Flaxseed Oil

I also wouldn’t mind trying this in combination with CTRAC. I have been wearing wrist braces to sleep at night for the past six months with very little improvement. It seems to be stagnant at the moment. I’m also trying to avoid surgery as much as possible because I know a lot of people who have had it done and they have issues in pain and tingling still years after the surgery. I find that kind of pointless to drop almost $10,000 for two hands to be done that will never likely be the same again. I’ve read quite a few reviews online and the CTR AC thing seems to be somewhat hopeful and definitely worth a try before considering cutting stuff in your wrists that’s not supposed to be cut.

I should also probably provide some more information about myself. I am 30 years old I have been working out with weights for over 10 years now, I am a bodybuilder who does competitions. Over the last eight months I developed a small tingling in my left thumb which would the exacerbated by working out. I have been wearing splints for a while now, And recently in the past two months my right hand has started developing some symptoms. I do not feel any pain or tingling at night when I sleep with or without wrist braces as sometimes I forget to put them on. But throughout the day especially when I get on my phone and text anything it starts to hurt.

However working out now does not seem to aggravate the problem as it did in the beginning. I’ve also ergonomically switched my workouts around to other exercises that don’t aggravate the wrist. In my left arm the pain goes from my wrist to my elbow to my shoulder exactly as CTS as described. I understand I’m probably pretty young to have bilateral carpal tunnel but it is what it is and as a competitor I have to be very careful about surgery as I do not want to completely destroy My hands and wrists. I’ve also added in turmeric because I’ve read it has some powerful anti-inflammatory properties.

The flax-seed oil article has lots of problems as a piece of scientific evidence. It is an unblinded, very short term (3 weeks follow-up) study which uses an incorrect unit of analysis which invalidates the statistics and where the two study groups were not well balanced for symptoms at the outset. I do not think this amounts to convincing evidence that the oil does anything useful though it might be worth carrying out a proper placebo controlled trial. It wouldn't be difficult to do.

My first thought on reading your story would be that you probably do not have CTS. You could try running through the symptom questionnaire to see what sort of estimate it comes out with - it is surprisingly accurate when validated against nerve conduction studies. JB

So I went ahead and I took the test and it said that I had a 10% chance of it being CTS. However I am inclined to disagree with that. I do have a tingling in my left thumb all day long and never goes away pains will come and go with certain activities especially texting on my phone. Which I forgot to mention that I have worked from home on my computer and on my phone for the past 10 years as well. Tingling and pain is most prominent in the thumb index and middle fingers. It’s not severe yet it’s very mild however I fear it will get worse. Once my left hand had it a few months ago I started taking over activities with my right hand a little bit more to the rest of the left. And then I started developing similar symptoms in my right hand. No tingling in my right hand only the left but the right hand experiences pain in the same manner. I don’t feel any pain or tingling at night when I’m sleeping. But it’s definitely constant throughout the day and especially when I pick my phone up, it will begin to hurt almost instantly if I start texting with my thumbs. I have also switched to talk to text instead. So if you see any misspellings or improper syntax than that is the most explainable reason!

Both my mother and father had carpal tunnel in their hands as well. I fear it also may be genetic.

The family history is significant but those are not really typical CTS symptoms so I would certainly want to get it thoroughly tested before embarking on any potentially damaging treatment. The AI's assesmment of the probability of CTS is probably about right  - 1 in 10. You might push it up to about 15% if we pay a bit more attention to the family history. Far too many of the cases you have obviously encountered where surgery fails result from insufficient care being taken to make sure the diagnosis is right before operating on it. I gather you are also in the USA where there are a lot of perverse incentives operating with regard to both diagnosis and treatment - which makes life even more difficult.

How did your parents get on with having theirs treated? JB

My parents got surgery my father suffered permanent weakness in his hand and my mother had it in both. Do you think CTRAC is an option? I don’t believe surgery is the best route for me and my occupation.

May I also add my symptoms started coincidentally appearing after I used HGH for athletic purposes. I find it maybe could be just a coincidence. I’m not quite sure how they don’t sound like carpal tunnel symptoms nevertheless they are symptoms that I do deal with on a daily basis. I have acknowledged that you are a doctor and I want to ask you something. Let’s just say that we both agreed I have carpal tunnel hypothetically. As as an athlete that that’s looking to make his pro debut on stage. And who makes his money through bodybuilding and personal training etc. Do you believe I should just go full force For this upcoming competition that could likely change my life, and go ahead and push the symptoms to the side and deal with any severity and symptoms afterwards? To be honest right now I don’t have money to drop on surgery and symptoms aren’t severe to where I can’t sleep at night or to where I can’t use them. However I do notice a very slow progressive increase in symptoms from six months ago when I first noticed it.

There isn't a known association with HGH use but it hasn't been studied and there is definitely a link with 'female' hormones - oestrogen and progestogen - or their balance, so it's not impossible that HGH might end up implicated if one looked at it carefully. The key to making a decision about what to do next in your case is to get it tested and find out whether you really are dealing with CTS and how bad it is. Regardless of what you may read from some orthopaedic surgeons, nerve conduction studies are a fairly good guide to whether you have CTS and how bad it is, or an ultrasound scan can confirm the diagnosis with similar sensitivity, though it is not as good at measuring severity. Both tests need to be done by someone well trained and knowledgeable about CTS. In the US look for someone who is board certified by the AANEM to test it, preferably in a lab which is approved by their accreditation scheme. If we get some objective measurements of nerve function then it's much easier to advise on what to do about it. JB

I'm not really impressed with C-trac. The only halfway decent trial I have seen found it was no better than a conventional night splint costing a fraction of the price. It would probably be worth further well-designed trials but on current evidence one could not recommend it as an evidence based treatment.

Weakness after surgery when the diagnosis of CTS is correct takes two forms - thumb weakness because the CTS was allowed to progress too far before being treated and grip weakness which can be a mechanical side effect of surgery if you are unlucky. Of course if the diagnosis is wrong then it's a whole different ball game. JB

I would probably most definitely prefer the Ultrasound scan over the nerve conduction studies. I’ve heard those can be quite painful. I wanted to ask you if you have heard of or know of any probable future non-invasive treatments for CTS that have been at least talked about or studied? I remember reading a post on here you were saying something about some sort of ultrasound therapy that looks promising in one of your old posts. I went ahead and ordered the flaxseed oil I’m going to try it and I will let you know how it works. As far as CTRAC, would probably try that as a last resort before having to do surgery. I am not totally against surgery I just worry about that permanent weakness or permanent pain that COULD follow. Have you ever heard of cases of CTS just going away Without treatment?

Again you are slightly handicapped by being in the USA. Nerve conduction studies for CTS are likely to be quite a lot more painful there than in the rest of the world, not to mention more expensive. In my clinic patients generally find them not much worse than having a blood sample taken, though reactions do vary a lot. It's much harder to find someone who knows how to do ultrasound of nerve competently but there are some good people around depending on exactly where you are.

There is a list of all the 'alternative' or 'suggested' treatments that I have come across HERE. I don't think any of them can be recommended as having been clearly shown to be of benefit. I have a couple of new ones to add next time I get round to editing that page.

We did carry out a trial of ultrasound treatment, which is very popular with physiotherapists. I'm afraid we did not find it to have any effect whatsoever.

With the flaxseed oil you could try an 'n of 1 trial' as you have fairly similar symptoms in both hands. Get a friend to make you up two small bottles of oil, one of the flaxseed and one of a roughly similar looking ordinary cooking oil, and just label them 'A' and 'B', not telling you which is which. If they have a very different odour you might think about adding something to both to disguise that. Use one on one wrist and the other on the other wrist for 4 weeks and then see if you can guess which is which.You can even repeat the symptom severity score on here after a 4 week trial to see how the scores have changed.

In cases where the diagnosis is uncertain some people use a steroid injection as a diagnostic tactic. Because we know that 80% of people with CTS get dramatically better in the short term after a steroid injection and injections are very safe (almost certainly a lot safer than 'athletic' HGH), you can use the response, or lack of it, as an indicator of whether CTS really is the problem and to some extent the response to injection is predictive of the response to surgery.

Yes I will definitely be trying the flaxseed oil. I took a look at that list that you posted about all the alternative therapies. And the one that catches my eye is the insulin. What type of insulin did they use? I tend to use insulin from time to time for bodybuilding purposes. I have not done so in a long while. I am curious to as if I run a cycle of this if it could perhaps produce some sort of relief?

Also question on cortisone shots. Is it possible to get one and for the symptoms to never return? And do they cause muscular atrophy?

The insulin study was done in diabetic subjects. It would be somewhat dangerous to inject insulin in significant doses into a healthy individual.

Steroid injections for CTS have very little in the way of systemic side effects because the overall dose is so small. We use 40mg of triamcinolone and averaged out over 6-12 months that is much less steroid than the body produces itself anyway. If you were taking 40mg daily in tablet form you would get all kinds of unpleasant dose related side effects. There can be local side effects - thinning of the subcutaneous fat and depigmentation at the injection site (There is a picture on the steroids page) but most patients are not unduly bothered by essentially cosmetic things like that. We have now seen 5 serious side effects out of nearly 14,000 injections - again there is a scary picture on the steroids page - but 5 out of 14,000 is pretty good odds when you compare to surgery. I have never seen muscle atrophy after a single steroid injection for CTS.

About half of the patients we inject return to the clinic with recurrent symptoms within a year. The other half seem to be OK at one year. There are no satisfactory long term follow-up studies to put exact figures to what happens for 5-10 years. Occasional patients return to us after very long remissions following a single injection (5-15 years) and I have met one patient who had her CTS injected in 1960 and developed recurrent symptoms in 2008 so whether or not it ever goes away 'permanently' after one injection remains a bit of an open question and rather dependent on how long the patient survives after injection - many patients with CTS are aged 60-90 before they get it and therefore succumb to other diseases before their CTS has a chance to recur. It's also not unknown for the disorder to clear up by itself without any treatment - it's not always relentlessly progressive. JB

So would you say that one shot would cause the pigmentation? Is this side effect permanent? Well it is very comforting to know that a shot can last a very long time. I hear bits and pieces were people see that shots only last 2 to 3 weeks and then back to square one. And hopefully I can be one of those cases to where it just resolves on its own. I ice it a few times a day and I wear splints on both wrists at night and I have ergonomically changed the way that I do things. As far as the age thing goes, were you suggesting that I have a chance of getting the shot and it going away versus someone who was 50 or 60? And I understand nothing is permanent but hell, 5 to 10 years sounds pretty damn good to me

By the way sorry for so many questions this is just all new to me and to me it’s very detrimental if this is what it is.

I don't mind questions - that's what the site is for. A lot of the answers can be found in the pages of the site but it's pretty large now and it can be difficult to find things unless I point them out. This is not a "child's guide to CTS" either. There are other sites that try to present material so as to be accessible to 6th grade readers whereas in the main pages of this site I have pitched the content at those who really do want to drill into the details so I do sometimes have to provide additional answers and explanation here in the forums and I don't mind doing that.

Yes one injection can cause depigentation but it does usually fade over time.

There is no evidence that age affects the response to steroids but obviously 5 years relief of symptoms for a 90 year old is a slightly different proposition to 5 years relief for a 20 year old when you are asking the question - "can it be permanent?" To some extent the same is true of surgery. As with injection there are no satisfactory really long term studies but we do see patients who have had it successfully operated 20-30 years previously who then seem to get a genuine recurrence of CTS.

The biggest problem in your case is the issue of whether you actually have CTS or not and you really should get it tested to find out as there is little point in worrying about the best way to treat CTS if what you actually have is flexor tenosynovitis or cervical radiculopathy or complex regional pain syndrome etc.

5 years of relief from an injection would of course be great for you but that would be a bonus I think, the real reason for injecting would be as a test of the diagnosis if you can't get it tested - no response to injection = even more evidence that your problem is not CTS. If it is CTS then you essentially have a 50/50 chance of at least 1 year of relief. JB

I appreciate all the thought out answers you have replied with. One last question. If you had to pick any other alternative way to deal with carpal tunnel, aside from surgery and Cortizone shots and splinting, what one would you choose? Also what are the odds Of my wrists becoming weaker or damaged during weightlifting after a Cortizone shot

Also may I add in that last night on my right hand my ring finger and my pinky went numb but it didn’t wake me up I woke up to go to the bathroom and it just happened to be there. When I fell back asleep and woke up again it didn’t do it.

If I were going to run a trial at the moment my first choice would be a long term study of repeated steroid injection as an alternative to surgery. I've tried this in the past but couldn't get anyone to fund it. Of the 'alternative' methods the one that is perhaps most interesting is extracorporeal shock wave therapy but it's really hard to design truly blind placebo controlled trials for that, and I have a sneaking suspicion that all of the studies done so far have just been demonstrating placebo effect. The hot topic in the CTS research world at present is whether it matters if you do steroid injections under ultrasound guidance or not and whether you have to be very precise about where you put the steroids or whether somewhere in the rough vicinity of the carpal tunnel will do (and as a supplementary question, whether it might actually just be the process of injecting fluid into the tunnel that helps, regardless of what fluid it is - in recent years people have taken to injecting all sorts of weird and wonderful things). I've also got a novel splint design to try out from Italy - I'm trying to work out how to do an approximately blind study but things have been interrupted a bit by COVID.

The odds of you developing weakness or other serious side effects affecting weightlifting from a single steroid injection are extremely small if they are done by someone competent - but not zero.

Nubness of the little and ring fingers is probably because you have been sleeping with the elbow flexed - see this page. JB

Thank you for everything I really appreciate it. This is kind of stressed me out for a long time so it’s nice to speak to somebody knowledgeable versus hearing horror stories from people. I’m also glad to hear that it is possible for carpal tunnel syndrome to disappear on its own without treatment. I may consider a Cortizone shot if symptoms become too bad to where I can’t deal with them. Like I said if you times I wear my splint at night, so I hope I can be one of those miracles and recover without having to take any Medical treatment

If you do get it injected you need 40mg triamcinolone or an equivalent dose of another steroid. Make sure the person doing it has lots of experience - ask them how many they have done... and better still get it tested first! JB

Question about your study regarding long term cortisone shots. Do you believe long term shots could in fact be worse than surgery? I’ve read that they can be bad long term

I think it's very unlikely that they are riskier than surgery but it needs a high quality study doing over a long period to establish a definitive answer and it's impossible to get any of the medical research bodies to fund such a study - it would be extremely expensive. The last time we put together a bid to do even 2 years follow-up it came to UKP 2 million and that propoosal was thrown out  without even thinking by the research funding body. Most of the horror stories you hear about injection come from surgeons who, to my mind at least, are not an impartial source. JB