In this issue of our newsletter we discuss an effective treatment protocol for Carpal Tunnel, based on an article written by Ronald Grisanti D.C., D.A.B.C.O., D.A.C.B.N., M.S. from Functional Medicine University.
Carpal Tunnel Syndrome is prevalent in the general population: in the following overview on Carpal Tunnel Syndrome from the American Family Physician website it suggests that the incidence ranges from 3 to 6 percent in the general population:
Carpal tunnel syndrome is the most common entrapment neuropathy, affecting approximately 3 to 6 percent of adults in the general population. Although the cause is not usually determined, it can include trauma, repetitive maneuvers, certain diseases, and pregnancy.
Symptoms are related to compression of the median nerve, which results in pain, numbness, and tingling. Physical examination findings, such as hypalgesia, square wrist sign, and a classic or probable pattern on hand symptom diagram, are useful in making the diagnosis. Nerve conduction studies and electromyography can resolve diagnostic uncertainty and can be used to quantify and stratify disease severity. Treatment options are based on disease severity. Six weeks to three months of conservative treatment can be considered in patients with mild disease.
Lifestyle modifications, including decreasing repetitive activity and using ergonomic devices, have been traditionally advocated, but have inconsistent evidence to support their effectiveness. Cock-up and neutral wrist splints and oral corticosteroids are considered first-line therapies, with local corticosteroid injections used for refractory symptoms. Nonsteroidal anti-inflammatory drugs, diuretics, and pyridoxine (vitamin B6) have been shown to be no more effective than placebo. Most conservative treatments provide short-term symptom relief, with little evidence supporting long-term benefits. Patients with moderate to severe disease should be considered for surgical evaluation. Open and endoscopic surgical approaches have similar five-year outcomes.
Acupuncture has also been suggested to be of benefit for Carpal Tunnel Syndrome:
Following is a representative study from the Journal of Research Sciences which suggests this:
J Res Med Sci. 2012 Jan; 17(1): 1–7.
Acupuncture in treatment of carpal tunnel syndrome: A randomized controlled trial study
Another suggested modality of therapy which may be of benefit is supplementation of Vitamin B6, and it is always worth consideration to use the best biologically active form of B6 (pyridoxal 5′-phosphate. (P-5-P)
Here is a good article on Vitamin B6 from Oregon State University Biotics offers a range of formulations which include Vitamin B6 (specifically the Pyridoxal-5- Phosphate form): here are some of the specific B Vitamin formulations
Following is the article by Dr. Ronald Grisanti.
Robert Lamberton Consulting
Functional Medicine Consultant – Biotics Canada Products
Author of the Biotics Newsletter Articles
Nutritional Therapy Practitioner (c)
Certified Light/Darfield Microscopy Nutritionist
Formulator of Professional Nutraceutical Products
Contributing Writer / Advisory Board Member:
Just recently I had the opportunity to consult with a patient by the name of Andrea who was suffering with carpal tunnel syndrome.
Andrea was a 47 year women who was employed as an executive secretary for a Fortune 500 company. Her job responsibilities included typing business documents, scheduling telephone meetings and pretty much everything that is associated with this type of position.
Andrea mentioned during our first consult that the tingling and numbness in her fingers and hand, especially her thumb and index, middle and ring fingers was getting so bad that she was afraid she might lose her job. The condition was at a point that she consistently needed to “shake out” her hands after 15 minutes of typing on the computer.
She was nervous and worried.
She did her due diligence and did go see an orthopedic hand specialist who initially recommended a nonsteroidal anti-inflammatory drug, corticosteroids and a carpal tunnel splint (also commonly called cock-up splint). Unfortunately, the treatment failed to produce any long-term relief.
I confirmed the diagnosis with orthopedic tests called phalen’s and tinel’s tests.
I need to mention that review of her past medical records showed a positive nerve conduction test.
My initial treatment consisted of biomechanical and myofascial treatments. Adjustments of her cervical spine, wrist (carpals) , radius and ulnar followed with myofascial release and ultrasound did provide some relief but it was short lived.
Worried that she would need to settle for a surgical release to help with her carpal tunnel syndrome, I recommended a simple supplement that proved to solve the case and return Andrea back to a normal functional life.
This simple nutrient was B6.
I prescribed the more biological active form called pyridoxal 5′-phosphate.
Surgeon Dr. John Ellis wrote extensively about how vitamin B6 cleared the majority of carpal tunnel syndromes, and other clinicians confirmed this.
The normal dose of pyridoxal 5′-phosphate for carpal tunnel syndrome is Vitamin B6 50 mg 3 times day for just a month or two to reverse the condition.
If you don’t see results consider the fact that B6 requires adequate levels of zinc.
Zinc deficiency inhibits conversion of B6 into its active form.
B6 is useless until the zinc deficiency is corrected.
Going downstream in the functional medicine thinking, it also important to remember to check for low alkaline phosphatase (<70). Levels below 70 is commonly correlated with a zinc deficiency.
I also want to mention that plasticizers or phthalates create hidden zinc deficiencies which in turn could impact the usability of B6.
An even more common reason for failure of simple and previously effective therapies is the high level of hidden heavy metals that everyone carries. Mercury, arsenic, lead, cadmium, and aluminum are some of the most common heavy metals that are in all of us.
They sit right in enzymes, kicking out the minerals that are required for normal function. It’s not until we have stockpiled enough that we then get symptoms in a place that never bothered us before, like the wrist (carpal tunnel syndrome).
So the take away from today’s article is put your functional medicine hat on when working with patients suffering with carpal tunnel syndrome and consider a trial of the pyridoxal 5′-phosphate. If you are not seeing results after one month, please don’t throw the towel in. Consider a zinc deficiency, plasticizers or phthalates accumulation and heavy metal toxicities.
Folkers K, et al, Biochemical evidence for a deficiency of vitamin B6 in the carpal tunnel syndrome based on a cross-over clinical study, Proc Nat Acad Sci USA 75: 3410-12, 1978
Ellis JM, et al, Response of vitamin B6 deficiency and the carpal tunnel syndrome to pyridoxine, Proc Nat Acad Sci USA 79: 7494-98, 1982
Analysts J. M., Treatment of carpal tunnel syndrome with vitamin B6, South Med J , 80:882-84, 1987
Ellis JM, et al, Clinical aspects of treatment of carpal tunnel syndrome with vitamin B6, Ann New York Acad Sci, 585:302-20, 1990