Carpal tunnel syndrome and low vitamin D - many studies

VitaminDWiki

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CTS treated somewhat by a small dose of vitamin D (2,000 IU daily for 3 months) - RCT June 2024

The Role of Vitamin D in the Treatment of Carpal Tunnel Syndrome: Clinical and Electroneuromyographic Responses
Nutrients. 2024 Jun 19;16(12):1947. doi: 10.3390/nu16121947
Antônio Vicente D Andrade 1, Dallianny G S Martins 1, Gabriel S Rocha 2, Gustavo S Damasceno 1, Francisca T S Gomes 1, Yasmin P F Albuquerque 1, Paloma K M Melo 1, Marco A M Freire 2, Dayane P Araújo 1, Lucidio C Oliveira 1, Fausto P Guzen 1, Paulo L A G Morais 1, José R L P Cavalcanti 1

Carpal tunnel syndrome (CTS) is the most common cause of peripheral compressive neuropathy and consists of compression of the median nerve in the wrist. Although there are several etiologies, idiopathic is the most prevalent origin, and among the forms of treatment for CTS, conservative is the most indicated. However, despite the high prevalence in and impact of this syndrome on the healthcare system, there are still controversies regarding the best therapeutic approach for patients. Therefore, noting that some studies point to vitamin D deficiency as an independent risk factor, which increases the symptoms of the syndrome, this study evaluated the role of vitamin D supplementation and its influence on pain control, physical examination and response electroneuromyography to conservative treatment of carpal tunnel syndrome. For this, the sample consisted of 14 patients diagnosed with CTS and hypovitaminosis D, who were allocated into two groups. The control group received corticosteroid treatment, while the experimental group received corticosteroid treatment associated with vitamin D. Thus, from this study, it can be concluded that patients who received vitamin D, when compared to those who did not receive it, showed improvement in the degree of pain intensity, a reduction in symptom severity and an improvement in some electroneuromyographic parameters.
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CTS worse if low vitamin D, treated by Vitamin D supplementation – May 2023

The role of Vitamin D in carpal tunnel syndrome risk and supplementation outcomes: A systematic review
Curr Rheumatol Rev. 2023 May 5. doi: 10.2174/1573397119666230505101443 PDF is behind paywall
Shahin Asgari Savadjani 1, Catherine Mt Sherwin 2, Saeid Heidari-Soureshjani 3, Mohammad Darvishi 4, Mehdi Mohammadian Amiri 5

Background: Carpal tunnel syndrome (CTS) is a debilitating neuropathy that accompanies pain and other physical limitations and disrupts the normal functioning of the victims' lives.

Objective: We aimed to investigate Vitamin D's preventive and therapeutic effects on the occurrence and remission of CTS symptoms.

Methods: In this systematic review the PRISMA statement has been designed primarily. An extensive search was undertaken in various databases, including PubMed, Cochrane library, Web of Science, EMBASE, and Scopus. After considering the inclusion and exclusion criteria of the study, finally, 19 articles were retrieved. The raw data were extracted and entered into an Excel form, and the study outcomes were investigated.

Results: The main symptoms and tests, including functional score, nerve conduction, and pain, were improved after Vitamin D supplementation in CTS patients. However, they revealed worse scores in people with low Vitamin D levels. In addition, the scores of mentioned indices were worsened in people with lower serum Vitamin D levels. Nevertheless, some studies did not find a significant relationship between low serum 25(OH)D and more significant pain scores in CTS patients. In addition, Vitamin D inserts its effects on CTS by regulating cell proliferation, nerve growth factor, suppression of oxidative stress and inflammatory cytokines, and improvement in cartilage and microvascular damage.

Conclusion: Vitamin D supplementation can improve the symptoms in CTS patients, and low serum 25(OH)D can aggravate the symptoms of the disease and could be a risk factor for its occurrence. However, more observational studies and clinical trials are needed.

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Carpal Tunnel Syndrome reduced by weekly 50,000 IU of vitamin D or 8 weeks – April 2020

Electrophysiological Evaluation of Carpal Tunnel Syndrome Female Patients After Vitamin D Replacement
Arq Neuropsiquiatr. 2020 Apr 9;S0004-282X2020005008201. doi: 10.1590/0004-282X20190193.
Hikmet Saçmaci 1, Nermin Tanik 1, Özlem Balbaloğlu 2, Tülin Aktürk 1, Levent Ertuğrul Inan 1
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Objective: The effects of vitamin D on the central and peripheral nervous system continue to be investigated today. In the present study, we aimed to evaluate pain and electrophysiologic response in patients with carpal tunnel syndrome (CTS) who have undergone replacement therapy due to vitamin D deficiency.

Methods: Fifty female patients diagnosed with mild and moderate CTS and accompanied by vitamin D deficiency were included in this study. Nerve conduction study (NCS) was performed before and after vitamin D replacement, and the patient's pain was evaluated with Visual Analogue Scale (VAS).

Results: When NCS were compared before and after treatment, there was a statistically significant improvement in the median distal sensory onset latency (DSOL) and sensory conduction velocity (CV) and motor distal latencies (DML) values (p=0.001; p<0.001; p=0.001, respectively). At the same time, there was a decrease in the VAS values in patients (p<0.001). When the two groups were compared there was an improvement in DSOL and sensory CV in both groups, but in DML only in moderate CTS group.

Conclusion: In this study, it was shown that mild and moderate CTS patients had an improvement in pain and electrophysiological parameters after vitamin D replacement. Replacing vitamin D in early stages of CTS may be beneficial.

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Carpal Tunnel syndrome 2.3X more likely if low Vitamin D - Aug 2019

Vitamin D Deficiency Increases Risk of Carpal Tunnel Syndrome
Posted on August 30, 2019 by Korea Bizwire in Health & Wellness

SEOUL, Aug. 30 (Korea Bizwire) — A lack of vitamin D could increase the risk of carpal tunnel syndrome, which causes muscle weakness and numbness in the hands, a local study has revealed.

A research team at Seoul National University (SNU) Bundang Hospital analyzed the link between vitamin D and carpal tunnel syndrome among 135 female patients who visited the hospital between 2011 and 2014 and 135 women who visited the hospital for medical checkups.

The results showed that women with low levels of vitamin D were about 2.3 times more likely to develop carpal tunnel syndrome than normal groups.

In addition, the lower the vitamin level, the earlier in age the disease was reported.

In particular, the effects of deficiency were even greater in groups under the age of 50, and the risk of developing carpal tunnel syndrome was found to be about five times higher.

“A lack of vitamin D can cause upward adjustment of the receptor to compensate for the deficiency, which causes the proliferation of intravenous wall cells and connective tissue,” the team explained.

“That’s why the tunnel eventually becomes cramped and affects the incidence of carpal tunnel syndrome,” the team added.

Follow up research has also confirmed that supplementing vitamin D deficiency can help recover from carpal tunnel syndrome surgery, which broadens the wrist tunnel.

After checking vitamin levels prior to surgery, the team corrected the deficiency by treating patients who were deficient for six months.

As a result, the recovered group showed better results in the DASH test which evaluates postoperative results of carpal tunnel syndrome.

“Vitamin D is good for keeping your nerves healthy as well as your bones and muscles, so if it’s hard to supply enough food and sunlight, it’s better to take nutritional supplements,” said Prof. Gong Hyun-sik, a professor at SNU Bundang Hospital who led the research team.

D. M. Park (dmpark@koreabizwire.com)

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Carpal Tunnel Syndrome relief for 24% getting 600,000 IU injection of Vitamin D

Role of vitamin- D in carpal tunnel syndrome
Shailesh Gupta1’guptahandsurgery@gmail.com, Ravindra Gupta2
Consultant, Gupta Hand Surgery Centre, Indore, Madhya Pradesh, 2Assistant Professor, Index Medical College, Indore, Madhya
Pradesh

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In order to evaluate the effect of vitamin D3 we have evaluated around 50 patients in whom vitamin D deficiency was found & were suffering from CTS. They were all given deep intramuscular 6 lakhs unit of vitamin D. Out of this 12 patients had a substantial relief to full relief in whom surgery was deffered. The idea of writing this paper was a further study is warranted to prove its larger role in many compressive neuropathies & metabolic neuropathies if it can lead to clinical improvement in patients can save some of them from surgery

Cliped from PDF
CTS may be classified into three stages:

• Mild: less than 1 year duration with absent weakness & atrophy with normal two point discrimination & EmG & NCV
• Moderate: duration may be less than or more than 1 year. Minimal presence of weakness & atrophy. Possible abnormality in two point discrimination examination. No to mild denervation in EMG test. No to mild decrease in velocity in NCV testing.
• Severe: duration is more than 1 year. Marked presence of weakness & atrophy. Marked abnormality in two point discrimation on examination.

During 1st author’s yearly regular health check-up a deficiency of vitamin D was diagnosed. His level was 7 (normal reference range 30 to 100). So 1st author took an injection of 6 lakh unit of vitamin D3 (cholecalciferol) deep intramuscular. To author’s surprise the tingling & numbness disappeared suddenly. Till now 1.5 year has been passed & he is still asymptomatic.

Rest is in the PDF

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Carpal Tunnel Syndrome is associated with both low vitamin D and few receptors– Jan 2018

Expression of vitamin D receptor in the subsynovial connective tissue in women with carpal tunnel syndrome.
J Hand Surg Eur Vol. 2018 Jan 1:1753193417749158. doi: 10.1177/1753193417749158
Kim K1, Gong HS2, Kim J2, Baek GH2.

Studies suggest that low vitamin D levels are associated with carpal tunnel syndrome. We aimed to evaluate whether level of vitamin D receptor expression in the endothelial cells of the subsynovial connective tissue is associated with clinical features of carpal tunnel syndrome. We obtained the subsynovial connective tissue from 52 women with carpal tunnel syndrome during surgery and performed immunohistochemical analysis of vitamin D receptors in the endothelial cells of the subsynovial connective tissue. We explored correlation of vitamin D receptor expression with clinical features of carpal tunnel syndrome, such as age, symptom duration, symptom severity and electrophysiological severity. Diverse range of vitamin D receptor expression was observed. Vitamin D receptor expression was independently associated with distal motor latency.
This suggests that vitamin D receptor expression may be associated with disease progression, as prolonged distal motor latency reflects severity of the disease. Further studies are necessary to explore the role of vitamin D and vitamin D receptors in patients with carpal tunnel syndrome.
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Vitamin D levels much lower if CTS - May 2017

The Effect of Vitamin D Levels on Pain In Carpal Tunnel Syndrome.
Orthop Traumatol Surg Res. 2017 May 25. pii: S1877-0568(17)30142-1. doi: 10.1016/j.otsr.2017.05.003
Demiryurek BE1, Gundogdu AA2.

BACKGROUND:
Carpal tunnel syndrome (CTS) and vitamin D deficiency are two discrete common clinical pictures that can cause chronic pain. In this study, we aimed to evaluate the association of 25 (OH) D deficiency with electrophysiological findings and severity of pain in patients with mild CTS.
METHOD:
The consecutive patients admitted to our laboratory with the symptoms of CTS between May 2016 and August 2016 were enrolled in this study. According to their electrophysiological examination results, only the patients with normal conduction results and ones with mild grade CTS were included. Demographic data, the results of the electrophysiological studies, vitamin D levels (our laboratory normal is > 20 ng / mL), duration of pain and pain intensity due to CTS which was assessed with visual analog scale were collected.
RESULTS:
Totally, 76 patients (36 patients with mild CTS and 40 without CTS) were included. In the mild CTS patients, vitamin D levels were significantly lower than those electrophysiologically normal patients (p = 0.003). The relationship between gender, duration of pain and vitamin D levels were evaluated in the normal and mild CTS group. There was no significant relationship between the pain and vitamin D levels in the normal group, while vitamin D level was significantly lower in the mild CTS group (p = 0.730 and p = 0.002; respectively).
DISCUSSION:
Vitamin D deficiency increases the pain intensity in patients with CTS. Treatment of vitamin D deficiency in these patients may play a role in pain relief. Further studies involving analyses of post-Vitamin D replacement therapy are warranted to confirm the association between vitamin D deficiency and pain due to CTS.
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Note that CTS pain decreases with increased Vitamin D

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Carpal tunnel syndrome triggered by low vitamin D - March 2016

Does vitamin D deficiency trigger carpal tunnel syndrome?
J Back Musculoskelet Rehabil. 2016 Mar 31.
Tanik N1, Balbaloğlu Ö2, Ucar M2, Sarp U3, Atalay T4, Çelikbilek A1, Göçmen AY5, Inan LE1.
1Department of Neurology, Bozok University Medical School, Yozgat, Turkey.
2Department of Physical Treatment and Rehabilitation, Bozok University Medical School, Yozgat, Turkey.
3Department of Physical Medicine and Rehabilitation, Yozgat State Hospital, Yozgat, Turkey.
4Department of Neurosurgery, Bozok University Medical School, Yozgat, Turkey.
5Department of Biochemistry, Bozok University Medical School, Yozgat, Turkey.

OBJECTIVE:
Vitamin D deficiencies are associated with a variety of chronic diseases. The goal of the present study was to investigate the relationship between vitamin D levels and carpal tunnel syndrome (CTS).
METHODS:
This study included 90 patients with mild to moderate CTS and assessed their routine serum 25-hydroxyvitamin D levels. Additionally, the pain level of each subject was evaluated using the Visual Analogue Scale and the Douleur Neuropathique 4 Questionnaire (DN4).
RESULTS:
The severity levels of CTS were at a 75% mild level in the vitamin D deficiency group and a 47.1% mild level in the vitamin D normal group, with a significant difference between groups (p = 0.008). Correlation analyses revealed positive correlations between body mass index and DN4 scores (r = 0.499, p = 0.025) and between vitamin D levels and CTS severity (r = 0.364, p = 0.004) in the vitamin D deficiency group.
CONCLUSIONS:
The present findings demonstrated that CTS may be triggered by vitamin D deficiency, and that the severity of CTS was correlated with vitamin D levels in the deficiency group. Additionally, there was a correlation between weight gain and neuropathic pain intensity in CTS patients with vitamin D deficiency. The present findings indicate that vitamin D levels should be assessed in CTS patients.

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Could Vitamin D be Linked to Carpal Tunnel Syndrome? MedPageToday

Reporting on poster at American Society for Bone and Mineral Research meeting. (Oct 9-12, 2015)
Women (< age 50) with carpal tunnel release had vitamin D levels of 17 nanograms
Control women had vitamin D levels of 21 nanograms

The association did not exist for women > 50 years old
Publisher wants $40 for the PDF of the published paper Dec 2015

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The evaluation of vitamin D levels in patients with carpal tunnel syndrome - March 2016

Neurological Sciences, pp 1-7
Azize Esra Gürsoy , Halide Rengin Bilgen, Hümeyra Dürüyen, Özge Altıntaş, Mehmet Kolukisa, Talip Asil, Azize Esra Gürsoy
1. Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih, 34093, Istanbul, Turkey
2. Department of Neurology, Şişli Etfal Education and Research Hospital, Istanbul, Turkey
3. Department of Neurology, Niğde-Bor State Hospital, Niğde, Turkey

Publisher wants $39.95 / €34.95 / £29.95 for the PDF

The aim of this study was to evaluate the relationship between 25-hydroxyvitamin D (25(OH)D) levels and carpal tunnel syndrome (CTS). 25(OH)D levels were checked in 108 consecutive patients with CTS symptoms and 52 healthy controls. All patients underwent nerve conduction studies and completed Boston Carpal Tunnel Questionnaire (BQ) symptom severity and functional status scales to quantify symptom severity, pain status and functional status. There were 57 patients with electrophysiological confirmed CTS (EP+ group) and 51 electrophysiological negative symptomatic patients (EP− group). 25(OH) D deficiency (25(OH)D < 20 ng/ml) was found in 96.1 % of EP− group, in 94.7 % of EP+ group and in 73.8 % of control group. 25(0H) D level was found significantly lower both in EP+ and EP− groups compared to control group (p = 0.006, p < 0.001, respectively). Although mean vitamin D level in EP− group was lower than EP+ group, statistically difference was not significant between EP+ and EP− groups (p = 0.182). BQ symptom severity and functional status scores and BQ pain sum score were not significantly different between EP+ and EP− groups. We found no correlation with 25(OH) D level for BQ symptom severity, functional status and pain sum scores. 25(OH) D deficiency is a common problem in patients with CTS symptoms. As evidenced by the present study, assessment of serum 25(OH)D is recommended in CTS patients even with electrophysiological negative results.
References are online, free

95% of people with CTS had Vitamin D <20 ng (vs 74% of people without CTS)

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Somewhat better recovery from CT Surgery if take a paltry 1,000 IU of Vitamin D daily - April 2019

The Effect of Vitamin D Deficiency Correction on the Outcomes in Women After Carpal Tunnel Release
The Journal of Hand Surgery. https://doi.org/10.1016/j.jhsa.2019.03.008

Purpose
Studies suggest that vitamin D supplementation improves myelination and recovery after nerve injuries. The purpose of this study was to evaluate whether correction of vitamin D level leads to better surgical outcomes in women with both carpal tunnel syndrome (CTS) and vitamin D deficiency.

Methods
We retrospectively reviewed 84 vitamin D–deficient women with CTS who underwent carpal tunnel release and then received daily vitamin D supplementation of 1,000 IU vitamin D for 6 months. We also reviewed 35 control patients who were vitamin D–nondeficient at baseline and thus did not receive the supplementation. At baseline and 6 months after surgery, we measured serum vitamin D levels, the Disabilities of the Arm, Shoulder, and Hand (DASH) score, motor conduction velocity, and grip and pinch strengths. We compared the outcomes of CTS related to vitamin D levels. We also correlated baseline and follow-up vitamin D levels with the assessed parameters.

Results
At 6 months, 59 patients became vitamin D–nondeficient (≥ 20 ng/mL) and 25 were still vitamin D–deficient (< 20 ng/mL). Patients who became vitamin D–nondeficient had subtle but better DASH scores than patients who were still vitamin D–deficient or the control patients. Vitamin D levels at 6 months were found to have significant correlation with the DASH score at 6 months. Vitamin D levels at 6 months did not have significant correlation with motor conduction velocity or grip and pinch strengths.

Conclusions
Women with CTS and vitamin D deficiency showed subtle but better DASH scores after surgery when vitamin D deficiency was corrected by supplementation.

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See also web

• The effect of vitamin D levels on pain in carpal tunnel syndrome Oct 2017
  Vitamin D level was significantly lower in the mild CTS group P=0.002 (vs controls)
• Does vitamin D deficiency trigger carpal tunnel syndrome? Nov 2016 YES
  “The present findings demonstrated that CTS may be triggered by vitamin D deficiency, and that the severity of CTS was correlated with vitamin D levels in the deficiency group.”
  Free PDF online
• Life Extension Magazine reports that Low Level Laser Therapy
  "One study showed LLLT to be as effective as surgical treatment for mild-to-moderate CTS, while another demonstrated the procedure to be as cost-effective as surgery "
  Note: I designed and made a LLLT for my wife's painful Lymphodemia
  It has worked extremely well for > 5 years.
• Natural home remedies: Carpal tunnel syndrome is one of many websites discussing CTS treatment
  Ice & heat; Bromelin, St. John’s Wort,, Flaxseed oil, Curcumin, Magnesium, Does not mention vitamin D
• Natural Carpal Tunnel Remedies Tendonitisexpert.
  "Carpal Tunnel Symptoms absolutely can come from being Vitamin D deficient. It doesn't make a lot of sense, but I've seen it. I've seen all sorts of pain and problem of all sorts, even debilitating pain and problem, that goes away entirely or partially by getting back up to appropriate Vitamin D levels."

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