Ms P, a successful manager at a leading IT company, was driving home after a tiring meeting at the office. Off late, she was experiencing slight weakness at the wrist and two fingers, especially while writing or holding a telephone receiver for long time. Today, while driving the car, she started getting severe tingling and numbness with stitching type of pain in the palm. After some time, she could not even drive the car efficiently and had to make an effort to reach home safely. She immediately took an appointment with a neurologist, who confirmed it to be the classical case of ‘Carpal Tunnel Syndrome’.
Background:
Carpal tunnel syndrome (CTS) is a compressive neuropathy marked by weakness and pain in the hand and wrist. Its manifestations can range from a minor inconvenience to a severely disabling condition – depending on its cause, treatment and the maintaining factors.
The incidence is so common that it is estimated that approximately 500,00 people undergo surgery for CTS in the US alone.
The pathophysiology:
The carpal tunnel is located at the base of the palm and is bounded on 3 sides by carpal bones and anteriorly by the transverse carpal ligament. Inside run the median nerve, flexor tendons, and their synovial sheaths. CTS is predominantly caused by compression of the median nerve at the wrist, because of the swelling or growth of the flexor synovium. The pain in CTS is usually a secondary phenomenon rather than a direct physical damage.
Risk Factors:
- It usually runs in families.
- Obesity – or sudden increase in the weight.
- Occupation that involves repetitive wrist joint movement – e.g., piano players, or typing work.
- Medical conditions – like, diabetes, hypothyroidism, acromegaly, gout or rheumatoid arthritis.
- It is more prevalent in middle-aged females.
Clinical presentation:
Symptoms of carpal tunnel syndrome usually progress gradually over weeks and months and sometimes years. Anyone with recurrent or persistent pain, numbness and tingling, or weakness of the hand should consult a doctor for a diagnosis. Symptoms often develop as follows:
- Initial symptoms include pain in the wrist and palm side hand. Symptoms commonly occur in both hands. (Even when only one hand is painful, the other hand often shows signs of nerve conduction abnormalities on testing.)
- Early on, the patient also usually reports numbness, tingling, burning, or some combination of symptoms on the palm side of the index, middle, and ring fingers. (Typically the fifth finger has no symptoms.) Such sensations may radiate to the forearm or shoulder.
- Over time, the hand may become numb, and patients may lose the ability to feel heat and cold. Patients may experience a sense of weakness and a tendency to drop things.
- Patients may feel that their hands are swollen even though there is no visible swelling. This symptom may actually prove to be an important indicator of greater CTS severity.
Diagnosis:
- A plain X-ray is of minimal use in diagnosing CTS.
- A magnetic resonance imaging [MRI] is reasonably accurate in locating the lesion.
- Electromyelography [EMG] or nerve-conduction studies can reveal the nerve block.
Treatment:
Drugs:
- These cases are usually treated with pain-killers.
- Local steroidal injections can drastically reduce the symptoms.
- A splint minimizing the movement at wrist joint
Exercises:
- Extend and stretch both wrists and fingers acutely as if they are in a hand-stand position. Hold this position for a count of five.
- Straighten both wrists and relax fingers for a count of five.
- Make a tight fist with both hands. Then bend both wrists down while keeping the fist. Hold for a count of five.
- Straighten both wrists and relax fingers for a count of five.
- Repeat each exercise 10 times, then hang arms loosely at side and shake them for a couple of seconds.
Surgery:
In more severe and limiting cases, surgical correction by releasing the transverse carpal ligament can be thought about. Surgery for CTS has a long-term success rate of greater than 75%.
Role of Homeopathy:
Since allopathic drugs give a temporary pain-relief, and surgery is not indicated in majority of cases suffering with CTS, a well-selected homeopathic remedy has a key-role to play in the treatment of CTS, by reducing the edema and the nerve compression. The usual duration of the therapy depends on the severity, depth of affection and concomitant medical disorders. Typically it takes around 6-8 months to obtain significant relief.
In my experience, both constitutional as well as locally acting remedies like Paris quadr, Hypericum, Guiacum, Causticum or Rhus tox have given relief. The key symptoms to elicit from the patient include: the type of pain, side of affection, causative factors, modalities and concomitant ailments.
CTS predominantly falls under sycotic miasm and thus an anti-sycotic intercurrent is needed whenever the case holds standstill.
