by Paul Winter, author and alternative health publisher since
1989
With Illustrations By Chris Dutsch Links
My surgeon told me the Carpal Tunnel Syndrome (CTS) release operation was 90% successful. However, a year after the surgery my CTS returned. I was suspicious and decided to try and verify that success rate. I interviewed a dozen physical therapists and found that the real success rate for Carpal Tunnel Syndrome was more like 15%. To keep the use of my hands, I had to find things that worked. The best things I found were:
- Trigger point therapy for which I eventually make a device the Mini-Roller.
- Some topical application for which I have written a comparison table.
- Rest which is very difficult so I made a device the Use Reducer that prevents me from unconsciously using my hand.
Carpal Tunnel Syndrome Pathology
Carpal Tunnel Syndrome (CTS) is the group of symptoms that result from pinching the medial nerve in the wrist. These symptoms range from numbness in a few fingers to pain in forearms, hands, or even shoulders. The first symptom most people notice is numbness in the three middle fingers when they first wake up.
Failure to reduce the pinching of medial nerve can result in loss of hand use.
The carpal tunnel is the interior of the wrist through which the medial nerve, tendons, and blood vessels pass. Three sides of the carpal tunnel are bone. The other side is a sheath, the flexor retinaculum, which is made of ligament material, refer to Figure 1. The medial nerve actually consists of a number of different nerves. This is the reason why there are various symptoms - different symptoms indicate different nerves are being affected.
Figure 1. The Carpal Tunnel Cross-section
Carpal Tunnel Syndrome can be confused with tendonitis, an inflammation of tendons, which almost always causes pain in the actual area of the inflammation. Sufferers of tendonitis cannot get relief by using a cock-up splint - the use of which is explained below in the section entitled The Cock-up Splint. Obtaining relief by using a cock-up splint is evidence of CTS.
See Alternative Pathology further down this page.
Letters from Users
After hours of painting a 3500 sq foot room I found my forearms to be extremely sore. So sore that I could hardly pick up a cup of coffee. Nothing that I did would take this pain away. That is until I tried the Mini-Roller II massager. Instantly my arms began to relax and I was able to gain mobility. After only two days of sporadic massaging I was completely back to normal.
The Mini-Roller II really works!
Wensday Wagner
Owner, You Got Memories heritagescrapbooking.com
Here is an online review from the webmaster of everythingmenopause.com, Cathy Taylor:
Relief for Carpal Tunnel Syndrome, Product Review
Paul Winter sent me a Mini-roller II because I've been dealing with carpal tunnel in both arms for months. I put it on the end table where I sit and watch tv at night so that I'd use it at least a few times a week, which is what I did.
At first I thought it was too simplistic to be of any real help. I was wrong. It actually works like a mini-massage. So instead of having to get my masseuse or my chiropractor to work extra on my arms endlessly, I just use this mini-roller and am able to keep working.
I type a lot, every day working on websites or doing internet marketing. So it's imperative that I am able to use my hands and arms without pain. I find that I still need to take breaks, like a long weekend and sometimes have to wear a brace on my right hand, but this little tool is well worth the $17.95 it costs. It offers much relief.Cathy Taylor
I just wanted to thank you for the informative and helpful web site you provide...
After a test last week, I was told that I have early signs of CTS. Well, a day after, I found your web site. I followed your exercises and 4 days in, my left hand no longer aches all day and right hand is 75% better than it was last week. Again, thank you very much for providing such a wonderful and helpful site, it has helped me greatly!
Michael
New Jersey, USA
My husband Tom has been using your massager and he really likes it. He thinks it works great. He rubes it on his arm, elbows, and I rubbed his back with it. He said it does cover more areas and it feels great. Thank you.
Bonnie Kehl
Alain Pinel Realtors
408-357-8733(Direct)
408-605-0236(cell)Trigger Points Self-therapy
Trigger point therapy is one of the most successful alternative healthy techniques. In the forearm muscles near the elbow, there are nerve endings that start in the carpal tunnel. You can find these by looking for spots on your forearm that ache when pressed (if you have CTS). They ache because of the pressure they are under in the carpal tunnel. If you over stimulate these nerve endings, certain functions of the nerve turn off. One of those functions happens to be the swelling cycle.
It can be difficult to find these points because you have to press firmly with a fingertip in so many places. Therefore, the best way to stimulate these trigger points is with a device that goes deep enough to apply pressure to these trigger points over a fairly wide ares, about two inches. without damaging tissue. There are two massage devices on the market that can do this. The Stick was the first one we located, but the Mini-Roller turned out to be much better.
The Mini-Roller II
- Durable and quiet
- Reasonably priced, $17.95 (order with the Use Reducer and save $8)
- Easily portable
- Ergonomic; you apply a straight downward pressure
- Small rollers best suited for trigger points in the forearm
- Feels great
How to Use the Mini-Roller II
Roll across the areas that ache with enough pressure to obtain deep muscle massage. Use the Mini-Roller on your forearm muscles; never the wrist or tendons on your forearm. Make sure that you massage any aching points until they stop aching (stop after 30 seconds on one spot). The trigger points for CTS are usually at the ends of the forearm muscle near the elbow and also about half way between the wrist and elbow.Ordering
To order either the Mini-Roller II or the Use Reducer from the secure store at Yahoo, click one of the Order buttons below:
Both for only $27.95
Shipped using priority US mail is only $5.
Sales tax applies to tax Arizona residence only.
Sorry no international orders.Refund Policy
If not satisfied for any reason, return the Mini-Roller II or the USe Reducer within 60 days and include your name, reason for return, credit card number and expiration date (to protect you and Yahoo, your credit card number is removed from my records after 30 days).Use Reducer
When you first get up, everything is stiff. This is the time when inflammation can get a head start. It is the best time to limit the use of your problem hand. Unfortunately, almost no one can stop using one of their hands without a little help. Wearing the Use Reducer allows you to gradually start using your hand.
The Use Reducer covers the area from a few inches below the elbow to the finger tips. It makes it impossible to use your hand without consciously lifting it with your other hand. So although you can use you hand when you absolutely need it, you can't use your hand unconsciously. It is very lightweight and has a couple of holes to allow air flow.
Use Reducer with the Position Strap in the Big Person Configuration
If you take an anti-inflammatory such as vitamin B6, the Use Reducer gives your anti-inflammatory time to get ahead of the inflammation. As you sleep, inflammation goes down (provided you learned how to stop clawing your hands). However, if you start using you hand right after waking, you are likely to start inflammation which will be harder to suppress.
The Use Reducer comes with two adjustable straps. The Position Strap controls its position on your forearm. The Attachment Strap goes around your arm just above the elbow. It is very easy to put on even with one hand.
The Position Strap can be used in two configurations; one for small people (above), one for large people (see other photo). Both configurations are adjustable.
The Use Reducer is very light and durable. It's great for knocking around the house in the morning. Literally.
Tests For CTS
Simple test one :
- Relax your wrist by placing your arm, from elbow to finger tip, on a table, palm up.
- Using your other hand, vigorously tap the inside of your wrist on the slight depression in the center of your wrist, along side the predominant tendon. Use the end of your finger and a quick downward motion.
If the pain is activated or increased, or if an electric-like sensation is felt, the test is positive - you have CTS. If there is no pain or sensation you may have it anyway: you will need the complicated test.
Simple test two:
- Hold your arms up such that your forearms are vertical. Relax your wrists and allow your hands to drop so your palms are facing the floor.
- Hold your arms this way for one minute.
If this position induces your symptoms chances are those symptoms are caused by CTS.
The sophisticated test: This test requires a small jolt of electricity to be sent through your arm. Low current is used; there is almost no sensation. The time delay in the nerve impulses traveling through your carpal tunnel are measured. Too much delay and the test is positive.
CTS Causes
According to the Professional Guide to Diseases (Springhouse Corp. 1987) there are many conditions that can cause the contents of the carpal tunnel to swell and thereby put pressure on the medial nerve.
- Inflammation or fibrosis of the tendon sheaths that pass through the carpal tunnel. Fibrosis is the build up of thread-like growths similar to scar tissue.
- Water retention due to pregnancy.
- Rheumatoid arthritis.
A lesser known cause of CTS is that the sheath across the carpal tunnel has shrunk due to aging and is squeezing the bone structure of the tunnel together. If your CTS was caused by an obvious increase in strenuous activities or computer keyboard work, your CTS was most likely not due to a shrinking sheath.
The Operation
My surgeon told me the CTS release operation was 90% successful. However, the surgery failed to remove my CTS. I suspected I had been lied to. I decided to find out the real success rate. I interviewed a dozen physical therapists.
Bottom Line
Surgeons are suspiciously ignorant about the success rate of the surgery. Surgeons who have one appointment after CTS surgery say it works 90% of the time. Of course they examine the CTS patient after they have not used their hand for a week. Of course the inflammation which is CTS goes down during this time.Physical therapists work with patients months after the CTS surgery. That is when a person had resumed normal hand use. The twelve physical therapists I interviewed agreed that the CTS surgery works about 15% of the time.
Still Worth It?
Still if you have insurance and can go without the use of your hand for a week or so, the surgery might be worth the gamble because:Failure to reduce the pinching of medial nerve can result in loss of hand use.
Although even hand surgeons attack the low success rate of this procedure, it is getting less and less evasive. In other words, even though it is only 15% successful, it maybe worth the pain.
The operation consists of cutting out a strip in the middle of the sheath that holds the carpal tunnel tightly together. The theory is that without the sheath the pressure on the contents of the carpal tunnel will be reduced. Therefore, some permanent relief usually results from the surgical procedure. This is especially true if a person starts moving their wrist as soon as they can stand the pain. This early use encourages the contents of the carpal tunnel to "move out" into the region opened up by the cutting of the sheath. It also prevents a build up of scar tissue. For these reasons it is essential to obtain the services of a physical therapist if you decide to have the operation. Do not let your surgeon discourage you from this help. Insist on it.
If you have developed CTS due to strenuous activities, your symptoms will most likely recede after the surgery. The reason for this is that any inflammation will have plenty of time to subside while the wound heals. Also, your tendons may become thinner (atrophy) due to the cessation of the strenuous activity. After the surgeon cuts the sheath your hand will be painful to move for weeks. The resultant inactivity is exactly what is needed to encourage the inflammation to subside and your tendons to atrophy. The problem with this "fix" is that once you resume your strenuous activity, your tendons or their sheaths, may once again increase in size and CTS may come back.
Clawing and The Cock-up Splint
A common cause of CTS is clawing your hands involuntarily when sleeping. Constantly forcing your hands further and further into this fetal-like hand position applies great pressure on the medial nerve. This dose as much damage as repetitive hand activities. The cock-up splint prevents this clawing at night and the Use Reducer prevents over use right after you wake.
Doctors recommend you only use this splint at night while sleeping.
This splint is recommended by most doctors when patients first complain of CTS. The cock-up position, induced by the splint, can be obtained by holding your hand straight out, palm down, then bending your wrist such that your knuckles rise up as far up as reasonable. In this position the pressure on the carpal tunnel is 1/10 of the pressure that is caused by placing the wrist in the opposite (hand curled up) position. There are three problems with using the cock-up splint during normal activities:
- It does not work on the cause of the problem; your fingers are free to operate as usual.
- While wearing this splint you are not able to move your wrist. This encourages a further reduction in flexibility of the bone structure.
- The hard brace of the splint digs into the palm of your hand causing you to lift your fingers up. This puts tension in the exact same way as typing on a keyboard.
The Alternative Pathology
In order to develop an alternative treatment to the operation the following theoretical causes for CTS were formulated. Once they were formulated, the treatments were developed and used on myself. In the end, all that is significant is that the treatments worked. These are one way to avoid a painful experience - the operation:
- Performing repetitive hand motions with the wrist in the same position for long periods of time causes the bones that form the carpal tunnel to lose their ability to move and flex - they become fixated, literally stuck together. The free and unrestricted movement of these bones is essential to prevent pressure on the medial nerve.
- We constantly use the muscles that control our fingers, but we rarely use the muscles that make our wrist move (especially at a keyboard). As a result the wrist controlling muscles get weaker. To compensate for this weakness we often place more strain on our finger controlling muscles and tendons. This excessive use and strain causes inflammation of the tendon sheaths.
- People who have increased the amount of strenuous activity usually increase the size of their muscles. If their tendons increase in size in order to match the increased strain that the stronger muscles can now apply, the medial nerve can get crowded.
To summarize: the alternative pathology proposes that the pressure on the medial nerve can be increased by a loss of flexibility in the bone structure of the carpal tunnel, an imbalance in the use and strength of the muscles that control the fingers and the wrist, or an increase in the size of the tendons. The CTS solutions presented on this web page are based on this alternative pathology.
Alternative Solutions
The best feature of the alternative pathology of CTS, just above, is that it readily produces ideas for alleviating CTS. The alternative approaches presented in this web page are directed at obtaining five separate goals. You can pick any or all for the following approaches based on your needs:
- Using trigger points to turn off the inflammation cycle. See Trigger Points - The Best Self-therapy.
- Regaining flexibility of the carpal tunnel bone structure, by stretching and making ergonomic adjustments to your work place.
- Strengthening the muscles that operate the wrist - not the fingers.
- Restoring flexibility and the full range of motion for the wrist.
- Reducing the diameter of the tendons in the carpal tunnel. This can be accomplished by causing the tendons to atrophy. (This goal is only for people who already have CTS as a result of strenuous activity).
Vitamin B-6
Although there is some controversy regarding the effectiveness of vitamin B-6 for carpal tunnel syndrome, it is a recognized anti-inflammatory. My own experience and the experience of the people I have recommended it to indicate that it does offer significant relief. I take three B complex pills containing 100 mg a day. Since the minimum requirement of B6 is 10 mg per day, that is a lot of B6. However, some people take 400 mg a day. There does not seem to be any side effects, but it leaves your body pretty fast so you must spread out your dosages.
Turmeric
This herb with anti-inflammatory properties is gaining recognition, but there is no research on its effectiveness. I recently has good results with it to help my back which went out. However, dosage is a problem. If you purchase it in a health food store, the recommended dose for the 450 mg pills is one a day. I was taking three such pills, three times a day.
Ibuprofen
Although not as effective as CT Cream, it is the most widely recognized anti-inflammatory on the market. I have used Ibuprofen to prevent the start of CTS symptoms. Ibuprofen is not without side effects which you should study before taking.
Topical Applications
The following table represents my own experience and the experiences of two friends who used these products. This is not a scientific study by any means. The links for ordering connect to web sites that are not associated with cts-carpal-tunnel-syndrome.com.
Application Name Effectiveness Order CT Cream Most effective application we tried. Click Doc's Glucosamine Emu Oil MSM cream Fairly effective, also some relief of arthritis. Click Topricin CTS No noticeable effect Click Things To Avoid
Repetition
Avoid repetitive finger motions by breaking up your daily tasks. Do not perform a repetitive finger action: like typing for more than 30 minutes without doing something else. This is not as hard at it may seem. Most people have three or four different tasks they do every day. Instead of doing one until it is finished, switch around.
Overexertion
Do not overexert your finger actions, such as hard hand grasping, especially in a repetitious manner. The common problem causing activities are:
1) Using a screwdriver for a prolonged time - use an electric screwdriver or a variable speed electric drill with a screwdriver bit.
2) Cutting large amounts of paper with scissors - use electric scissors (BEST stores sell one for about $6).
3) Sawing a lot of wood - buy an electric saber saw. They are less expensive, less dangerous, and quieter than a circular saw and they can cut a circle.
4) Hammering for long periods - get a friend to help. Switch off periodically. Use screws whenever you can.
Wrist Strengthening Exercises
This section has been moved to a new page. Click here to go to the new page for Wrist Strengthening Exercises.
Alternative Experiences
From e-mails people have sent me.
Hi,
Just wanted to let you know about my Carpal Tunnel Syndrome experience.
I had very mild symptoms for several years. After a trip to China in the spring of 2002, I "moved" to Shenzhen in June from the Bay area (though I came back to San Jose in spring 2003).
Four days after my return to China, I woke up with my right hand becoming disabled. Within a couple of hours, it was virtually crippled. I had no control over my wrist at all, and practically no control over my fingers.
Skipping the intermediate info, more than a month later I began getting acupuncture treatments at the Traditional Chinese Medicine hospital (actually, a department in a regular hospital).
I paid for a course of six treatments at a time. I did not go in every day but after 21 treatments spread out over a couple of months time, I achieved a total recovery. I also took some herbs, but am not sure how much they contributed to the success.
The cost for six treatments was 10 RMB for the doctor consultation and 300 RMB for the six acupuncture treatments. That is about $38 USD. Not counting the herbs, the total was about $152 (I didn't even go in for the last three treatments).
Of course, it would be more expensive in the US and I'm sure it depends on the skill of the acupuncturist. I was very lucky to get someone so qualified. And it sure as heck beat going over to Hong Kong for surgery or shots.
During those months, I did not suffer any pain associated with CTS. However, any type of cold (even blowing wind on a hot day) caused my wrists and hands to become extremely uncomfortable. I covered my wrists with socks after cutting out the heel and a portion of the toe (for my thumb and fingers).
It was very frustrating to search on the internet and find so little information about the success of acupuncture for CTS. In contrast, I saw a number of "health professionals" who spoke disparagingly about the possibility that acupuncture was a viable treatment for anything. One "doctor" with no experience of acupuncture whatsoever opined that it was more of a psychological treatment than a valid science.
If I had believed such statements, I would have such limited choices as: no use of my right hand for an unimaginable length of time (perhaps permanently); surgery (with limited results, and probable excruciating pain thereafter); shots (variable results). The last two range from somewhat expensive and hard to find, to very expensive and lifetime disability. In contrast, acupuncture poses no risks; is cheap; and requires no more psychological belief than the accepted Western "worship" of an allopathic priest.
I don't recommend using this approach with anyone who just tacks "acupuncture" onto a business card. My treatments were in a hospital, performed by a doctor or supervised medical student, and (forgot to mention this) involved needles which were hooked up to a box which directed electrical currents as well in order to improve results. (This can get quite a bit more uncomfortable than needles alone, but is certainly worth it.)
So choose a practitioner very carefully.
Best regards,
Virginia RainesThe Cancer Cover Up Uncovered
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Links
To add your web site, add your URL, or add your web page to this page, follow the directions below.Exchange Links with cts-carpal-tunnel-syndrome.com
Webmasters, I am happy to exchange links with healthcare related web sites provided the information on your site is relevant and accurate and your link page is Google rated 2 or more. When you contact me make sure to include the URL of the page where you have or intend to place my link. Please use the following URL and text or something similar for my web site description on your web site:
http://cts-carpal-tunnel-syndrome.com/ Carpal Tunnel Syndrome Relief - A large collections of therapies to recover from or avoid CTS plus a trigger point massager and a use reducer to be worn especially when you first get up.
To exchange links for another of my web sites, go to the link page for Alternative Cancer Treatments Comparison and Testing.
My Links
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Disclaimer
This web site is for information only and is not intended to substitute for medical advice. People who suspect that they have carpal tunnel should verify this condition with a medical doctor and obtain the conventional as well as the alternative treatment options. Most especially a person should contact physical therapists. They regularly work with patients after conventional treatments have been used. They are most aware of the long term effects of conventional treatments.
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