Carpal tunnel syndrome is pressure on the median nerve, the nerve in the wrist that supplies feeling and movement to parts of the hand. It can lead to numbness, tingling, weakness, or muscle damage in the hand and fingers.
Carpal Tunnel Syndrome, CTS, first described by Sir James Paget in 1863, is the most common type of nerve injury. It results from compression of the median nerve (the nerve that supplies some of the muscles of the hand and also sensation to the palmar side of the thumb, first two fingers, and half of the fourth finger) in the carpal tunnel. The carpal tunnel is an enclosed ring formed by the transverse carpal ligament. This ring acts as a gateway from the forearm to the hand, through which pass not only the median nerve but also many of the tendons that connect the forearm muscle to the fingers they flex.
The primary anatomical “design flaw” of the carpal tunnel is that it is completely enclosed and not very flexible. So if there is any swelling of the tissue within the carpal tunnel it cannot expand to accommodate the swelling and the result is an increase in pressure inside the ligament. This pressure compresses the median nerve, damaging it. Swelling, in turn, can be caused by trauma, repeated use, direct external compression, flexing the wrist, inflammation, edema (water retention in the tissues), and even rarely tumors or masses.
Treatment for CTS is divided into two categories, surgery and conservative (everything other than surgery). Conservative management is almost always tried first and/or in combination with surgery. It consists of removing or avoiding the trauma that is causing the increased pressure in the carpal tunnel, wearing a wrist brace to protect the wrist and avoid hyperflexion, taking anti-inflammatories to treat inflammation (this can either be aspirin-like medications or steroids, which can either be oral or injected), treating edema, and now using the pain relieving device called Reliev-ER. This device will effectively release endorphins into nervous tissues. These released endorphins are three times stronger than morphine. There is some evidence that vitamin B6 may help nerve recovery, but by itself does not address the nerve compression. Also there are a number of symptomatic treatments for the pain, but again these are not curative as they do not address the underlying mechanism of nerve injury.
Conservative treatment usually helps to some degree (largely dependent upon compliance), but is often not sufficient for long-term control of CTS. That’s why the Reliev-ER was developed to provide effective relief for CTS long-term. Nevertheless, when conservative management fails, or is not sufficient, there are a variety of surgical options.
The primary anatomical “design flaw” of the carpal tunnel is that it is completely enclosed and not very flexible. So if there is any swelling of the tissue within the carpal tunnel it cannot expand to accommodate the swelling and the result is an increase in pressure inside the ligament. This pressure compresses the median nerve, damaging it. Swelling, in turn, can be caused by trauma, repeated use, direct external compression, flexing the wrist, inflammation, edema (water retention in the tissues), and even rarely tumors or masses.
Treatment for CTS is divided into two categories, surgery and conservative (everything other than surgery). Conservative management is almost always tried first and/or in combination with surgery. It consists of removing or avoiding the trauma that is causing the increased pressure in the carpal tunnel, wearing a wrist brace to protect the wrist and avoid hyperflexion, taking anti-inflammatories to treat inflammation (this can either be aspirin-like medications or steroids, which can either be oral or injected), treating edema, and now using the pain relieving device called Reliev-ER. This device will effectively release endorphins into nervous tissues. These released endorphins are three times stronger than morphine. There is some evidence that vitamin B6 may help nerve recovery, but by itself does not address the nerve compression. Also there are a number of symptomatic treatments for the pain, but again these are not curative as they do not address the underlying mechanism of nerve injury.
Conservative treatment usually helps to some degree (largely dependent upon compliance), but is often not sufficient for long-term control of CTS. That’s why the Reliev-ER was developed to provide effective relief for CTS long-term. Nevertheless, when conservative management fails, or is not sufficient, there are a variety of surgical options.
Natural Pain Relief for Carpal Tunnel Pain
The first surgical procedure developed was carpal tunnel release (CTR), now called open CTR, which consists of cutting the transverse carpal ligament, thereby opening up the carpal tunnel and releasing the pressure. This procedure was developed in 1933 for traumatic CTS by Dr. Learmonth, and in 1946 for spontaneous CTS by Drs. Cannon and Love. It was the standard of surgical care, without rival, for over 40 years.
In 1988 the first alternative to open CTR was developed by Dr. Michael G. Brown, who developed the process of endoscopic CTR. This procedure involves a smaller incision in the skin than open CTR and uses small cameras to visualize the transverse carpal ligament to make the proper transection.
In 1988 the first alternative to open CTR was developed by Dr. Michael G. Brown, who developed the process of endoscopic CTR. This procedure involves a smaller incision in the skin than open CTR and uses small cameras to visualize the transverse carpal ligament to make the proper transection.
These two options, open vs endoscopic CTR, remain the only procedures for CTS. There are some newer technologies, for example using a less invasive Knife Light cutting tool, that are promising yet incremental technological advances but are still somewhat new and experimental. But the basic concept of cutting the ligament to relieve the pressure is still the gold standard.
There are two situations where there is at least a plausible mechanism for an effect. The first is when there is a more proximal nerve compression – in the neck or shoulder, that is caused or exacerbated by muscle spasm or hypertrophy. This situation is not CTS, but rather a compression of the nerve farther up that can mimic some of the symptoms of CTS. So this really would not be a treatment for CTS, but for another syndrome that can be mistaken for CTS. As an aside, as a neuromuscular expert I can say that a good clinician should not confuse these syndromes, and if there is clinical overlap then a nerve conduction study should be able to sort out the proper diagnosis.
There are two situations where there is at least a plausible mechanism for an effect. The first is when there is a more proximal nerve compression – in the neck or shoulder, that is caused or exacerbated by muscle spasm or hypertrophy. This situation is not CTS, but rather a compression of the nerve farther up that can mimic some of the symptoms of CTS. So this really would not be a treatment for CTS, but for another syndrome that can be mistaken for CTS. As an aside, as a neuromuscular expert I can say that a good clinician should not confuse these syndromes, and if there is clinical overlap then a nerve conduction study should be able to sort out the proper diagnosis.
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