Transcription:

RadioMD Presents:Healthy Talk | Original Air Date: March 27, 2015
Host: Michael Smith, MD

Living longer and staying healthier. It's Healthy Talk with Dr. Michael Smith, MD. Here's your host, Dr. Mike:

DR MIKE: So, let's talk about carpal tunnel syndrome and how we may be able to treat it naturally. Carpal tunnel syndrome--it's pretty common today. Basically, it's an overuse type of condition. Typing on typewriters, I guess we don't use typewriters any more. That was funny. We don't? No. I don't even think kids know what typewriters are. Computer keyboards and typing on computer keyboards. That would have been a better way of saying that.

What happens is, there is a nerve that runs through your wrist, on the palm side of your hand and it goes right underneath this band of connective tissue and when you're overusing your wrists, even baseball players get this because, you know, they're using the wrist a lot in swinging the bat. Golfers can get this. Even tennis players and just office workers typing on typewriters. Sorry. I make myself laugh sometimes.

So, what happens, there's some inflammation that can occur within that connective tissue. You can even damage the connective tissue which then seeps down. That damage, that inflammation seeps down and into the nerve and begins to affect the nerve that runs through that connective tissue right at the wrist and then that starts to affect your hand. Symptoms range from pain and tingling and numbness, even changes in sensation and it's mainly wrist and fingers. That nerve, by the way, is called the "median" nerve. There is some evidence, a significant portion of the population will be affected by carpal tunnel at some point in their lifetimes with estimates of lifetime prevalence ranging from 3-20%.

That's a pretty big range. I actually think it's on the higher end of that—20%. Especially kids. When I was young, I actually did take typewriting class. I did. That was in middle school. I'm telling my age a little bit, but other than that, we didn't us that. I didn't use keyboards and stuff, but kids today, gosh. Before they talk, they're on smartphones and computers, so this could become a significant issue for a larger and larger percent of our population in the future.

How do you treat it now? Surgery . That's what you do. They go in there and they cut that connective tissue and that relieves the pressure off the wound. It only works about half the time, about 50% of the time, because what happens in some people is, the repair process can be worse. That connective band that covers the median nerve can actually be thicker and impinge the nerve even more, so about half of the people that get surgery need to have the surgery again. Then, we have to do steroids and stuff like that to decrease inflammation. They've got to wear these wristbands all the time. So, conventionally speaking, we don't really do much for carpal tunnel. So, let's talk about some things that might be a little bit better for you if you are dealing with CTS—carpal tunnel syndrome.

The first one is called low-level laser therapy. This was a study in 2014 that was published in Lasers, Medicine and Science. It's interesting. It involves the use of a low power laser, so it's not like it's a weaponized laser. It's a low-powered laser. As a matter of fact, that's what it's called. Low level laser therapy—LLLT. It stimulates the nerve. It's been shown to enhance some aspects of median nerve function. Several clinical studies have shown that LLT , low level laser therapy, improves the very symptoms related to carpal tunnel. One study showed that it could be as effective as surgical treatment for mild to moderate cases and while other demonstrated to be as cost-effective as surgery. Observed benefits—these are research proven benefits of low level laser therapy (LLLT).

Improved grip strength; alleviation of pain; improved nerve conduction study parameters and reduced tingling and numbness. Those have been well proven in research papers and that was reviewed in Lasers, Medicine and Science in 2014, so that might be something you talk to your doctor about if you don't want to do surgery. Or, maybe you've already tried surgery and you don't want to do it again and you fall into that 50% that didn't get too much from the surgery, you might consider LLLT (laser therapy).

Another interesting therapy for carpal tunnel which was becoming popular in 2010, 2011, but it's dropped off a little bit. I'm not sure why. It's called "microwave heat treatment". One of the original studies for this—for the microwaves—was published in clinical rehabilitation, 2011. It's called "microwave hyperthermia" which uses micro waves to heat the skin to about 39.7 degrees and I pulled this right out of the study, and it may be helpful for CTS. A 2011 trial, used hyperthermia to treat 22 subjects with mild to moderate CTS. Over 3 weeks, 11 subjects underwent 6 microwave hyperthermia treatments and 11 underwent 6 sham treatments (placebos).

After 3 weeks, significant reductions in pain and significant improvements in hand function were reported in the microwave hyperthermia treated group, but not in the sham (placebo) group. I don't know how often this is used. Maybe I should talk to some hand specialists, but I don't hear about microwave heat treatment as much as I do the laser therapy, but it works great. I mean, so this is another option for you if you're doctor has said, "Well, you're going to have to have surgery."

Maybe rehabilitation is not working for you. I mean, you don't want to go through surgery, or you've gone through surgery. This is another option just like the laser therapy. Obviously, both of these, the laser therapy and the microwave heat treatment, what they offer beyond surgery is, hopefully, better results, longer lasting results and, of course, they're not invasive. That's always a good thing if we can find something in medicine that replaces an invasive diagnostic study or treatment study or whatever. If we can replace something invasive with something non-invasive and it's not as good, that's always best.

There's always risk when you have to cut somebody open, right? There's inherent risk to that type of procedure. That doesn't mean that laser therapy and microwave heat treatment don't have their own risk, but, generally speaking, it's best not to cut somebody open unless you absolutely have to. So, we try to be as non-invasive as we can because my oath is to do no harm. Lastly, I want to mention something called "protease therapy". This is even something you can do over the counter with supplements. Protease is a type of enzyme that breaks down protein, so protease therapy is going to be using these types of natural proteases. I think in this one study, they used one called "serratiopeptidase" and it helps just to break down some of the connective fiber that's pushing on that median nerve. In this one study, they took proteases derived from silkworms, right?

Oh, and they also said these proteases, not only is it breaking down the connective tissue, it's also anti-inflammatory. By the way, there are protease supplements out there that people take to reduce inflammation, so not only is it helping maybe to break down that connective tissue from pushing down on the median nerve, they're also anti-inflammatory. So, this one study reported that 10 mg of oral serratiopeptidase, given twice daily for 6 weeks was associated with significant clinical improvement in 13 of 20 subjects. That's 65%. You know, you might think, "Well, not that great," but when you put it in the context of maybe the beginnings of carpal tunnel, maybe this is where we begin--with protease therapy. It's a supplement. It's easy to do. That was published in the Journal of Association for Indian Physicians in 1999.

This is Healthy Talk on RadioMD. I'm Dr. Mike. Stay well.