Carpal Tunnel Syndrome

by John G. Connor, M.Ac., L.Ac. edited by Barbara Connor, M.Ac., L.Ac.

TABLE OF CONTENTS
Barbara and I see many patients with carpal tunnel syndrome and we get excellent results treating these conditions with a combination of acupuncture, craniosacral therapy, herbal medicine and nutritional supplements.  By combining acupuncture with craniosacral therapy we are able to effect energetic and physiological mobilization, fluid exchange, improved delivery of nutrients and removal of metabolic waste products in the affected areas which helps your body to heal naturally.  The addition of specific herbs and supplements helps reduce the inflammation and rebuild damaged tissues without the harmful side effects of drugs.  In order to facilitate the healing process in those who suffer from these conditions we have compiled a list of useful foods, foods to avoid and helpful supplements below for your information.

A study published in the J Altern Complement Med, 1999 Feb;5(1):5-26 by Branco and Naeser entitled “Carpal tunnel syndrome: clinical outcome after low-level laser acupuncture, microamps transcutaneous electrical nerve stimulation, and other alternative therapies — an open protocol study” found that post treatment carpal tunnel syndrome pain was significantly reduced, and 33 of 36 hands had no pain or else pain had been reduced by more than 50%.  In follow-up after 1-2 years, in cases where the age was less than age 60, in only 2 of 23 hands had pain returned, but these were successfully re-treated within a few weeks.

The  NIH (National Institutes of Health) Consensus Statement on Acupuncture (1997 Nov 3-5;15(5):1-34) concluded that carpal tunnel syndrome was one of the situations in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program.

HIGHLY RECOMMENDED FOODS
Barley and wheat grass, omega-3 and GLA fatty acids*, whole alfalfa or alfalfa tablets or tea, oatmeal, brown rice, wheat, rye, fresh pineapple, oat bran, rice bran or ground flaxseed, sprouts, legumes, algae, asparagus, onions, carrots and most other vegetables and fruits except those mentioned below to avoid.  Fresh pineapple contains bromelain, which reduces inflammation.* Animal experiments and clinical intervention studies indicate that omega-3 fatty acids have anti-inflammatory properties and, therefore, might be useful in the management of inflammatory conditions.  Many of the placebo-controlled trials of fish oil in chronic inflammatory disease reveal significant benefit, including decreased disease activity and a lowered use of anti-inflammatory drugs. (Simopoulus, AP, “Omega-3 fatty acids in inflammation and autoimmune diseases” J Am Coll Nutr 2002 Dec;21(6):495-505)

Consider an anti-inflammatory diet such as the one outlined by Andrew Weil which emphasizes monosaturated fats (found in olive oil, canola oil, avocado and nuts) and omega-3 fatty acids (in fish, walnuts and flax) and the elimination of polyunsaturated and trans fats (in many processed foods).  He also recommends taking 2 grams per day of a fish-oil supplement containing both EPA and DHA.

FOODS TO AVOID
Avoid salt and all foods containing sodium.  They promote water retention and may aggravate carpal tunnel syndrome.
Avoid white sugar, white flour, white rice, white pasta.
Avoid pastries, cakes, ice cream, sodas, fast food.
Avoid alcohol, MSG, nitrites, milk chocolate.
Avoid nutrasweet, Splenda, Equal, aspartame.
Avoid omega-6 fatty acids which promote inflammation.  These are found in polyunsaturated fats such as safflower, sunflower or corn oils and foods made with them.
Avoid pro-inflammatory trans fats which are in partially hydrogenated oils, margarines, vegetable shortening and all foods made from them.
Avoid NSAIDs if you possibly can as they promote inflammation at the same time they are relieving your pain.  The ulceration, perforation and bleeding in the GI tract is an example of how NSAIDs promote inflammation.

NUTRITIONAL SUPPORT
· Vitamin B6 supplementation has been shown to be effective for carpal tunnel syndrome.  Dosage: 50-300 mg. daily for a minimum of 12 weeks.  (Parry and Bredesen ,1985; Kasden and Janes, 1987; Driskell et al, 1986;Ellis and Folkers, 1990).
·    Boswellia decreases leukotriene synthesis that is responsible for maintaining inflammation and edema. (Bruneton, 1995; Gupta et al, 1997)
·    Bromelain stimulates production of prostaglandins.
·    Dandelion root may have potential use as an anti-inflammatory agent in inflammatory conditions. (Tito et al, 1993 & Mascolo et al, 1987)
· Primrose oil or salmon oil helps control pain & inflammation.
· PABA is good for swelling.
· Vitamin C destroys free radicals and is anti-inflammatory.
· Amino acids supply protein needed for tissue repair.
· Flavonoids, e.g., Quercetin reduce inflammation and prevent free radical damage.
· D-Glucuronic Acid provides antioxidant protection of synovial tissues.
· Sea cucumber helps lubricate the joints.
· Silica helps in rebuilding of connective tissue and bone.
· Superoxide dismutase protects the fluid in the joints from destruction by free radicals.
· Vitamin E protects the joints from damage by free radicals.
· Calcium prevents bone loss.
· Boron is needed for better calcium absorption.
· Magnesium is needed to balance with calcium
· Copper is a cofactor for lysyl oxidase that strengthens connective tissue.
· Zinc is beneficial for bone growth, is an anti-oxidant & reduces wound healing time.
· Coenzyme Q10 increases tissue oxygenation to aid in repair of connective tissue.
· Manganese is needed for normal bone growth.  Do not take manganese and calcium at the same time as they compete for absorption.
· Selenium is a powerful antioxidant.
· Vitamin B complex (B vitamins work best when taken together)
· Glucosamine sulfate relieves pain and inflammation in osteoarthritis & exerts a protective effect against joint destruction.·

For more information on herbs and supplements which can help in relieving pain please read our article entitled Pain Management on our website.

Useful Botanicals & Herbs
· Feverfew (Tanacetum parthenium) – has anti-inflammatory properties
· Omega 3 Fatty Acids – have anti-inflammatory properties
· Willow Bark – has anti-inflammatory properties
· Resveratrol  – has anti-inflammatory properties
· Turmeric (Curcumin) – has anti-inflammatory properties
· CoQ10 – increases blood flow to the brain and improves circulation.
· Magnesium and Calcium help to regulate muscular tone
· Quercetin – has anti-inflammatory properties
· Cat’s Claw – has anti-inflammatory properties
· Atractylodes – has anti-inflammatory properties
· Grape Seed proanthoycyanidins – has anti-inflammatory properties
· Green Tea Extract – has anti-inflammatory properties
· Honokiol – has anti-inflammatory properties
· Magnolol – has anti-inflammatory properties
· Milk Thistle (Silymarin) – has anti-inflammatory properties
· Panax ginseng & Panax notoginseng – have anti-inflammatory properties
· Holy Basil & Rosemary – have anti-inflammatory properties
· Reishi mushrooms – has anti-inflammatory properties
· Chinese skullcap – has anti-inflammatory properties
· Royal Jelly extract – has anti-inflammatory properties

LIFESTYLE RECOMMENDATIONS
·  If you engage in repetitive mechanical tasks, try to reduce the impact on your wrists and hands by using a tool, for example, rather than flexing your wrists forcibly.

·  Consider getting a wrist rest or an ergonomic keyboard for your workstation if the carpal tunnel syndrome is due to excessive but unavoidable keyboard work.

·  Consider using a splint to keep the carpal tunnel as open as possible.

·  If you sit in front of a computer all day long make sure you are not putting undue stress on your wrists through your posture or sitting position.  Keep your elbows bent and use arm rests.  Take breaks periodically and perform simple stretching and strengthening exercises

REFERENCES
Balch, James F, M.D. & Balch, Phyllis A, C.N.C, Prescription for Nutritional Healing New York: Avery Publishing Group. 1997
Bratman, Steven, MD & Andrea M. Girman, MD MPH, Mosby’s Handbook of Herbs and Supplements and their Therapeutic Uses, St Louis: Mosby, 2003
Ma, Shou-Chun, MTCM, Chinese Nutrition Class Notes from Northwest Institute of Acupuncture and Oriental Medicine, Seattle, 1994
Maciocia, Giovanni, The Foundations of Chinese Medicine, Edinburgh: Churchill Livingston, 1989
Pitchford, Paul, Healing with Whole Foods, Berkeley, CA: North Atlantic Books, 1993
Skidmore-Roth, Linda, Mosby’s Handbook of Herbs & Natural Supplements, 2nd edition, St. Louis: Mosby, Inc., 2004
Weil, Andrew, M.D., “Coping with Chemotherapy and Radiation” Self Healing, July 2004
Werbach, Melvyn R., M.D., Nutritional Influences on Illness, Tarzana, CA: Third Line Press, 1996:p.192-194

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Compassionate Acupuncture and Healing Arts, providing craniosacral acupuncture, herbal and nutritional medicine in Durham, North Carolina. Phone number 919-309-7753.

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