Drug – bio-affecting and body treating compositions – Designated organic active ingredient containing – Ketone doai
Reexamination Certificate
2000-02-08
2001-07-10
Criares, Theodore J. (Department: 1617)
Drug, bio-affecting and body treating compositions
Designated organic active ingredient containing
Ketone doai
Reexamination Certificate
active
06258855
ABSTRACT:
FIELD OF THE INVENTION
This invention relates to the treatment and prevention of carpal tunnel syndrome. More particularly the invention relates to a method for treatment and prevention of carpal tunnel syndrome using, as a basis, the protective properties of astaxanthin. Most particularly the invention relates to treatment and prevention of carpal tunnel syndrome using orally administered astaxanthin.
BACKGROUND OF THE INVENTION
Carpal Tunnel Syndrome (CTS) is an ailment caused by excess pressure of the median nerve in the wrist resulting in numbness, tingling, and pain in the arm, hand, and fingers. Usually, CTS is considered a disorder caused by repetitive stress, physical injury, or other conditions that cause the tissues around the median nerve to become swollen. It occurs either when the protective lining of the tendons within the carpal tunnel becomes swollen or when the ligament that forms the roof becomes thicker and broader. Compression on the median nerve fibers by the swollen tendons and thickened ligament slows down the transmission of nerve signals through the carpal tunnel. The result is pain, numbness, and tingling in the wrist, hand and fingers except the little finger which is not affected by the median nerve.
The carpal tunnel is an opening into the hand that is made up of the bones of the wrist on the bottom and the transverse carpal ligament on the top. The tunnel is the space in the wrist bones where nine tendons for bending the hand and the median nerve pass from the forearm to the hand, the median nerve is relatively large, about the size of a pencil and contains thousands of small individual nerve fibers. The nerve also supplies a branch to the thenar muscle that allows the thumb to move, lift the thumb up and out from the hand and allow the thumb to turn and pinch the other fingertips (opposition). The other nerve fibers bring feeling from the tip of the thumb, index, middle, and part of the ring fingers.
The flexor tendons are important because they allow movement of the fingers and the hand for grasping objects. The tendons are covered by a material called tenosynovium. The tenosynovium is very slippery, and allows the tendons to glide against each other as the hand is used to grasp objects. Any condition that causes irritation or inflammation of the tendons can result in swelling and thickening of the tenosynovium. As the tenosynovium covering all of the tendons begin to swell and thicken, the pressure begins to increase in the carpal tunnel because the bones and ligaments that make up the tunnel are not able to stretch in response to the swelling. Increased pressure in the carpal tunnel begins to squeeze the median nerve against the transverse carpal ligament since the nerve is the softest structure in the carpal tunnel. Eventually, the pressure reaches a point when the nerve can no longer function normally and pain and numbness in the hand begins.
Pressure on the median nerve resulting from inflammation and a thickened lining of the tendons is called ‘tenosynovitis’. When the pressure builds up, the blood flow in the nerve decreases and the nerve does not get enough oxygen. This results in the numbness and tingling feelings in the fingers. During sleep, the wrist is often bent down and pushes the nerve harder against the ligament. This further decreases the blood flow to the nerve and awakens people with the feeling that ones hand is “asleep.” Tenosynovitis (swelling of the tendon sheath in the hands and fingers) is an associated repetitive stress injury of CTS and can effect various parts of the hand and fingers. One or more fingers may feel painful and stiff, especially in the morning; the wrist may be swollen. Trigger finger (also called snapping finger) is a condition brought on when a tendon thickens, leaving the finger in a bent position. It is a common complication of rheumatoid arthritis and may also occur in diabetes or for unknown causes. De Quervain's disease involves tenosynovitis at the base of the thumb. These disorders are often present with carpal tunnel syndrome.
The initial symptoms of carpal tunnel syndrome usually progress gradually over weeks and months and, in some cases, years. The first signs may be pain in the wrist and hand or numbness and tingling of the fingers, except the little finger. Patients may also experience a sense of weakness and a tendency to drop things. They may lose the sense of heat and cold or feel that their hands are swollen even though there is no visible swelling. The pain may also radiate up the arm to the shoulder, and, sometimes the neck. If the condition is allowed to progress, weakness of the thenar muscles can occur. This results in an inability to bring the thumb into opposition with the other fingers and hinders one's grasp. Symptoms may occur not only when the hand is being used but also when it is at rest. In fact, the disorder may be distinguished from similar conditions by pain occurring at night after going to bed. In some cases, labor-related CTS symptoms first occur outside of work, so patients may fail to associate the symptoms with work-related activity.
Repetitive work can cause pressure on the median nerve in locations other than the wrist and can also affect other nerves in the arm and hand. The branch of the median nerve that runs through the palm of the hand can be damaged directly by repeated pounding or by the use of certain tools requiring a strong grip using the palm, such as needle-nosed pliers. The median nerve can also be pinched up in the forearm. The ulnar nerve supplies sensation to the ring and little fingers. Like the median nerve, it too can become trapped as a result of repetitive stress, with subsequent loss of sensation in these fingers and the outer half of the palm. This condition, known as ulnar tunnel syndrome, can be a separate disorder or appear with carpal tunnel syndrome. In the latter case, release surgery for CTS usually also relieves the ulnar nerve entrapment. The ulnar nerve can also be affected at the elbow.
Evaluation begins by obtaining a history of the problem, followed by a thorough physical examination. Commonly, patients will complain first of waking in the middle of the night with pain and a feeling that the whole hand is asleep. Careful investigation usually shows that the little finger is unaffected. This can be a key piece of information to make the diagnosis. Other complaints include numbness while using the hand for gripping activities, such as sweeping, hammering, or driving. The major physical findings reflect that pressure is increased in the carpal tunnel. Several screens are available to see how well the median nerve is functioning, including the nerve conduction velocity test. This test measures how fast nerve impulses are conducted through the nerve.
In the early stages of carpal tunnel syndrome, a simple brace will sometimes decrease the symptoms, especially the numbness and pain occurring at night. Braces simply keep the wrist in a neutral position (not bent back too far nor bent down too far). When the wrist is in this position, the carpal tunnel is as large as it can be so the nerve has as much room as possible. The brace needs to be worn at night while one sleeps to prevent the numbness and pain occurring at night. If symptoms occur during the day as well, the brace may help reduce those symptoms as well. Standard conservative treatment for CTS is the splint plus anti-inflammatory medication, for several weeks.
Anti-inflammatory medicines are often recommended to help control the swelling of the tenosynovium and reduce the symptoms of carpal tunnel syndrome. These medications include the common over the counter medications such as ibuprofen and aspirin. In some studies, high doses of Vitamin B-6 have shown limited efficacy in decreasing the symptoms of CTS. Steroids are used to decrease inflammation and a local anesthetic is injected directly into the canal in an attempt to decrease the inflammation and swelling in the canal, thereby decreasing the compression on the median nerve and the patient's symptoms. T
Cysewski Gerald R.
Lorenz R. Todd
Criares Theodore J.
Cyanotech Corporation
Devine, Millimet & Branch P.A.
Kim Jennifer M
Kohler Kristin
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