(also referred to as...)
CTS, Repetitive Motion Injury, Repetitive Strain Injury, RSI
Our modern lifestyle of computers, video games, Internet surfing, assembly line production, and data entry has brought with it a wrath of physical (and emotional) conditions not experienced in previous generations. From laziness, to emotional isolation, to painful, shooting pains in our wrists and hands, the mainstream medical community has been caught off guard with little conventional, effective means to deal with a number of these conditions.
Chief among them is carpal tunnel syndrome, a repetitive motion injury that has seen an exponential increase in cases over the last decade. Though this condition has been around for some time, with bookkeepers and cashiers comprising the bulk of sufferers, the rapid deployment of computers into the workplace during the 1980's and the home during the 1990's has made carpal tunnel syndrome a household term. United States Bureau of Labor Statistics show that between 1986 and 1992, the number of "repetitive trauma disorders" involving CTS and similar conditions rose from 50,000 to 282,000 cases. The U.S. National Center for Health Statistics reported 849,000 new cases of carpal tunnel syndrome in 1994. And with the rise of the Internet and the computer mouse as the primary interface tool, the number of cases continues to climb exponentially.
Symptoms and Signs:
Numbness, tingling, stiffness, and burning sensations may be felt along the hand, towards the wrist, and along the lower arm. Pain and weakness may also be experienced along the arm and neck. Symptoms are often sporadic at first and become more persistent as the condition worsens. The palmar side of the thumb, index, and middle finger and radial half of the ring finger are usually the foci of pain. Symptoms can affect one or both hands. Movement is often restricted. The little finger receives nerve impulses from outside the carpal tunnel and is thus spared from this particular condition.
Symptoms are often worse at night or in the morning, when circulation has slowed. Pain from curled wrists during sleeping (see Causes, below), is also a primary indicator of carpal tunnel syndrome.
Symptoms can become so severe that merely gripping a glass or turning a doorknob causes excessive pain. At this point, it is essential that you consult with your naturopath or other health practitioner.
Carpal tunnel syndrome is caused by cumulative trauma to the carpal tunnel, a bony, hourglass-shaped passageway located one-quarter of an inch below the surface, on the underside of the wrist. The carpal tunnel is encased in a slippery sheath called the synovium and contains a number of critical "parts" within this very small confine. Among the bone and nine tendons is a median nerve travelling from the arm to the fingers. This nerve controls a number of small muscles in the hand and provides sensation to the thumb and first three fingers.
Steady overuse or stress of this area leads to swelling and inflammation of the tendons alongside the median nerve and synovium encasing. As a result, the median nerve is literally crushed in the tunnel, causing weakness, pain, stiffness, "pins and needles", and restricted movement.
Bookkeepers, cashiers, carpenters, data entry clerks, some factory workers, musicians, phone operators, typists, writers, or any person working at a computer keyboard or performing steady, rapid, repetitive finger / wrist / hand movements can develop carpal tunnel syndrome.
Women between twenty-nine and sixty two years of age tend to develop carpal tunnel syndrome more than men, as the hormone fluctuations of menstruation, birth control pills, pregnancy, and menopause can promote swelling of the synovium. In addition, women typically have smaller wrists, making slight inflammations more susceptible to carpal tunnel syndrome.
As many people unknowingly curl their wrists while sleeping, the resulting pressure can lead to CTS. This underlying cause and resulting lack of sleep is also one of the most bothersome symptoms of carpal tunnel syndrome.
Bone spurs, inflammatory arthritis, lack of exercise, obesity (due to extra carpal tunnel pressure), pregnancy (due to water retention) and even tendinitis can all contribute to the development of CTS. Diabetes mellitus, hypothyroidism, and Raynaud's syndrome all increase risk as well.
To help determine whether you have carpal tunnel syndrome, perform the following test:
1. Place the backs of your hands together while pointing your fingers straight down.
2. Keep your wrists at a 90º angle so that your elbows point straight out to the sides.
3. Hold this position for one minute.
If you experience symptoms, you likely have carpal tunnel syndrome.
To conclusively determine whether you have carpal tunnel syndrome, your naturopath or other health practitioner can perform an electromyography (EMG) that transmits low-voltage electrical impulses through your arm. Damaged nerves or those entrapped by swollen tissue transmit at a rate of 90 to 95 metres per second, as opposed to the normal rate of 136 metres per second.
What to Expect:
If not treated, carpal tunnel syndrome becomes increasingly painful over time. Small motor movements become more difficult to the point of being impossible to perform.
Pain also appears more often when the hand and wrist are not in use. Continual muscle motion helps relieve pain in some cases. However, the motion is likely that which has aggravated the condition in the first place.
Traditional approaches to treating carpal tunnel syndrome include painkillers that block pain, rather than targeting the condition, wrist restraints/splints that relieve stress and symptoms in one muscle group while possibly promoting them in another, and high-risk surgical decompression techniques (more than 100,000 yearly in the United States alone), with their associated risk of side effects.
A number of alternative remedies exist, however, that either treat the problem at its source or promote lifestyle changes that can significantly reduce the pain and discomfort of this condition. In most cases, short-term alterations in habit coupled with longer-term supplementation yield optimal results.
To prepare a bromelain-rich, anti-inflammatory fruit salad (or AI Salad), combine pineapple and papaya with grated ginger and enjoy! For more information on bromelain, see Miscellaneous, below.
Essential fatty acids interrupt the inflammation process and help soothe inflamed nerves and tissues. Flaxseed/linseed oil, borage oil, pumpkin seed oil, hemp seed oil, evening primrose oil, fish, eggs, and walnuts are all sources of EFA's. The oils may be the most ideal. Take one tablespoon daily on yogurt, rice and/or bean dishes, salads, and vegetables. If using flaxseed oil capsules, take 2 to 3 capsules daily, in the morning. If using evening primrose oil take 1 500mg capsule daily, in the morning. You will begin to notice an effect after 2 to 4 weeks of supplementation.
Cayenne is well known for its anti-inflammatory properties. Indeed, this fiery plant contains six pain relieving and seven anti-inflammatory compounds, with capsaicin being the most well known constituent. Add several teaspoons powdered cayenne to 1/4 cup skin lotion and rub into your wrists. Alternatively, prepare your own skin application by steeping five to ten red cayenne peppers in 1 litre/2 pints rubbing alcohol for several days. NOTE: Many people are quite sensitive to cayenne. Apply to a small test area on your skin before using a full application. Discontinue use if irritation occurs. In addition, be sure to thoroughly wash your hands with soap and water after use and take great care to avoid eye contact.
Along with its calming abilities, chamomile contains several compounds (bisabolol, chamazulene and cyclic ethers) that have anti-inflammatory properties and this herb is commonly used in Europe to treat inflammatory conditions. To prepare an infusion, add 2 teaspoons dried herb to one cup hot water. Drink three times daily. If using a tincture, take 40 to 80 drops three times daily. NOTE: Chamomile oil can act as a uterine stimulant. Do not use during pregnancy.
When applied externally, comfrey can relieve swelling, inflammation, and pain. Add several teaspoons comfrey leaves or minced root (soaked in boiling water beforehand) to 1/4 cup skin lotion and rub into your wrists. Alternatively, prepare your own skin application by steeping 8 to 10 tablespoons fresh or 4 to 5 tablespoons dried comfrey in 1 litre/2 pints rubbing alcohol for several days.
Add cumin to foods and curried rice. This herb contains a number of pain-relieving, anti-inflammatory compounds that also reduce swelling.
Six anti-inflammatory compounds present in sage make it an ideal addition to many meals as well. NOTE: Do not use this herb if you are pregnant.
St. John's Wort promotes the recovery of damaged, inflamed, or strained nerves and has been used to relieve nerve pain and tingling for generations. The sedative properties help reduce pain while its anti-inflammatory actions help shrink swollen tendons. Take 300 to 500mg two to three times daily. If desired, you may choose a preparation standardized to 0.3% hypericin, however, traditional herbalists prefer preparations involving the herb in its entirety. You will likely need to take this herb for several weeks before noting any improvement. NOTE: Do not use this herb if you are pregnant.
Turmeric contains curcumin, which has anti-inflammatory properties. As this compound is present in only 1 to 4% of dried turmeric, supplementation is recommended. Take 250 to 500mg pure curcumin daily, between meals. Maintain this dosage until symptoms subside and follow with a 125 to 250mg maintenance dosage for 1 to 2 weeks. If you enjoy this spice, add liberally to food. NOTE: Do not use this herb if you are pregnant.
Willow is the original source of aspirin and contains salicylates that reduce inflammation and relieve pain. To prepare an infusion, bring 1 1/2 cups water and 1 teaspoon herb to a boil and simmer 10 minutes. Cool, strain, and enjoy. You may wish to add lemonade if you find the taste too bitter. Drink two to three cups daily.
Meadowsweet and wintergreen also contain salicylates and may prove useful. Prepare as willow, above.
Certain remedies can be used in acute situations if your symptoms fit the symptom picture of the remedy. For dosages, see the dedicated section on Homeopathy. Consult your homeopath or naturopath to determine your constitutional remedy: the remedy that best fits you as a whole person. Your homeopath or naturopath will take a complete case history considering all of your mental and physical ailments and match these symptoms with the symptom picture of the remedy.
Arnica: Arnica is the classic remedy used to treat muscle injuries and may prove useful in treating carpal tunnel syndrome. Use for flare-ups or inflammation of new injuries caused by the repetitive use of the fingers and wrists. Area feels bruised and sore and cramping may occur. External applications are also available in cream or gel form. Use to ease soreness and swelling.
Calcarea phosphorica: Painful bones and nerves of the wrist and arm. Possible neck stiffness and discomfort. Cold rooms and drafts aggravate the condition. Person is irritable, sensitive, and weak from excess work or pain.
Causticum: For chronic carpal tunnel syndrome. Area feels bruised with drawing, burning pains. Muscles of the hand and forearm are weak, stiff, and feel contracted. Condition improves with warmth and is made worse by the cold. Person feels better in rainy weather.
Guaiacum: Wrists (primarily the left) are stiff with burning pain that is relieved by the application of ice or ice-cold water. Person may feel the need to stretch their wrists due to tightness, regardless of the resulting pain.
Hypericum: Sharp, shooting pains originating from the wrists. Useful for its soothing effect when body parts containing many nerves are injured. Also used for traumatic nerve conditions.
Rhus toxicodendron: Stiffness and pain feel worse on initial motion and made better as movement continues. Overuse can cause increased stiffness, pain, and soreness. Condition improves with warmth and is made worse by cold, damp weather.
Ruta: For excess stiffness resulting from joint overuse and nerve irritation. Wrist may feel bruised and weak, even when at rest. Repetitive tasks that stress joints and nerves cause weakness in the arms and wrists.
Viola odorata: Useful for conditions affecting the right wrist and hand. Pain and numbness start at the wrist and continue through the hand into the fingers. Hand and arms may tremble. Condition made worse when person gets cold.
Take frequent breaks. It is important to step away from the task at hand and have your body do something physically different. This includes relaxing and stretching (see below). If you have been sitting for an extended period, get up and walk around. Grab something to eat. Go for a stroll. In short, offering yourself a frequent change of pace, as it were, allows you to use different muscle groups and reduces stress on your fingers, hands, wrists, and lower arms.
Stretch! Along with the rest of your body, hand stretching is very important before, during, and after intense use of your fingers, hands, wrists, and lower arms. Stretch before you start, to warm up your muscles. Stretch while you work, to relieve tension and stress and work different muscle groups. And, just as in a workout, stretch when you are done, to "cool down" and release tension from the various muscle groups. Open and close your fingers. Press your hands together. Keep your fingers curled together and pull your hands apart. Bend your wrists in both directions. Gently rotate your wrists in a circle for two minutes, stretching the hand muscles. Rest one forearm on the table, grasp the fingertips, and gently pull back and hold for five seconds. Repeat with the other arm. Press your palms flat on the table, in a "push-up" position. Lean forward to stretch the forearm muscles and wrists. In short, anything that extends the range of motion in your fingers and wrist is beneficial. In the end, give your hands a good, gentle shake. You can also relieve stress and tension in your shoulders, neck, and upper back by raising your arms above your head and rotating your arms and wrists.
Writing lightly, using a soft led pencil or free-flowing ink pen, also reduces strain in your hand. Choose writing instruments that are more fat and round, too.
Reorganization of your workspace often yields positive results. An analysis of your chair, keyboard, desk, and monitor will show which areas require improvement. Your monitor should be just below eye level, at least twenty four inches away, and should not be facing or reflecting the light from a window. Watch your posture and sit straight (but not rigid) in your chair. Your elbows should be at a 90º angle when typing and manipulating the mouse, while your forearms should be parallel to the floor. Your wrists and hands should be straight. Your knees should also be at a 90º angle with the floor and your feet should be flat on the floor. If not, lower your chair or purchase an ergonomic foot rest. Due to their smaller footprint, notebook computers indirectly promote poor hand, wrist, forearm, and elbow positions. If possible, use an external keyboard and mouse on a proper desk.
Machinery vibrations cause you to grip tools and objects more forcefully in order to keep things steady, straining your wrists and hands. This includes electric knives, power tools, and wood-cutting machines. Extensive damage leads to a condition called hand-arm vibration syndrome. When purchasing tools such as power saws, chain saws, and wood-cutting tools, look for products with "vibration control".
In keeping with the home improvement theme, enlarge the handles of commonly used tools such as the broom and rake. Small handles press directly on tendons and the median nerve in your palm, promoting CTS. Cover handles with foam rubber or tape. Make the handle a comfortable size -- too big will also hurt your wrist.
Sharpen knives and shears. Using dull knives to cut meat or dull blades to clip hedges causes excess strain on your carpal tunnel. By keeping these items sharp, you reduce the amount of pressure exerted by your hands and arms during use.
Bromelain is a protein-dissolving (proteolytic) enzyme that can be used both as a digestive supplement after a particularly large meal as well as a CTS treatment that reduces swelling, inflammation, and pain. For CTS, take 250 to 1,500mg pure bromelain daily in divided doses, between meals (or the enzymatic energy will be used up in the digestive process). Supplements with a higher milk-clotting unit (mcu) and gelatin-dissolving unit (gdu) rating have greater potency. Look for a supplement containing 1,800 to 2,400mcu or 1,080 to 1,440gdu per capsule. Alternatively, obtain your bromelain as part of an "AI Salad" described under Foods, above.
Using Chinese hand balls makes for a gentle, massaging hand exercise. The balls are usually made of steel, may have a chrome, brass, or copper coating, and are slightly heavy. They are available at many small markets and Asian stores. When taking your break, hold the two balls in your hand and roll them around. The rolling motion massages the small muscles and ligaments in your hand and wrist. Switch to the other hand and repeat. Do this often whenever you take a break -- or make it your break!
Cool your wrists. When you experience swelling, inflammation, and pain, place an ice pack or bag of frozen vegetables wrapped in a towel on your wrist. Ice cubes wrapped in the same manner will also do the trick. Leave for 10 to 15 minutes, then remove for an equal length of time and reapply if desired. This method reduces the possibility of "freezer burn" on your skin.
Warm your wrists. In stark contrast to the remedy listed above, hold a warm compress or heating pad between your wrists to relax tense, overworked muscles. You may need to try both the cold application above and this warmth remedy to determine the one most suitable for your needs.
It is widely believed that a vitamin B6 deficiency is a critical factor in developing symptoms associated with carpal tunnel syndrome. Adequate levels of vitamin B6 reduce synovium swelling and increase elasticity and may also relieve pain. Take 50 to 100mg daily, in divided doses. Consult with your naturopath or other health practitioner if exceeding 100mg daily. Note that doses exceeding 1,000mg can cause neurological damage. Foods that contain B6 include avocados, bananas, beans, blackstrap molasses, brewer's yeast, brown rice, cabbage, chicken, corn, eggs, fish, meat, peas, potatoes, soy, spinach, walnuts, wheat bran, and wheat germ. You will likely require supplementation for 6 to 12 weeks before noticing an improvement.
It is best to take B6 as part of a B Complex supplement instead, which keeps the B vitamins balanced in the body and synergistically provide a number of beneficial effects. Take one 50mg capsule once or twice daily. Do not take more than 50mg at one time, as your body cannot absorb a larger amount in a single dosage
Actions and Remedy Listings
For More Information ...
Association of Canadian Ergonomists
CTDNews: Workplace Solutions for RSI Online
Deborah Quilter's RSIHelp.com
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consult with their naturopath or other health practitioner before undertaking additional regime for their ailment.
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