QUESTION FROM READER:CARPAL TUNNEL SYNDROME

Q:Three months before I was due to give birth, I experienced particularly bad carpal tunnel syndrome, and had to wear splints on my hands at night.

The main symptoms gradually disappeared four months after the baby was born, but I am still left with occasional numbness (particularly at night) in my fingers, achy wrists and tingly elbows.

The department of neurophysiology conducted an EMG/NCV nerve and muscle study on my hands and found that the flow of blood into my right hand was twice as slow as it should be, and that the muscle at the base of my thumb was beginning to waste away. They have recommended surgery to open up the ligaments and reconnect the nerve on this hand.

As a pianist, violinist and writer who uses a computer a lot, I am very reluctant to have an operation on my hands. Is there an alternative? S N, Edinburgh………

A:The carpal tunnel is a tiny space between the carpal bones, and the route of the main nerve (called the median nerve) as it passes from the arm to the hands and fingers. Carpal tunnel syndrome is pain caused by pressure on this nerve, either through swelling or repetitive wrist movements, such as with repetitive strain injury (RSI). It is the most common nerve problem seen by doctors today.

The symptoms can affect either or both hands, and usually gets worse at night. The syndrome most typically affects women those who are pregnant, on the Pill or in their middle years. Sufferers usually complain that they feel pain and swelling, pins and needles in their fingers, and a reduced ability to grip the hand or flex the fingers.

The usual medical treatment is steroids, which have become a catch all drug for any and all inflammations, or wrist splints. When these treatments fail, as they often do, GPs give way to surgeons, who recommend surgery to decompress the nerve.

Oftentimes, carpal tunnel syndrome results from a deficiency of B6. At least a dozen medical studies have demonstrated good results in treating the syndrome with B6.

Dr John Ellis, medical director of Clinical Research at Titus Country Hospital District, in Mount Pleasant, Texas, is credited with discovering the use of B6 to treat CTS some 35 years ago (see WDDTY vol 8 no 9). Ellis, who came to believe that CTS patients were basically deficient in B6, found in one study of four patients about to have surgery for CTS that all had a B6 deficiency (Res Comm Chem Pathol Pharmacol, 1981; 33: 331). Other studies have concluded that the levels of the active form of B6 were two and a half times lower than normal in CTS patients (Arch Surg, 1989; 124: 1329-30).

Ellis himself has found that some 85 per cent of his patients get completely better when taking between 50 mg and 200 mg daily, usually within eight to 12 weeks.

Nevertheless, he suggests that up to 300 mg daily of vitamin B6 needs to be taken by pregnant women who have gestational diabetes and in diabetic women who have CTS.

He also finds that 200-300 mg per day of B6 relieves the edema of pregnancy without any danger of nerve damage.

Dr Antonio Reyes, a Texan obstetrician, has conducted a trial in which he gave pregnant patients with CTS between 100-300 mg of B6. The patients had improvement in neurological symptoms and edema, and none reported any side effects.

WDDTY panellist Melvyn Werbach, who has researched studies on B6, nevertheless says that some of the results are mixed, with some patients healing completely and some only experiencing pain relief. One reason, he says, may be that some people have difficulty converting pyridoxine (the form of vitamin B6) into its active form, pyridoxal-5′ phosphate. Consequently, he usually recommends that people take pyroxidal-5′ phosphate, rather than pyridoxine (although you take one tenth of the dosage of pyroxidal-5′ than you do of pyridoxine). Furthermore, taking the active form is one way of ensuring that you don’t develop sensory neuropathy, the occasional side effect of very high doses of B6 (usually 2 grams or more) (Townsend Letter for Doctors and Patients, July 1997).

Besides B6 deficiency, it’s vital that you have your thyroid activity checked out. There is some evidence that both an underactive and overactive thyroid can be linked with CTS.

Once the thyroid problem is treated, the CTS often resolves itself (Acta Neruol Scanda, 1993; 88: 149-52, as reported in Townsend, February/ March 1994).

Osteopathy has had proven success in treating CTS, usually a new “opponens roll” maneuver a thenar abduction combined with extension and lateral rotation. In one study of 16 patients, both symptoms decreased and mobility improved within one to three months, after a series of treatments (J Am Osteopath Assoc, 1994; 94: 647-663, as reported in Townsend, February/March 1995).

One of the most long lasting and successful treatments is acupuncture of the PC-6 and PC7 points. In one study of 36 patients, 17 of whom had undergone surgery without relief of symptoms, all but one had immediate reduction of pain and discomfort after acupuncture treatment of at least four sessions.

The patients were followed up for years, and 24, or two thirds, reported relief of pain and discomfort for two and a half to seven and a half years after their last treatment (Vet Acupuncture Newsletter, 1989; 15: 14, as reported in Townsend, October 1991).