A study from Ohio State University carried out a meta-analysis of a range of studies that all confirmed this finding. Some of the studies found that women were up to 11 times more likely to suffer one of the disorders.

‘Anyway you slice the data, women have a significantly higher prevalence for many of these disorders,’ said Delia Treasler, one of the research team.

So the next big question is why?

(Source: Ohio State University, news release, July 21, 2004).

It is prevalent among office workers. One study in Canada estimates that one in 10 keyboard workers suffers from RSI at some time in any 12-month period (Health Rep, 2003; 14: 11-30) – but it can affect anyone who does repetitive work that requires keeping the body at an awkward angle, such as construction workers, musicians and dentists; even carpet weavers in Iran have been singled out as potential victims (Int J Occup Saf Ergon, 2004; 10: 65-78).

Your last chance to prevent a serious onset of RSI is when you feel the first twinges of pain, or possibly a tightening or stiffness in your hands, wrists, fingers, forearms or elbows.

So, as soon as you feel the pain, or if you’re involved in repetitive work, these are some of the things you can do:
* Be body conscious. Our body is wonderful at unconsciously compensating for poor posture or the uncomfortable positions we put ourselves in. Make sure that your body is sitting properly, and that your keyboard and monitor are positioned correctly. We should look down on monitors, and they should be at least an arm’s length from us.

Chairs and keyboards should be set so that the thighs and forearms are level; the wrists should remain straight when we type, and not be bent down or back, and they shouldn’t be resting on anything when typing. The back should be straight and not slouching, and you shouldn’t be stretching forward. Before you begin work, warm up your muscle groups with a few simple exercises, just as you would prepare before beginning a workout at a gym.

* Move around. Even a good posture and ergonomics won’t give you a licence to sit and type for eight hours a day. You need to move, stand up and walk around – one software developer has even devised a programme that alerts you to your next ‘walkaround’. You can set an alarm on your computer, mobile phone or digital watch to do the same thing.

* Exercise. You need to strengthen your muscles, and increase your vitality and stamina, especially as you grow older. Get advice from an instructor at your local gym. Concentrate on the muscle groups that hold your shoulders back, your arms up and extend your fingers. Motion exercises known as ‘glides’, where you move your arm from one position to another, are also helpful.

* Get a massage. Build sessions of regular massage by a trained therapist into your routine. Deep-muscle and fascia-release massage is especially helpful, and can even reduce pain if you already suffer from RSI.

* Eliminate adhesions. These ‘knots’ can trap the nerves, but they can be worked on with vigorous and localised massage. Ideally, a therapist should do this, but it’s something you can also do yourself. If you are feeling pain, pinch the area and, while holding firmly onto it, perform the movement that the muscle would allow you to do.

* Take your Bs. The B vitamins are especially good for bones and muscles. B1, B6 and B12 are particularly beneficial, but you need to take up to 100 mg three times a day.

* Get the balance right. RSI is also a symptom that we’re getting our priorities wrong. Work and workloads need to be put into perspective, and you need to find time for yourself and your other interests. Simple relaxation techniques, yoga and meditation can all help de-stress you and your body.

The main symptoms gradually disappeared four months after the baby was born, but I am still left with occasional numbness (particularly at night) in my fingers, achy wrists and tingly elbows.

The department of neurophysiology conducted an EMG/NCV nerve and muscle study on my hands and found that the flow of blood into my right hand was twice as slow as it should be, and that the muscle at the base of my thumb was beginning to waste away. They have recommended surgery to open up the ligaments and reconnect the nerve on this hand.

As a pianist, violinist and writer who uses a computer a lot, I am very reluctant to have an operation on my hands. Is there an alternative? S N, Edinburgh………

A:The carpal tunnel is a tiny space between the carpal bones, and the route of the main nerve (called the median nerve) as it passes from the arm to the hands and fingers. Carpal tunnel syndrome is pain caused by pressure on this nerve, either through swelling or repetitive wrist movements, such as with repetitive strain injury (RSI). It is the most common nerve problem seen by doctors today.

The symptoms can affect either or both hands, and usually gets worse at night. The syndrome most typically affects women those who are pregnant, on the Pill or in their middle years. Sufferers usually complain that they feel pain and swelling, pins and needles in their fingers, and a reduced ability to grip the hand or flex the fingers.

The usual medical treatment is steroids, which have become a catch all drug for any and all inflammations, or wrist splints. When these treatments fail, as they often do, GPs give way to surgeons, who recommend surgery to decompress the nerve.

Oftentimes, carpal tunnel syndrome results from a deficiency of B6. At least a dozen medical studies have demonstrated good results in treating the syndrome with B6.

Dr John Ellis, medical director of Clinical Research at Titus Country Hospital District, in Mount Pleasant, Texas, is credited with discovering the use of B6 to treat CTS some 35 years ago (see WDDTY vol 8 no 9). Ellis, who came to believe that CTS patients were basically deficient in B6, found in one study of four patients about to have surgery for CTS that all had a B6 deficiency (Res Comm Chem Pathol Pharmacol, 1981; 33: 331). Other studies have concluded that the levels of the active form of B6 were two and a half times lower than normal in CTS patients (Arch Surg, 1989; 124: 1329-30).

Ellis himself has found that some 85 per cent of his patients get completely better when taking between 50 mg and 200 mg daily, usually within eight to 12 weeks.

Nevertheless, he suggests that up to 300 mg daily of vitamin B6 needs to be taken by pregnant women who have gestational diabetes and in diabetic women who have CTS.

He also finds that 200-300 mg per day of B6 relieves the edema of pregnancy without any danger of nerve damage.

Dr Antonio Reyes, a Texan obstetrician, has conducted a trial in which he gave pregnant patients with CTS between 100-300 mg of B6. The patients had improvement in neurological symptoms and edema, and none reported any side effects.

WDDTY panellist Melvyn Werbach, who has researched studies on B6, nevertheless says that some of the results are mixed, with some patients healing completely and some only experiencing pain relief. One reason, he says, may be that some people have difficulty converting pyridoxine (the form of vitamin B6) into its active form, pyridoxal-5′ phosphate. Consequently, he usually recommends that people take pyroxidal-5′ phosphate, rather than pyridoxine (although you take one tenth of the dosage of pyroxidal-5′ than you do of pyridoxine). Furthermore, taking the active form is one way of ensuring that you don’t develop sensory neuropathy, the occasional side effect of very high doses of B6 (usually 2 grams or more) (Townsend Letter for Doctors and Patients, July 1997).

Besides B6 deficiency, it’s vital that you have your thyroid activity checked out. There is some evidence that both an underactive and overactive thyroid can be linked with CTS.

Once the thyroid problem is treated, the CTS often resolves itself (Acta Neruol Scanda, 1993; 88: 149-52, as reported in Townsend, February/ March 1994).

Osteopathy has had proven success in treating CTS, usually a new “opponens roll” maneuver a thenar abduction combined with extension and lateral rotation. In one study of 16 patients, both symptoms decreased and mobility improved within one to three months, after a series of treatments (J Am Osteopath Assoc, 1994; 94: 647-663, as reported in Townsend, February/March 1995).

One of the most long lasting and successful treatments is acupuncture of the PC-6 and PC7 points. In one study of 36 patients, 17 of whom had undergone surgery without relief of symptoms, all but one had immediate reduction of pain and discomfort after acupuncture treatment of at least four sessions.

The patients were followed up for years, and 24, or two thirds, reported relief of pain and discomfort for two and a half to seven and a half years after their last treatment (Vet Acupuncture Newsletter, 1989; 15: 14, as reported in Townsend, October 1991).

Repetitive Strain Injury (RSI) has become an epidemic. The National Institute of Occupational Safety and Health in the US estimates that the problem has increased from 18 per cent to 56 per cent of all workplace maladies in less than 10 years. RSI now accounts for over half of all worker compensation claims.

This increase is pretty much down to the use of the computer. “Without stepped up keys to reach, paper to change or a carriage to push, computer typists get no breaks from activity that is drastically confined to the wrist and forearms,” explains Dr Alan Hedge, director of ergonomic research at Cornell University, New York.

Despite its prevalence, there still remains a hard core of GPs who refuse to recognise RSI as anything more than yet another psychosomatic disorder, mainly because there is little supportive epidemiological or pathological evidence.

They can also be a bit sniffy about the language. RSI is not a medical definition; it is a layman’s term for a range of symptoms affecting the muscles, nerves and tendons of the upper limbs which is collectively known by your doctor as carpal tunnel syndrome (CTS), bursitis or tendonitis, to name but three.

Your other problem is political. Doctors and, it’s rumoured, UK government health agencies are reticent to recognise and diagnose a condition that can lead to expensive, and sometimes disputed, claims against employers.

Assuming you overcome all this and can find yourself a sympathetic doctor, there is a limited amount he can offer. Depending on the severity of the condition, he might prescribe an anti inflammatory, a diuretic or steroids.

Of the three, steroids seem to be the most effective, according to one double blind placebo study (Neurology, 1998; 51: 390-3).

In another study, the steroid prednisone offered rapid and effective relief for the first eight weeks only (Neurology, 1995; 45: 1923-5). This finding was also observed in another study involving 32 carpal-tunnel-syndrome patients, which found that the benefits of steroids were “transient” (J Neurol, 1993; 240: 187-90).

Your GP might also tell you to stop whatever’s causing the RSI. Good advice, in fact, and by far the best thing to do is to stop it before it really starts. Once it takes hold, full recovery is uncertain and may go on for a very long time, irrespective of the treatment, conventional or alternative.

If you’re getting early warning signals, such as numbness or tingling around the thumb or fingers, you must find a way to curb the activity. Even if you can’t take time off work, learn to break up the day and walk away from the keyboards once an hour or so, or vary the workload so that you are not constantly keying in.

You also need to get advice about posture and the positioning of the keyboard and screen. The desk should be at an appropriate height without a sharp leading edge, and the keyboard should be spaced 8 to 10 cm away from the desk’s leading edge.

Finally, try and use an ergonomically designed chair that makes your back do more of the work and prevents slouching. A good source is Back in Action (3 Quoiting Square, Oxford Road, Marlow, Bucks SL7 2NH; tel: 01628 477177).

There might also be a method of early detection, even before the tingling begins. Dr Bruce Lynn of University College Hospital in London and physiotherapist Jane Greening have used a machine called a vibrametre, produced by Somedic in Stockholm, Sweden, which detects a change in the nerve vibrations among typists who may go on to suffer RSI (Int Arch Occup Environ Health, 1998; 71: 29-34).

If your problem is more advanced, your doctor may well refer you to a specialist. As the average wait in Britain on the NHS to see a consultant is around seven months, and if you are wedded to the idea of staying with conventional medicine, you could book in to see an orthopaedic surgeon or a physiotherapist in the meantime.

The consultant more than likely is going to recommend surgery, particularly if your RSI, or CTS, is particularly chronic.

The UK support group RSI Association urges anyone to think twice before accepting surgery. “We are not aware of any surgery that has been completely successful. Ask the consultant for details of any patients whose surgery has been 100 per cent successful. He never can,” says association chairperson Wendy Lawrence, an RSI sufferer for more than 10 years.

Her view is supported by the medical trials. In one study, incisions for carpal tunnel release, the standard procedure, on 47 patients resulted in pain and scar sensitivity (J Hand Surg, 1997; 22: 317-21). In another, involving 57 neuritis patients, surgery was no better than steroids (Int J Lepr Other Mycobact Dis, 1996; 64: 282-6).

Keyhole surgery is becoming a popular technique, but recovery with this form of surgery does not seem any better than with conventional surgery. In one study of 29 CTS patients, those who had the keyhole surgery suffered numbness in the ring finger (J Hand Surg, 1996; 21: 202-4).

Another new technique, involving the use of a glass tube with a groove which is inserted into the hand, is also of questionable value. In a trial using 10 hands from patients who had recently died, the cotton tip came off inside the incision of one hand, and the glass tube broke in another (J Hand Surg, 1995; 20: 465-9).

Other approaches your consultant might suggest include ultrasound or electrical therapy. A mixed bag of electro therapies has been developed in the last few years, possibly born out of the indifferent success of other conventional treatments.

The jury’s out on ultrasound treatment. In one study, it was no more effective than placebo (Arch Phys Med Rehabil, 1998; 79: 1540-4), whereas another trial found that ultrasound did offer short term relief (BMJ, 1998; 316: 731-5). A better result was had with high voltage pulsed current (HVPC), which was passed through a wrist splint. Those who had the treatment were able to carry out repetitive tasks afterwards (AAOHN J, 1998; 46: 233-6).

Low level laser has been used with some success for long term management. The laser rapidly stopped the pain and tingling in the arms, hands and fingers of 35 CTS patients in one study, and the researchers believe it could be used together with physical supports, such as cervical collars (Int J Clin Pharmacol Ther, 1995; 33: 208-11).

According to research, CTS sufferers tend to be low in vitamin B6 (pyridoxine). A double blind trial using either placebo or vitamins found that the condition of those given the supplement improved to such an extent that surgery was not necessary (Proc Natl Acad Sci USA, 1982; 79: 7494-8). Wendy Lawrence at the RSI Association says that nutrition is an entirely new area of treatment, and that building the immune system has helped to ease the condition. Interestingly, she’s noted that more than the expected number of RSI patients also suffer from either endometriosis or irritable bowel syndrome.

In view of the limited help that conventional medicine can offer, it’s little wonder that the favoured route for many RSI sufferers is alternative medicine. Wendy Lawrence says that her members report greater benefits and pain relief using one of the alternatives, and of these chiropractic, osteopathy and Alexander technique seem to be the most favoured, although osteopathy seems to be of little use in treating chronic cases.

The types of alternative treatments which can help, depending on the extent of your RSI and your own inclination, fall into several groupings, as listed by RSI sufferer and author David Ruegg. The physical treatments are chiropractic, osteopathy and dietary supplements; postural therapies include the Alexander technique or Feldenkrais; relaxation techniques encompass massage, biofeedback and flotation tanks; exercise involves walking, swimming and jogging; stretching comprises yoga and stretching exercises; energy medicine is made up of acupuncture and healing; and cognitive behavioural therapy embraces pain clinics and counselling.

Scientific evidence for any of these therapies is in limited supply. Yoga exercises were tested on 42 CTS sufferers who went through a regimen of 11 postures to strengthen, stretch and balance each joint for eight weeks. The yoga group reported significant improvements in grip strength, pain intensity and sleep disturbance (JAMA, 1998; 280: 1601-3).

Chiropractic was tested against the use of ibuprofen (a non steroidal anti inflammatory drug) on 96 CTS patients and was found to be as good as but no better than the drug therapy (J Manipul Physiol Ther, 1998; 21: 317-26).

Osteopathy came out better in one trial when it was tried on 20 CTS patients with mild to moderate symptoms (J Am Osteopath Assoc, 1994; 94: 647-63).

Biofeedback was tested against relaxation training in a group of patients with a range of chronic, upper body traumas. All patients had immediate relief from pain, but the relaxation group expressed greater short term benefits. However, within six months there were no differences between the groups (Pain, 1995; 63: 199-206).

Useful UK contacts: RSI Association, tel: 0800 018 5012; British School of Osteopathy, tel: 0171 930 9254; Society of Teachers in Alexander Technique, tel: 0171 351 0828.

A recent study has shown that yoga can help reduce pain and increase the grip of sufferers.

Dr Winston Dequeira from the Rush College of Medicine in Chicago believes that industrialists and trade unions should consider introducing yoga into the working day for any employee involved in repetitive work, now recognised as a major cause of the syndrome (BMJ, 1999; 353: 689-90).

In the randomised controlled trial, sufferers were treated either with yoga exercises or with splints. The yoga group tried 11 postures for the arm, each held for 30 seconds, and relaxation.

After eight weeks, grip strength was significantly better and pain reduction greater in the yoga group (JAMA, 1998; 280: 1601-3).

Dr Sequeira postulates that the exercises might help stretch the space within the carpal tunnel.

Patients treated both constitutionally and with appropriate points experience significant improvement.

RSI patients generally need additional advice on changes or adaptations related to the cause of the problem. The use of local points does have a place and, used in the right way, should not be ‘counterproductive’.

I have been a registered acupuncturist for 15 years and am also a director of The Northern College of Acupuncture in York. – Mike Stephenson, East Yorkshire

It is more common in middle-aged women, particularly those taking the Pill and in those going through the menopause, and is more likely to occur after arm trauma or in pregnancy, rheumatoid arthritis, severe hypothyroidism or acromegaly (overproduction of growth hormone making certain bones larger), or with haemodialysis.

As with a ‘frozen shoulder’, CTS may be associated with a systemic disorder such as chronic pulmonary disease, leukaemia, multiple myeloma, sarcoidosis or diabetes. There may be pain in the forearm, neck, shoulder and upper arm. Symptoms and pain occur mostly at night and are more pronounced in the morning.

Lithium treatment can cause CTS as a side-effect.

Although orthodox medical treatment involves a wrist-splint to reduce movement and steroid injections, these may only provide temporary relief. However, there are a number of tried-and-tested alternative treatments.

About 80 per cent of sufferers have low levels of vitamin B6. Many double-blind studies have established that B6 supplementation (up to 100 mg/day) can relieve all symptoms of CTS in such patients (Proc Natl Acad Sci, 1982; 79: 7494-8; Am J Clin Nutr, 1979; 32: 2040-6; Res Commun Clin Path Pharm, 1977; 17: 165-7; Clin Chem, 1982; 28: 721; Nutr Rep Int, 1986; 34: 1031-40).

One major cause of CTS are drugs that lower levels of vitamin B6 (such as the antirheumatoid penicillamine and the antituberculous isoniazid), excessive protein intake and oral contraceptives. Such patients should increase foods containing B6, avoid foods containing yellow dyes (which lower B6), use another form of contraception and limit protein consumption to 50 g/day (Murray M, Pizzorno J, Encyclopaedia of Natural Medicine, Rocklin, CA: Prima Publishing, 1990: 190). However, only take high doses of B6 with the supervision of an experienced practitioner as chronic megadoses (over 100 mg daily) may cause a sensory neuropathology.

For patients who don’t respond to vitamin B6 (about 20 per cent), the anti-inflammatory effects of the proteolytic enzyme bromelain, from the common pineapple (Ananas comosus), may help alleviate the pain.

A proven potent naturopathic remedy consists of applying a poultice made from turmeric mixed with slaked lime (Ind J Exp Biol, 1972; 10: 235-6).

In homoeopathy, Dichapetalum thunbergh D6 is highly recommended (Allg Homoeop Zeit, 1960; 24: 127-30).

Local acupuncture treatment may be counterproductive in CTS and repetitive strain injuries (Gascoigne S, The Manual of Conventional Medicine for Alternative Practitioners, vol I, Richmond, Surrey: Jigme Press, 1993: 207) as those with this chronic condition have a weakness of Qi or Blood which, in Oriental medicine, suggests a need for constitutional treatment.

In herbal medicine, only Harpagophytum procumbens (grapple plant or Devil’s claw) has been extensively studied (Weiss RF et al., Ausserschulische Methoden bei rheumatischen Erkrankungen, Heidelberg: E Fischer Verlag, 1981). Only the storage roots (tubers) of the plant contain antirheumatoid agents, but the popular demand for this wild South African plant has led to the selling of the whole root structure. Thus, users may now be taking herbs with no antirheumatoid effects whatsoever (Weiss RF, Herbal Medicine, Gothenburg: Ab Arcanum, 1988: 266-7).

The most consistent work on CTS and repetitive strain injury has been done by osteopathic practitioners. In 1971, D.I. Abramson et al. showed that a decreased blood supply to a nerve alters conduction (J Appl Physiol, 1971; 30: 636-42). N.J. Larson suggested that upper thoracic vertebral dysfunction altered the blood supply to the upper extremities, and S. Sunderland showed that lymphatic and venous congestion contributed to CTS (J Am Osteo Assoc, 1972; 72: 94-100; J Neurol Neurosurg Psychiatr, 1976; 39: 615).

In 1973, A. Upton and A.J. McComas postulated the ‘double-crush syndrome’, which hypothesised that single neural-axon damage leads to a greater susceptibility to damage elsewhere on the nerve. K. Nemoto later demonstrated that single-point compression of the dog sciatic nerve failed to produce conduction loss, but two-point compressions – at both proximal and distal points on the nerve – did block conduction in half of the animals (Nippon Sea Gakkai Zasshi, 1983; 57: 1773-86).

Finally, by analysing 1000 cases of CTS, L.C. Hurst and colleagues conclusively showed that the second point of compression in CTS – the wrist lesion being the first – is cervical arthritis (J Hand Surg, 1985; 10: 202). This provided an explanation for the frequent involvement of the neck.

In short, osteopathic treatment needs to focus on the vertebrae in the lower neck as well as on the wrists when dealing with a patient with CTS.

To diagnose CTS, osteopaths now either use Phalen’s test (maximum flexing of the wrist for 60 seconds) or attempt to elicit (by tapping gently with the reflex hammer over the course of the injured nerve) Tinel’s sign, pain or tingling in the distribution of the nerve. The ‘double-crush syndrome’ may also explain why wrist splints and cortisone injections produce such notoriously short-lived or unreliable results.

Harald Gaier

Harald Gaier is a registered homoeopath, naturopath and osteopath.

Could you tell me what you know about Zoladex. The side-effects are possible damage to my liver and osteoporosis. Do you think this drug is effective, or is taking it a waste of time? – MH, Essex

A: Do see our response to another reader with a similar worry in WDDTY, vol 4, no 12, Q&A (available on our website http://www.wddty.co.uk). The drug’s side-effects include fatigue and lethargy, changes in hair growth patterns, breast-swelling and, rarely, osteoporosis. However, if you have cancer, these side-effects may be worth putting up with compared with the risks of surgery, which hasn’t been proved worthwhile.

Chaos and clinical controversy rage at hospitals worldwide over the best way to treat prostate cancer. Doctors are unsure whether to treat, and those who do take positive action are uncertain about the type of treatment (Br J Urol, 1997; 79: 749- 55; BMJ, 1998; 316: 1919-20; Med J Aust, 1998; 168: 483-6).

Prostate cancer is very slow-growing and doesn’t spread; two studies have shown that 86 per cent of patients with prostate cancer survive 10 years after diagnosis and, in two-thirds of cases, the cancer hadn’t spread (N Engl J Med, 27 January 1994; JAMA, 22-29 April 1992).

The onset of the condition is often marked by tenosynovitis (swelling and thickening of the tenosynovium, the tissue sheath surrounding the tendons), which increases pressure on the carpal tunnel, causing the median nerve and tendons to become trapped within. Ultimately, this causes numbness, tingling, nerve pain, and restricted movement of the hand and wrist. The nerve pain may also radiate up the arm to the shoulder and, sometimes, into the neck.

Eventually, compression – which restricts the supply of oxygen and nutrients – may lead to demyelinisation of the nerve, where its protective sheath is stripped away, so that it can longer carry out its job of transmitting nerve signals. Without these signals, the hand is unable to function properly and the muscles may waste away.

Although, in mild cases, the hands feel numb or tingling, in severe cases, the damage to the nerve and surrounding tissues may lead to permanently disabled hands.

The usual medical solutions

Your doctor’s first port of call is usually non-steroidal anti-inflammatory painkillers like ibuprofen, or even steroid injections next to the carpal tunnel. If these don’t work, the usual medical solution is surgery, which involves cutting the ligament over the tunnel to relieve the compression. This can be carried out through open surgery or with an endoscope. In the latter operation, only tiny incisions are made to allow insertion of a tiny flexible optical tube, or ‘scope’, which projects a magnified image on a TV screen to guide the surgeon.

The aim of both operations is to increase the carpal tunnel arch space by cutting the ligament and hoping it will grow back wider as a result of scar-tissue growth over the incision.

What doctors don’t tell you

Such simplistic solutions ignore the fact that the problem underlying CTS may be complex and varied, including:

* bad posture, leading to uneven loads on joints, and overloading muscles and tendons, thus inhibiting blood flow and nerve signals

* repetitive strain injury as a result of overuse of the hand and wrist

* neuropathological conditions such as diabetes, alcoholism and polyneuritis

* inflammatory autoimmune disorders, such as rheumatoid arthritis, polymyalgia and lupus erythematosus

* altered hormonal balance as a result of pregnancy

* kidney failure, hypo/hyperthyroidism and reproductive factors that can increase fluid swelling (oedema)

* anatomical variations in the ligaments and bones

* thoracic outlet syndrome, in which there is compression of the nerves and blood vessels that supply the arms and neck (eMed J, 2002; February)
(see box, p 11)
* congestion of the lymphatic vessels and veins (J Neurol Neurosurg Psychiatr, 1976; 39: 615).

Although surgery may relieve the pressure on the main nerve, by itself, it is unlikely to facilitate full recovery of the tissues. Indeed, in a study of around 700 Canadian workers (75 per cent of whom had undergone surgery), it was revealed that, four years after treatment, only 14 per cent were still symptom-free. Of the remaining patients, 46 per cent suffered moderate-to-severe pain, 47 per cent had moderate-to-severe numbness, and 40 per cent had difficulty using and grasping objects (J Hand Surg [Am], 2004; 29: 307-17).

Although doctors claim recovery times of 18-36 days, this doesn’t allow for recovery of degenerating tissues that are underlying the symptoms of CTS. Surgery may relieve the symptoms temporarily, but can actually worsen the underlying condition if the patient returns to the activity that contributed to the CTS before tissues are properly healed.

Besides often failing to work, surgery is hardly risk-free. The many complications include scar sensitivity, pillar pain (temporary tenderness on each side of the palm, where the ligament is attached to the bones), recurrent symptoms and grip weakness (Clin Biomech [Bristol, Avon], 2003; 18: 685-93).

In one study of postoperative complications, of 708 people who had undergone the endoscopic surgery for CTS, 64 per cent experienced major complications, including lacerations of the ulnar, median and digital (finger) nerves as well as damage to the tendons and vessels.

Open surgery fared only slightly better. Of 616 who’d undergone this type of operation, 46 per cent suffered major complications. Researchers concluded that ‘carpal tunnel release, be it endoscopic or open, is not a safe and simple procedure. Major, if not devastating, complications can and do occur’ (J Hand Surg [Am], 2000; 25: 85).

People with small wrists should be particularly wary of endoscopic surgery as, in such cases, access to the carpal tunnel becomes more difficult and may result in further complications (J Hand Surg [Br], 1999; 24: 6-8).

Myofascial release techniques (which involves specific exercises and self-massage) in addition to self-stretching can also improve the diameter of the carpal tunnel (thereby reducing pressure on the median nerve) and increase the ‘loudness’ of nerve signals (J Am Osteopath Assoc, 1994; 94: 289).

Osteopathy can also help those in whom CTS is a symptom of thoracic outlet, or ‘double crush’, syndrome (J Am Osteopath Assoc, 1995; 95: 471-9). In this syndrome, the nerves and blood vessels supplying the arm become trapped and compressed in the thoracic outlet (which lies just behind the collar bones) at two points, blocking nerve signals. In a case of CTS, the first point of compression in the wrist may be accompanied by compression in the cervical (neck) vertebrae (J Hand Surg, 1985; 10: 202). Osteopathic manipulation and stretching can ease the nerve compression in both the thoracic outlet area and in the neck.