The homoeopathic treatment of the carpal tunnel syndrome -Extract
Summary
The study refers to the treatment of 43 cases of the carpal tunnel syndrome and presents the results of the therapy.
Introduction
The carpal tunnel syndrome is a painful disease, caused by compression of the median nerve in the volar aspect of the wrist, between the inflexible tendons of forearm muscles, that flex the hand and the transverse superficial carpal ligament. This disease may be observed either following injuries of the wrist (fractures, disarticulations, bruises), or in people that have constantly and heavily used their hands. The syndrome is usually idiopathic in women after menopause. It also may be an expression of many other systematic diseases (rheumatoid arthritis, myxoedema, amyloidosis, sarkoidosis and leucaemia, acromegaly, hyper para thyroidism, hypo-calcemia and saccharoid diabetes).
The symptoms begin with pain in the hand involving the areas innervated by the median nerve in some cases, the pain has a burning or tingling character. The pain may radiate up along the arm, may be intermittent or continuous and aggravates especially during flexion or stretching of the wrist joint. In some cases the pain comes up only at night. Tinel's sign (tingling or lancinating pain on percussion of thenard surface of wrist) and Phalen's sign (marked flexion of the wrist for one minute) might be present. Muscle weakness or atrophy, especially of the abductor policies longus, can be observed after the appearance of sensory deficit. Helpful examinations are the electro-myogram (EMG) and the nerve conduction velocities test (NCT) of both sensational and kinetic nervous fibres.
Surgical incision of thenard carpal ligament is important when the symptoms and signs insist. Using analgesics, placing the hand and forearm in splints during night and corticosteroid injection into the carpal tunnel can lead to temporary relief from symptoms.
In this study we shall examine the homeopathic treatment of 43 cases, that suffer from carpal tunnel syndrome.
patients and method
The study was carried out after the command and with the support of Medical Institute for Homoeopathic Research and Application (M. I. H. R. A.). During the period between 1984 and 1987 we treated with Homoeopathy 43 patients suffering from carpal tunnel syndrome. No patient referred in his case history any past injury at the wrist and the examination for any systematic illnesses was negative. Before starting the therapy the patients were tested with electromyographic examination in a hospital unit, which confirmed the diagnosis of carpal tunnel syndrome.
32 of the cases were women between 33-61 years of age (mean age 50 years) and 11 were men between 45-69 years of age (mean age 57 years). These patients had been suffering for 4 months up to 10 years (mean interval 2 years). In all patients there was obvious aggravation when they used their hands, especially at flexion or stretching of the wrist joint and in 18 cases there was a history of tiring and constant using of hands due to their occupation (organ-players, painters, drivers, athletes). No one of them had been treated before by surgical incision of thenard carpal ligament.
14 from the 43 cases (11 women and 3 men) were in a more severe condition, from the point of view that they suffered more than five years, the pain was constantly present in both hands, they had disturbances of sensibility, decrease of muscle strength, positive Tinel's and Phalen's signs and constant use of paracetamol or acylosalicylic acid. Six other patients (5 women and 1 man) had the same symptoms in the same degree, but, they had a faster evolution in an interval of 4 to 6 months (4 patients on the right hand only, and 2 patients on both hands). The rest 23 cases (16 women and 7 men) suffered for 4 months up to 1 year, the pain was intermittent and mostly at night (table 1). The 18 of them had symptoms on the right hand only and 5 of them on both hands, the right one in a more severe degree.
After a detailed homoeopathic case history the indicated remedy for each case was administered. We prescribed : Medorrhinum in 15 cases, Pulsatilla in 8 cases, Nux vomica in 5 cases, Rhus toxicodendron in 5 cases, Sulphur in 3 cases, Natrum muriaticum in 3 cases, Zincum metallicum in 2 cases, and Lycopodium clavatum in 2 cases (table 2). Diagnosis was made according to the laws of the traditional Hahnemannian Homoeopathy. The patients were followed up every month and the treatment lasted 12 months. For the support of the constitutional remedy, we administered the indicated tissue salt, which was different every month in most of the cases.
Results
We observed that the 23 out of 43 patients, who were in a less severe condition, had a remarkable improvement from the first month of treatment. After one month of therapy, the mobility of their hands, as well as their muscle strength, were almost completely restored. The patients could use their hands, without complaining for pain or decrease of strength anymore and indeed in manual labour that demanded intense flexion and bending of the wrist joint. In the past, these patients avoided doing this kind of labour or didn't do it at all. After two months of treatment, electromyographic examination showed complete recovery. The following up of these patients for one year proved that their recovery was complete and permanent.
The recovery of the rest 20 patients, who had more severe symptoms, lasted longer. However, in six of them that had in their case history rapid development of their symptoms, there were remarkable results from the very first month. There was a 80-90% improvement of the mobility and sensibility of the hands. Characteristically, the patients mentioned that they started being very efficiently occupied in manual labour that demanded delicate use of their hands, like playing an organ, painting, sawing, or stitching, which they had given up because of the intense pain it used to bring. After the first month of treatment they still had pain, but only every now and then, at night or when they used their hands for a long time. In the next two months the pain decreased totally. After a total of three months of treatment the electromyographic examination showed complete recovery.
From the 14 of the rest patients, who suffered for a longer period (up to 10 years) from the carpal tunnel syndrome, 8 showed progressive but total clinical and electromyographic recovery in 6-8 months of treatment. The recovery of the rest 6 patients, however, was not complete. During the period of one year of therapy there was clinical and electromyographic improvement of 50-70%. The patients kept having troubles, not constant anymore, but coming after some special circumstances. That is, they were in pain at night, on intense weather changes, or when using for a long time their hands in manual labour which demanded flexion, bending or twisting of the wrist. These troubles were milder than in the past and were ameliorated in a greater degree by a common analgesic. This improvement was showed up progressively in six up to nine months and then it was stabilised.
Summarising, 23 patients (53,5%) had complete recovery in the first two months, 6 patients (14%) in two to three months, 8 patients (18,5%) in six to eight months and the rest 6 patients (14%) in twelve months of treatment showed an improvement of 50-70%, but not complete recovery (table 3).
Discussion
Out of a total of 43 cases that we treated with Homoeopathy, 5 of them showed an aggravation the first 2 to 6 days and their troubles aggravated mostly at night but also during daytime while working on their manual labour. According to the lax of therapeutical crisis, in some cases at the beginning of the treatment there is an aggravation of physical symptoms. The appearance of this therapeutical crisis is considered a guarantee for a good outcome of the therapy, it is a good sign of the oncoming recovery and is completely harmless for the organism. We calmed the patients down, explaining to them that this exaltation was a positive sign for the development of their treatment and that quite soon the body would relax and the pain would disappear. Indeed in ten to twenty days after the aggravation, a remarkable decrease of the symptoms established.
We noticed that in the 6 cases that had a case history of 4 to 6 months, but also fast development of symptoms, there was fast improvement of symptoms, there was fast improvement of symptoms, spite of the severeness of the clinical status. In Homoeopathy a factor of great significance for the duration of therapy is weather the illness is of a chronic nature, or not. The response of these 6 patients to the treatment agrees with the therapeutical law of Homoeopathy, according to which acute illnesses are cured much faster than chronic ones.
Considering the team of the 20 patients who had more severe problems in their case history, we can see in half the cases we had to administer more than one medicine per patient for the first months. And whereas on the first month we prescribed the indicated constitutional remedy, on the second, third and fourth month new idiosyncratic elements came up. These elements suggested a different constitutional status and, therefore, a new medicine. As a conclusion, we can say that the Homoeopathic physician must always be on guard for new idiosyncratic elements and possess a deeper knowledge of the course of the homoeopathic therapy. This way he will be able to distinguish promptly the differences brought forth in the patient's idiosyncrasy and to administer the appropriate medicine on the right timing, so as to gain the maximum therapeutical result.
We also note that many of the patients studied, besides the carpal tunnel syndrome, had many other physical or psycho-intellectual disorders, like gastritis, colitis, headaches, eczema, insomnia, difficulty in concentration, and anxiety. According to the therapeutical law which states that the patient must be regarded holistically, that is as a united whole composed of body, mind and soul, we discussed in our case histories about all the problems that bothered our patients, in detail. In all cases we observed equally effective therapy of all these problems concurrently with the therapy of the carpal tunnel syndrome. That proves once again that the homoeopathic medicine cures the patient totally and not only a part of him.
The carpal tunnel syndrome, does not bother the homoeopathic doctor so often in everyday medical practise. This, however, doesn't mean that it is not an important problem for the patients. Especially for a pianist, a painter, or even a housewife who has to take care of a four-member family, the good mobility and sensibility of the hands is of primary importance. Homoeopathic treatment has the ability to be beneficial to these people and indeed in a holistic way, setting them into balance both physically
LIGA Congress 1988
P. DROSSOU, A. PROKOPIOU, K. HATZIGEORGIOU, S. DIAMANTIDIS