Carpal tunnel syndrome is caused by compression of the median nerve in the carpal tunnel of the wrist. Common symptoms include numbness and tingling in the thumb, index finger, middle finger and half of the ring finger, which are more pronounced at night and may radiate to the forearm; In severe cases, there will be a decrease in grip strength and thenar muscle atrophy, which can even be seen on both sides. Common triggers include repetitive wrist movements, heavy lifting, prolonged keyboard and mouse use, obesity and rheumatoid arthritis. In addition, the use of vibrating tools and the use of strong grips can also increase the risk.
How TCM looks at carpal tunnel syndrome
Traditional Chinese medicine generally classifies carpal tunnel syndrome as “paralysis” or “tendon paralysis”, believing that it is mostly caused by repeated strain, qi and blood stasis, and cold and dampness blockage, which in turn leads to numbness, pain and swelling of the wrists and fingers, worsening of symptoms at night and weakness in grasping. The treatment is mainly to dredge the meridians, activate blood circulation and dissolve blood stasis, warm the meridians and clear the meridians, and adjust the habit of using the wrist.
Syndrome differentiation and typing
- Qi stagnation and blood stasis: the pain is fixed, stabbing, and very painful when pressed, and the local swelling and darkness may occur.
- Cold and dampness obstruction: aggravated by cold, soreness, swelling and pain, relieved by heat, and stiffness in the morning.
- Qi and blood deficiency/liver and kidney deficiency: long-term illness, soreness and weakness, night paralysis affect sleep, and recovery is slow.
Acupuncture treatment
Commonly used acupuncture points include: Neiguan, Waiguan, Daling, Hegu, Yangchi, Yangxi, Laogong, Yujie, etc., leaving needles for about 20 to 30 minutes to circulate qi and activate blood, clear circulation and relieve pain. Treatment 1 to 2 times a week, with daily adjustments, generally 1 to 2 months to observe the effect; Most patients experience improvement in numbness and nocturnal symptoms.
Tuina
- Mainly loosen the flexor muscle group, carpal flexor tendon and soft tissue around the transverse carpal ligament, relax the fascia and release adhesions, and improve local circulation and nerve sliding.
- Local pressure on the Ah is acupoint and meridian tendons, but the patient’s pain tolerance must be determined to avoid overstimulation causing reactive edema.
Traditional Chinese medicine is taken internally and externally
- Prescription medicine: mainly to activate blood circulation and dissolve blood stasis, nourish qi and clear circulation, in the early stage, it can also dispel cold and dampness, and in the later stage, it can be added as a supplement to nourish the liver and kidneys, strengthen muscles and bones.
- Commonly used drugs: cinnamon twig, angelica, wei lingxian, chuanxiong, frankincense, chicken blood vine, safflower, bone grass, extensor grass, etc.; External fumigation is often done with pittosporum bark, bone grass, Wei Lingxian, cinnamon twig, etc.
- Fumigation and external application: Warm medicine baths on the wrists can help blood circulation and dispel cold, relieve fascial adhesions, and use acupuncture together to increase the curative effect.
Life adjustments
- Reduce the induced action and repetitive load, and the working gap should be stretched regularly. If necessary, wear a wrist rest at night to keep your wrist neutral and reduce nerve compression.
- When using a keyboard and mouse, keep it at the same height as the forearm to avoid the same posture for a long time with wrist dorsiflexion or palmar flexion. Gradually increase forearm and grip training to balance the load.
- Perform wrist dip and extension and nerve slide exercises every 45 to 60 minutes, combined with forearm extension and grip strength progressive training, and avoid prolonged fixed postures. warm care to reduce tension and promote circulation; Maintain a neutral position with the wrist rest at night to help relieve nighttime symptoms.
Efficacy and Expectations
Most patients with mild to moderate symptoms can be treated nonoperatively first. With acupuncture combined with traditional Chinese medicine, manual therapy and adjustment of the working environment, most patients experience a reduction in numbness and pain at night within a few weeks to two months, and their hand function can gradually improve and heal. If the pain and numbness at night are severe, the sensation progresses slowly, the thumb thenar atrophy or the grip strength is significantly reduced, Western medicine intervention should be considered.