, numbness, or tingling, nor in objective measurements of median nerve function. Some benefit, however, was seen in the relatively less important symptoms of finger swelling and discomfort after repetitive motion.
The bottom line: Because vitamin B 6 has not been proven effective and may be harmful in high doses, we do not recommend it for carpal tunnel syndrome.
For more information, including dosage and safety issues, see the full Vitamin B6 article.
Hatha yoga, a system of stretching and balancing exercises, has been tried for carpal tunnel syndrome. In one study, 42 individuals with carpal tunnel syndrome were randomly assigned to receive either yoga instruction or a wrist splint for a period of 8 weeks.6 The results indicated that yoga was more effective than the wrist splint.
However, this study has a serious flaw: participants in the control group were simply offered the wrist splint and given the choice of using it or not. It would have been preferable for them to have received an option with more “glamour,” such as fake laser acupuncture, or, even better, phony yoga postures. Experience from numerous studies shows that when people believe they are receiving an effective treatment, they report improvement, regardless of the nature of the treatment. (See, for example, the magnet therapy study described below.)
For more information on hatha yoga, see the full Yoga article.
Magnet Therapy TOP
In the one reported double, placebo-controlled study of magnet therapy for carpal tunnel syndrome, 30 people with CTS received treatment with either a real or a fake static magnet.7 Dramatic, long-lasting benefits were seen with the magnet treatment. However, identical, dramatic long-lasting benefits were seen with placebo treatment as well! This study underscores the need for a placebo group in studies—had there not been one in this trial, magnet therapy would have seemed to show itself quite effective for CTS. In two more small randomized trials, researchers again found that there were no differences between the treatment and the placebo groups. Both groups experiencedan improvement in symptoms.13-14
For more information on magnet therapy, see the full Magnet Therapy article.
Other Treatments TOP
In a double-blind, placebo-controlled study of 37 people undergoing surgery for CTS, an ointment made from the herb arnica (combined with homeopathic arnica tablets) proved slightly more effective than placebo for relieving pain after surgery.8
People who have a stroke that renders one hand paralyzed may develop CTS due to overuse of the remaining functional hand. One poorly designed study found preliminary evidence that mecobalamin, a form of vitamin B12, might provide some benefit.11
One study failed to find low-level laser therapy helpful for CTS.12
In addition, acupuncture has been studied as a potential treatment for CTS. Over a 4-week period, 77 people with mild to moderate carpal tunnel syndrome were randomized to receive medication (prednisolone) or 8 sessions of acupuncture.17 During the 7-month and 13-month follow-ups, those in the acupuncture group reported a greater improvement in their symptoms compared to the medication group.15 In addition, researchers analyzed 6 low-quality, randomized trials investigating acupuncture (and similar therapies) for CTS.16 In two of those trials (144 subjects), acupuncture was slightly better at improving symptoms than cortisone (steroid) injections, a standard treatment for CTS.
References[ + ]
1. Stransky M, Rubin A, Lava NS, et al. Treatment of carpal tunnel syndrome with vitamin B6: a double-blind study. South Med J. 1989;81:841-842.
2. 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.
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;38:485-491.
4. Stransky M, Rubin A, Lava NS, et al. Treatment of carpal tunnel syndrome with vitamin B6: a double-blind study. South Med J. 1989;81:841-842.
5. Spooner GR, Desai HB, Angel JF, et al. Using pyridoxine to treat carpal tunnel syndrome . Can Fam Physician . 1993;39:2122-2127.
6. Garfinkel MS, Singhal A, Katz WA, et al. Yoga-based intervention for carpal tunnel syndrome: a randomized trial. JAMA. 1998;280:1601-1603.
7. Carter R, Hall T, Aspy CB, et al. Effectiveness of magnet therapy for treatment of writs pain attributed to carpal tunnel syndrome. J Fam Pract. 2002;51:38-40.
8. Jeffrey SLA, Belcher HJCR. Use of arnica to relieve pain after carpal-tunnel release surgery. Altern Ther Health Med. 2002;8:66-68.
9. Hui AC, Wong S, Leung CH, Tong P, et al. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology. 2005;64:2074-2078.
10. Ly-Pen D, Andreu JL, de Blas G, et al. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum. 2005;52:612-619.
11. Sato Y, Honda Y, Iwamoto J, et al. Amelioration by mecobalamin of subclinical carpal tunnel syndrome involving unaffected limbs in stroke patients. J Neurol Sci. 2005;231:13-18.
12. Irvine J, Chong SL, Amirjani N, et al. Double-blind randomized controlled trial of low-level laser therapy in carpal tunnel syndrome. Muscle Nerve. 2004;30:182-187.
13. Colbert AP, Markov MS, Carlson N, Gregory WL, Carlson H, Elmer PJ. Static magnetic field therapy for carpal tunnel syndrome: a feasibility study. Arch Phys Med Rehabil. 2010;91(7):1098-1104.
14. Carter R, Aspy CB, Mold J. The effectiveness of magnet therapy for treatment of wrist pain attributed to carpal tunnel syndrome. J Fam Pract. 2002;51(1):38-40.
15. Yang CP, Wang NH, Li TC, et al. A randomized clinical trial of acupuncture versus oral steroids for carpal tunnel syndrome: a long-term follow-up. J Pain. 2011;12(2):272-279.
16. Sim H, Shin BC, Lee MS, Jung A, Lee H, Ernst E. Acupuncture for carpal tunnel syndrome: a systematic review of randomized controlled trials. J Pain. 2011;12(3):307-314.
17. Yang CP, Hsieh CL, Wang NH, et al. Acupuncture in patients with carpal tunnel syndrome: A randomized controlled trial. Clin J Pain. 2009;25(4):327-333.
Last reviewed December 2015 by EBSCO CAM Review Board
Last Updated: 12/15/2015
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