Compressive neuropathy means that a peripheral nerve is being compressed by scarring or inflammation. The term tunnel identifies a compression that occurs where the nerve goes through a tunnel formed by ligaments and tendons. The most common compressive neuropathy is carpal tunnel syndrome, compression of the median nerve at the wrist. There are several others as well, including radial tunnel (radial nerve in the forearm), cubital tunnel (ulnar nerve at the elbow), and tarsal tunnel (posterior tibial nerve in the ankle).

Compressive neuropathies are most often caused by overuse of these areas or injury at work, occasionally by pregnancy or obesity, and-rarely-thyroid disorders. Repetitive stress injuries are more frequent in women, possibly because of hormonal differences or a predilection for lower B6 levels, common in compressive neuropathies. Chronic pain and inability to use the area involved can cause significant disability and interfere with normal activities and work.

Common Symptoms

Pain, numbness, and tingling are the hallmarks of compressive neuropathies, and these symptoms are felt along the course of the affected nerve. For example, the median nerve goes to the thumb, first two fingers, and one-third of the ring finger, and this is where the numbness and tingling is usually felt in carpal tunnel. The ulnar nerve (cubital tunnel) goes to the inside part of the forearm and elbow and extends to two-thirds of the ring finger and the small finger. The posterior tibial nerve (tarsal tunnel) causes pain and tingling on the inside of the ankle and foot.

These symptoms are usually on and off at the beginning, but they eventually become constant. An important feature of carpal tunnel syndrome is that it tends to awaken you at night with the tingling and numbness. As the condition worsens, the symptoms may spread further up the affected arm or leg.

What You Need to Know

Many people are prone to developing compressive neuropathies and should avoid any type of repetitive work. But many who have been treated successfully for these syndromes often return to the same type of work that caused it in the first place, and as a result, find that their symptoms return.

Your Balanced Healing Action Plan for Carpal Tunnel Syndrome

• If your activities are causing the condition, you must stop performing them, or the symptoms will persist. If you must continue them, splints or braces are helpful in alleviating symptoms, especially at night and during work.
• If your symptoms are severe, or Nerve Conduction Velocity testing (which measures the speed at which electrical impulses travel down the nerve) shows decreased conduction time in the nerve, start with step 2.

Step 1: Undergo Physical Therapy and Take an NSAID and Vitamin B6

If you have just started having symptoms and they are mild (that is, they’re intermittent and don’t wake you at night), physical therapy using ultrasound (high-frequency sound that projects heat into the deep tissues) and iontophoresis (application of steroids through the skin using electrical current), NSAIDs, and vitamin B6 (100mg daily) are your first course of action. You should notice improvement within four to six weeks, alrhough vitamin B6 may take three months to be completely effective.

Step 2: Undergo Acupuncture

The National Institutes of Health (NIH) supports acupuncture as effective for these syndromes, especially carpal tunnel, and I recommend it if step 1 is not effective or the symptoms are already severe. Principal points for carpal tunnel are usually found on the arms and hands, and directly over the carpal tunnel. Acupuncture points for other nerve! involved depend on their location. Always seek evaluation and treatment from a practitioner certified in acupuncture.You should feel improvement within six treatments, but you might need additional sessions for maximum benefits.

Step 3: Undergo Low-Level Energy Laser Therapy

I recommend the use of low-level energy lasers, which appear to help heal the tissue, reduce the inflammatory response, and give long-lasting relief for about half of those who have compressive neuropathies. This laser has recently been approved by the FDA for treatment of carpal tunnel syndrome. However, this treatment is not available everywhere. I use the laser with acupuncture for even better results. You should observe a decrease in symptoms within six to nine laser treatments.

Step 4: Stretching Exercises During and After Treatment

Stretching exercises are helpful for some people during treatment, but I recommend these primarily for preventing the problem from recurring once your symptoms are reduced or eliminated and you’ve returned to work. The box gives some simple exercises that you can do.

Step 5: Undergo Corticosteroid Injections

Injection of corticosteroids just outside the specific “tunnel” might relieve your symptoms, but the relief is usually temporary. Try this only if the previous steps have failed to reduce your symptoms and before having surgery.

Step 6: Undergo Surgery

I recommend surgery only as a last resort. Although it’s currently the most frequent treatment in this country for compressive neuropathies, surgery often is not beneficial, or doesn’t provide permanent relief. There are several different types of carpal surgery, the most recent one being a “mini-open” technique that takes 10 minutes to perform. I recommend that you consider surgery only if you have at least four out of six of the following conditions:

• The previous steps fail to provide relief.
• You are 50 years or older.
• You have had symptoms for more than 10 months.
• You have constant numbness and tingling.
• Your fingers “catch” when flexed (called trigger fingering).
• You have a positive Phalen’s sign (tingling in the fingers when extending the wrist backwards for 30 seconds).

Even if you have surgery, there is no guarantee that it will provide permanent relief.

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Filed under: General Ailments