Carpal Tunnel Syndrome (CTS)

Carpal Tunnel Syndrome refers to a compression of the median nerve in the carpal tunnel, a bony canal in the wrist that is spanned by a firm band, the flexor retinaculum. This tunnel serves as a gliding surface for the tendons of the forearm muscles.
However, when irritation of the structures within the carpal tunnel occurs, the resulting swelling often leads to compression of the median nerve. This can cause painful symptoms and lead to tingling, weakness, and numbness in the hands.

The main triggers for Carpal Tunnel Syndrome are considered to be overuse and improper stress on the wrist. Typical triggers include repetitive movements, such as working with a bent wrist while typing, as well as traumas or inflammatory diseases like arthritis. This long-term irritation of the structures in the carpal tunnel leads to inflammation and swelling, which eventually compress the median nerve and cause painful symptoms.

Hormonal changes, such as those occurring during pregnancy, can also lead to compression of the nerve in the carpal tunnel. In this case, water retention and swelling can occur, temporarily increasing the pressure on the median nerve. However, this is almost always a temporary phenomenon and is usually reversible.

From a holistic perspective, systemic diseases and a disturbed acid-base balance in the body can also promote the development of Carpal Tunnel Syndrome. Various metabolic diseases, such as hemopyrrollactamuria (HPU), inflammatory processes in the intestine (e.g., leaky gut syndrome), or jaw inflammations (e.g., FDOJ/NICO) can trigger chronic acidification and thus inflammatory changes in the wrists. All these factors contribute to altering the structure of the carpal tunnel and promoting nerve compression.

The symptoms of Carpal Tunnel Syndrome can vary individually and depend on the severity. Patients often experience numbness and tingling in the thumb, index finger, and middle finger. Typically, they report that their hands fall asleep at night, causing wrist pain.

If left untreated, the condition can progress and lead to permanent functional disorders of the finger muscles. In severe cases, it can also result in irreversible nerve damage that significantly impairs fine motor skills.

To prevent this, it is crucial to identify the triggering cause early and work with your doctor to establish a treatment plan.

Carpal Tunnel Syndrome and cervical spine problems are closely connected, as the median nerve, which is compressed in the carpal tunnel, originates in the cervical spine and runs from there to the fingers. This explains why symptoms in both regions can occur together and cause similar symptoms.

Typical symptoms in both conditions include:

Often, affected individuals initially assume they have Carpal Tunnel Syndrome, although the actual cause may lie in the cervical spine. This makes diagnosis particularly challenging, especially since both conditions can occur simultaneously and cause similar complaints. Therefore, precise neurological diagnostics are essential to determine the exact cause. This includes analyzing the course of the complaints, checking the location of the symptoms, and examining potential triggers as well as connections between the cervical spine and wrist. This comprehensive analysis forms the basis for targeted and successful treatment.

If you experience pain and numbness in your fingers, you should seek medical advice promptly. Nevertheless, self-tests can also help to initially classify the problem and recognize possible overloads early on.

The following signs can provide you with initial insights into your complaints.

The Tinel test is a simple method to obtain indications of the presence of Carpal Tunnel Syndrome. The inner side of the wrist is tapped. If possible abnormal sensations, such as tingling or pain in the area of the thumb and index finger, occur, these can be a sign of nerve compression.
If there are corresponding positive signs, you should in any case seek medical advice to clarify and appropriately treat a potentially existing carpal tunnel problem.

The Phalen test also serves to check for possible carpal tunnel compression. Here, the wrist is bent towards the palm and held in this position for about a minute.

If a carpal tunnel problem exists, uncomfortable sensations such as tingling, numbness, or pain in the thumb and index finger will occur.

The bottle test checks the hand’s ability to securely grip a cylindrical object, such as a bottle. In the presence of median nerve paresis, this function is limited and a gap can form between the hand and the bottle.

A positive test result should not be ignored. It is advisable to seek medical help immediately, as permanent damage to the median nerve may have already occurred. Therefore, early diagnosis and treatment are crucial to prevent further damage.

The diagnosis of Carpal Tunnel Syndrome is usually made through a thorough clinical examination and various tests. First, the doctor conducts a detailed anamnesis, inquiring about occurring symptoms, their frequency, and triggers. This is usually followed by a physical examination, during which special tests such as the Tinel or Phalen test are performed to check the function of the median nerve. Additionally, imaging techniques such as ultrasound or magnetic resonance imaging (MRI) may be used to support the diagnosis or to detect any structural changes in the carpal tunnel. In many cases, an electromyography (EMG) is also performed to test the function of the nerve and to enable a precise differentiation from other possible causes. This allows for a targeted diagnosis and the initiation of appropriate treatment.

Various treatment options are available for Carpal Tunnel Syndrome, which are selected depending on the severity of the symptoms and the underlying cause.

In mild cases, wrist splints can be used for protection and overloads can be avoided. These splints support the wrist and prevent it from tilting into an unfavorable position, thereby reducing pressure on the median nerve. Physiotherapy and anti-inflammatory medications can also help to provide more space for the compressed nerve and alleviate the compression. Therapeutic applications such as ultrasound or laser treatments can also contribute to relieving symptoms by stimulating blood circulation and fighting inflammation.

Furthermore, a lifestyle change with an adjusted diet is crucial to harmonize the acid-base balance in the body. A healthy diet and the treatment of possible underlying diseases that lead to acidification play a central role. In many cases, intestinal rehabilitation or orthomolecular therapy can also have a supportive effect. Moreover, measures such as INUSpheresis or infusion therapy can provide valuable support in the treatment of Carpal Tunnel Syndrome.

If symptoms persist despite these measures, a cortisone injection may be considered to alleviate inflammation. In more severe cases, when symptoms do not respond to conservative treatments, surgery may be an option. This involves cutting the band over the carpal tunnel to reduce pressure on the nerve. A modern, minimally invasive alternative is the ultrasound-guided splitting of the carpal tunnel, where the constricting band is cut without a large skin incision and under visual control.

There are a variety of physiotherapeutic exercises that can be easily performed at home and aim to relieve the median nerve and release tension in the wrist. These exercises can promote blood circulation, improve wrist mobility, and help reduce pressure on the nerve. However, it’s important to have the exact cause of Carpal Tunnel Syndrome medically clarified and to have a physiotherapist show you how to perform the exercises correctly. Incorrect exercises or improper execution could further worsen the problem.

In the following, we’ll look at three helpful exercises. It’s important not to go beyond the pain threshold and to seek medical advice if symptoms worsen.

Instructions: Hold your arm straight out in front of you, palm facing up. With your other hand, grasp your fingertips and gently pull them down towards your body.

Duration: Hold the position for 15-30 seconds, then switch sides.

Repetitions: 3-5 times per hand.

Instructions: Place the affected wrist on a tennis ball on the table. The palm faces the floor. Now roll out the forearm muscles from the hand towards the elbow.

Duration: 10-15 seconds per set.

Repetitions: 3-5 times per arm.

Instructions: Form a fist with the affected hand and press it firmly on a tabletop. Then, under continuous pressure, open the hand until the back of the hand touches the surface. To make the exercise more comfortable, you can place a towel underneath.

Repetitions: 3-5 times per arm.

In the following section, we address frequently arising questions about Carpal Tunnel Syndrome. If you still have questions, you should consult your treating physician.

The information listed contains relevant topics and serves to improve understanding.