My Take on Carpal Tunnel Syndrome

Timothy B. McCall, M.D.

Carpal tunnel syndrome--caused when the median nerve to the hand gets compressed in the narrow tunnel formed by bones and ligaments in the wrist--has become a near-epidemic among computer users, musicians and others in recent years. As with other forms of repetitive strain injuries, people with CTS often report some kind of repetitive hand movement in their work or hobbies.

The characteristic symptoms of CTS include intermittent numbness and tingling in the hands, which often wake people up at night. Left unchecked, these symptoms can progress to permanent nerve damage and muscle weakness. Luckily, there’s much that can be done for CTS--including several things your doctor may not have learned in medical school.

The entire focus of my education on CTS focused on that one-square inch area of anatomy, the carpal tunnel. And so did all our treatments. Doctors often prescribe anti-inflammatory medicines, like ibuprofen, which in my experience don’t work that well for CTS. Or they recommend steroid injections into the wrist or surgery--both of which can be effective. But they are far from the only options.

A number of factors predispose you to CTS. People who have small wrists, including many women, appear to be at greater risk simply because there’s less space in their carpal tunnels. Several conditions including pregnancy, arthritis and underactivity of the thyroid gland (hypothyroidism) also can contribute to the problem.

But there are other factors for CTS which many physicians neglect including stress, poor posture and a lack of exercise. In fact, one recent study of workers in both the U.S. and Japan found that factors such as obesity, wrist size and physical inactivity correlated better with CTS than things like whether the workers used their hands in repetitive and forceful ways.

I believe it’s partly because it addresses some of these neglected factors that Iyengar-style hatha yoga was demonstrated to be more effective than wrist splints, a standard treatment for CTS, in a 1998 study published in the Journal of the American Medical Association. Besides helping to create more space in wrist joints, yoga cuts stress, provides exercise, improves posture and can even contribute to weight loss. I recommend it to anyone at risk of CTS.

If your symptoms are severe or have been present for many years, however, you need to consult an experienced teacher who can modify the poses to avoid putting too much weight on your wrists or bending them back too much. If you just wandered into a random yoga class at your health club and ended up doing the wrong poses, you could easily wind up in worse shape afterwards. A good bet is to try to find an Iyengar teacher in your area. (A list of certified teachers can be found on the web site of the Iyengar Yoga Association of the United States.)

Several other measure may also be worthwhile. Alternative approaches including acupuncture and the Alexander Technique, a study of movement and posture (and the topic of an upcoming column), can also help. If you get symptoms at night, wrist splints can help you from sleeping with your wrists angled (which can precipitate symptoms). Vitamin B6 seems to help some sufferers though, to avoid toxicity, don’t take more than 200 mg a day. If you work in an office, improving the ergonomics of your workstation is important as is taking frequent breaks to stretch.

As much as I favor the kind of holistic approach to CTS outlined above, if symptoms have progressed too far, your best option may be surgery. Done before permanent damage occurs--which usually takes years--it’s about 95 percent successful.

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