Carpal Tunnel Syndrome and dietary supplements, vitamins, herbs
July 5 2016 by Ray Sahelian, M.D.

Carpal Tunnel Syndrome (CTS) is the most common peripheral neuropathy that involves a single nerve; its symptoms and functional limitations significantly limit the daily activities and quality of life of many people. While surgery is reserved to most severe cases, the earlier stages of disease may be controlled by a pharmacological treatment aimed to limiting and correcting the nerve damage.

Carpal tunnel syndrome and computer keyboard use
People who spend much of their work time typing on a computer keyboard are actually less likely to develop carpal tunnel syndrome than those who spend less time working on a computer.

The use of nutritional supplements, natural herbs
Very little research has been published regarding the use of dietary supplements as a treatment for CTS.

Treatment of carpal tunnel syndrome with alpha-lipoic acid
Our study was aimed to compare the efficacy of a fixed association of alpha-lipoic acid (ALA) 600 mg/die and gamma-linolenic acid (GLA) 360 mg/die, and a multivitamin B preparation (Vit B6 150 mg, Vit B1 100 mg, Vit B12 500 microg daily) for 90 days in 112 subjects with moderately severe CTS. Demographic, case-history and treatment efficacy data were collected; the Boston questionnaire was administered and the patients were evaluated by Hi-Ob scale and electro-myography. A significant reduction in both symptoms scores and functional impairment (Boston questionnaire) was observed in ALA / GLA group, while the multivitamin group experienced a slight improvement of symptoms and a deterioration of functional scores. Electromyography showed a statistically significant improvement with ALA / GLA, but not with the multivitamin product. The Hi-Ob scale showed significant efficacy of ALA / GLA in improving symptoms and functional impairment, while in the multivitamin group the improvement was significant, but less marked than in the ALA / GLA group. In conclusion, the fixed association of ALA and GLA proved to be a useful tool and may be proposed for controlling symptoms and improving the evolution of CTS, especially in the earlier stages of disease.
Eur Rev Med Pharmacol Sci. 2009; Di Geronimo G, Caccese AF, Caruso L, Soldati A, Passaretti U. UO Chirurgia della Mano e dei Nervi Periferici, Presidio Ospedaliero dei Pellegrini, Napoli, Italy.

Omega-3 fatty acids, fish oils
The aim of this case series study was to investigate and report on patients with neuropathic pain who responded to treatment with omega-3 fatty acids. Five patients with different underlying diagnoses including cervical radiculopathy, thoracic outlet syndrome, fibromyalgia, carpal tunnel syndrome, burn injury were treated with high oral doses of omega 3 fish oil (varying from 2400-7200 mg/day of EPA-DHA). Outcome measures were obtained pretreatment and posttreatment. These included validated surveys (short-form McGill Pain questionnaire, DN4 neuropathic pain scale, Pain Detect Questionnaire), objective clinical tools (Jamar grip strength, Lafayette dynamometry, tender point algometry) and EMG Nerve Conduction studies. These patients had clinically significant pain reduction, improved function as documented with both subjective and objective outcome measures up to as much as 19 months after treatment initiation. No serious adverse effects were reported. This first-ever reported case series suggests that omega-3 fatty acids may be of benefit in the management of patients with neuropathic pain. Further investigations with randomized controlled trials in a more specific neuropathic pain population would be warranted. Clin J Pain. 2010. Omega-3 fatty acids for neuropathic pain: case series. Canadian Centre for Integrative Medicine and the Physiatry Interventional Pain Clinic, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.

Serrapeptase
A preliminary trial of serratiopeptidase in patients with carpal tunnel syndrome.
The Journal of the Association of Physicians of India. 1999.
This study was planned to assess the response of serratiopeptidase in patients with carpal tunnel syndrome. Twenty patients with carpal tunnel syndrome were evaluated clinically. After baseline electrophysiological studies, these patients were given serrapeptase 10 mg twice daily with initial short course of nimesulide. Clinical and electrophysiological reassessment was done after 6 weeks. Sixty five percent of serrapeptase cases showed significant clinical improvement which was supported by improvement in electrophysiological parameters. Recurrence was reported in four cases. No significant side effect was observed. Serrapeptase therapy may proved to be a useful alternative mode of conservative treatment. Larger study may be further helpful to establish the role of serrapeptase in carpal tunnel syndrome. Serratiopeptidase therapy.

Acupuncture
Results have not shown consistent benefits.

This article demonstrates that short-term acupuncture treatment may result in long-term improvement in mild-to-moderate idiopathic CTS. Acupuncture treatment can be considered as an alternative therapy to other conservative treatments for those who do not opt for early surgical decompression. J Pain. 2011. A randomized clinical trial of acupuncture versus oral steroids for carpal tunnel syndrome: a long-term follow-up. Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan; Department of Nutrition, Huang-Kuang University, Taichung, Taiwan.

Benefits of standard treatment
Strong and moderate evidence was found for the effectiveness of oral steroids, steroid injections, ultrasound, electromagnetic field therapy, nocturnal splinting, and the use of ergonomic keyboards compared with a standard keyboard, and traditional cupping versus heat pads in the short term. Also, moderate evidence was found for ultrasound in the midterm. With the exception of oral and steroid injections, no long-term results were reported for any of these treatments. No evidence was found for the effectiveness of oral steroids in long term. Moreover, although higher doses of steroid injections seem to be more effective in the midterm, the benefits of steroids injections were not maintained in the long term. For all other nonsurgical interventions studied, only limited or no evidence was found. Arch Phys Med Rehabil. 2010 Jul. Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments--a systematic review. Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands.

Carpal tunnel syndrome is the most common of the entrapment neuropathies. Surgical decompression is commonly performed and has traditionally been considered the defnitive treatment for CTS. Conservative treatment options include physical therapy, bracing, steroid injections and alternative medicine. While CTS is often progressive, patients may get better without formal treatment. The resolution of symptoms is not necessarily related to the severity of the clinical findings and self-limited activity is common. The current literature suggests that bracing and corticosteroid injections may be useful in the nonsurgical treatment of CTS, although the benefits may be short term. There is limited evidence regarding the efficacy of other treatments, such as therapy, exercise, yoga, acupuncture, lasers and magnets, and further studies are needed. Surgery is recommended for progressive functional deficits and significant pain. Int J Clin Rheumtol. 2010. Current options for nonsurgical management of carpal tunnel syndrome. Carlson H, Colbert A, Frydl J, Arnall E, Elliot M, Carlson N.

Surgery
Although open and endoscopic techniques for carpal tunnel release can provide excellent results, neither technique has demonstrated clinical superiority.

Diagnosis
Nerve conduction studies (NCS), ultrasonography (USG), and magnetic resonance imaging (MRI) are use in diagnosis. Nerve conduction studies remain the gold standard but ultrasonography and MRI help increase sensitivity and detect mass lesions amenable to surgery.

Comorbidity
Carpal tunnel syndrome appears to increase risk for migraine headaches, and migraines may make it more likely that you'll also have CTS. Other shared risk factors for migraine and CTS, are obesity, diabetes, smoking and being female. Plastic and Reconstructive Surgery -- Global Open, news release, March 23, 2015

Questions
Could you please let me know the type of doctor I would talk to about this. I'm assuming he/she would not be a general practitioner.
   Most often a neurologist would see nerve problems, but if the problem is severe, an orthopedic doctor would do the surgery. Initially a family doctor may take a look at it if the pain from the carpal tunnel syndrome is not too bad.