Carpal+Tunnel

Carpal tunnel syndrome occurs when the median nerve becomes compressed within the carpal tunnel, usually resulting from swelling of adjacent tendon sheaths due to inflammation.

Etiology
-Repetitive motion: CTS affects as many as 50% of workers in high-risk industries such as electronic parts assemblers, data entry workers, musicians, and dental hygienists -Other risk factors: diabetes mellitus, RA, thyroid disorders, pregnancy, and menopause

Symptoms
-Early-stage: pain, burning, and tingling along the palmar surface of the thumb, index, and middle fingers; symptoms are worse at night -As symptoms progress, paresthesia becomes more frequent; pain may radiate proximally into the forearm and occasionally to shoulder, chest, or neck.

Diagnosis
+ Tinel’s sign = tingling or shock-like pain on percussion of the transverse carpal ligament + Phalen’s sign = reproduction of symptoms after 60-90 seconds with the patient flexing wrists at 90º by pressing dorsal aspect of both hands together EMG = “gold standard;”

Differential diagnosis: CTS paresthesia often confused with paresthesia of brachial plexus in thoracic outlet syndrome or other cervicobrachial pain syndromes; Adson’s test

Biomedical Treatment
-Rest -Wrist splint -NSAIDs -Corticosteroid injections -Stretching and strengthening exercises -Some improvement achieved in over 70% of cases. Full restoration is achieved in less than 60% of surgeries. -Downtime and rehabiliation generally range from six weeks to three months, but can take over a year, depending on how many lingering symptoms result and the degree of scar tissue formation -Scar tissue formation during recovery from surgery is unpredictable and sometimes results in less space in this narrow anatomical passage of the wrist after the carpal tunnel surgical procedure, causing even more discomfort and numbness after surgery. This complicaton is reported in less than 15% of surgical procedures. -It is common for people recovering from the carpal tunnel surgical procedure to experience some permanent loss of grip strength, a perduring loss of lifting strength in the wrist/forearm and nagging loss of full range of motion of the hand and wrist after surgery. -A recent in a special surgery issue of The Lancet indicates that surgery is slightly better than non-surgical treatment for patients with carpal tunnel syndrome who don't have severe nerve damage (denervation). -The study included 44 patients who had surgery and 52 patients who had non-surgical treatment, such as hand therapy and ultrasound. A year after treatment, the patients' hand function was measured using the Carpal Tunnel Syndrome Assessment Questionnaire (CTSAQ). -The patients who had surgery showed an advantage in both function and symptoms -- calculated by proportions of patients having at least 30 percent improvement in CTSAQ scores for these indicators, and having minimal interference in daily work or household activities. The study found that 46 percent of surgery patients and 27 percent of non-surgery patients met all three criteria. -However,some patients allocated to surgery reported persistent symptoms, and 61 percent of patients allocated to non-surgical treatment avoided surgery altogether. Carpal Tunnel Syndrome:TCM Disease Categorization
 * Non-surgical treatment:**
 * Surgical treatment**

TCM Disease Categorizations
//Shou Zhi Ma Mu:// “hand and finger tingling and numbness” //Wan Tong:// “wrist pain” //Bi Zheng:// “painful obstruction syndrome”

Etiology and Pathogenesis
Overuse, sprain/traumatic injury: causes damage to the sinews resulting in Qi stagnation and Blood stasis in the channels and collaterals; this, in turn, leads to lack of nourishment (Blood and Qi) to the sinews Wind-Cold-Damp invasion: local vacuity of Defensive Qi and Blood allows pathogenic factors to invade Chronic injury, aging: long-term stasis from chronic injury and decline of Qi and Blood/Liver and Kidney Qi due to aging results in lack of nourishment to the sinews
 * Repletion:**
 * Vacuity:**

Qi Stagnation & Blood Stasis
severe pain that is fixed in location and sharp or stabbing in quality; pain may be exacerbated by activity and is usually worse at night
 * Tongue:** normal color and coat (if chronic, may be dark/purplish)
 * Pulse:** wiry or choppy
 * Treatment Principle:** Move Qi and quicken the Blood, eliminate stasis and relieve pain

Wind-Cold-Damp Invasion
1) Expel Wind, scatter Cold, eliminate Dampness, open the channels and collaterals, relieve pain 2) Scatter Cold, expel Wind, eliminate Dampness, warm and open the channels and collaterals, relieve pain 3) Eliminate Dampness, expel Wind, scatter Cold, open the channels and collaterals, relieve pain
 * Wind predominant:** sore, aching pain that is intermittent or moves around
 * Cold predominant:** severe, fixed pain that is aggravated by cold and relieved by warmth
 * Damp predominant (a.k.a. Fixed Bi):** heavy, sore, fixed aching pain that is aggravated by dampness; numbness in the affected area may be present
 * Tongue:** possibly moist, white coating with Wind predominant or greasy, white coating with Damp predominant
 * Pulse:** floating, tight, slippery, slow are theoretically possible; wiry or tight are most common
 * Treatment Principle:**

Qi & Blood Deficiency
sore, aching pain exacerbated by activity; tingling sensation in the hands; possible muscle wasting or weakness; fatigue, poor appetite, loose stool, abdominal distention, facial pallor, dizziness, palpitations possible
 * Tongue:** pale and possibly scalloped
 * Pulse:** thin, weak, deep
 * Treatment Principles:** Boost Qi, nourish Blood, open the channels and collaterals, stop pain

=Treatment=

Bodily Approach Treatment
-Strength and stretching wrist exercises

Orthomolecular Recommendations
-Omega-3 -Riboflavin -Vitamin B12 -Turmeric

Acupuncture Treatment
Local points: PC-7, PC-6, PC-8, Ba Xie Potentially LR-4 based on the holographic balance principle Modification based on the pattern: Wind-Cold-Damp: TW-5, LI-11, LI-4, SI-3, Moxa Qi stagnation and Blood stasis: SP-10, BL-17, 4 Gates Qi and Blood vacuity: BL-17, ST-36, CV-6 Herbal liniments and heat therapy

Carpal Tunnel Syndrome that has been symptomatic for less than one year usually responds reasonably well to treatment. If symptoms have lasted more than one year, the prognosis should be guarded.

Note: if symptoms are determined to be a result of pathology in the cervical spine or cervicobrachial plexus, treatment must be directed to that area for treatment to be effective.