Carpal tunnel syndrome is a common condition that affects the median nerve, which runs from the forearm to the hand through a narrow passage called the carpal tunnel. When the median nerve is compressed or irritated, it can cause symptoms such as pain, numbness, tingling, and weakness in the hand and fingers. According to the National Institute of Neurological Disorders and Stroke, carpal tunnel syndrome affects about 4 to 10 million Americans1.
However, not all cases of hand and wrist pain are due to carpal tunnel syndrome. There are other conditions that can mimic or coexist with carpal tunnel syndrome, and they require different treatments and management. In this article, we will discuss two conditions that are often misdiagnosed as carpal tunnel syndrome: rheumatoid arthritis and tendonitis.
Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation and damage to the joints, including those in the wrist and hand. It can affect people of any age, but it is more common in women and older adults. Rheumatoid arthritis can cause symptoms such as:
- Joint pain, swelling, stiffness, and deformity
- Reduced range of motion and function of the affected joints
- Fatigue, fever, and weight loss
- Skin rashes, eye problems, and lung issues
Rheumatoid arthritis can be confused with carpal tunnel syndrome because they both cause pain and numbness in the hand and wrist. However, there are some key differences that can help distinguish them:
- Rheumatoid arthritis usually affects both hands symmetrically, while carpal tunnel syndrome may affect one hand more than the other.
- Rheumatoid arthritis often involves the small joints of the fingers and the base of the thumb, while carpal tunnel syndrome mainly affects the thumb, index, and middle fingers.
- Rheumatoid arthritis causes joint inflammation and deformity, while carpal tunnel syndrome does not affect the appearance of the joints.
- Rheumatoid arthritis is a systemic disease that can affect other organs and tissues, while carpal tunnel syndrome is a local condition that only affects the median nerve.
The diagnosis of rheumatoid arthritis is based on the clinical history, physical examination, blood tests, and imaging studies. The treatment of rheumatoid arthritis aims to reduce inflammation, relieve pain, prevent joint damage, and improve function. The treatment options include:
- Medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and biologic agents
- Physical and occupational therapy, to improve joint mobility and strength, and to provide adaptive devices and strategies for daily activities
- Surgery, to repair or replace damaged joints, or to release the compressed median nerve in cases of coexisting carpal tunnel syndrome
Tendonitis
Tendonitis is a condition that occurs when the tendons, which are the fibrous tissues that connect the muscles to the bones, become inflamed or irritated due to overuse, injury, or infection. Tendonitis can affect any tendon in the body, but it is more common in the shoulder, elbow, knee, and ankle. In the wrist and hand, tendonitis can affect the tendons of the thumb (de Quervain’s tendonitis), the wrist extensors (tennis elbow), or the wrist flexors (golfer’s elbow). Tendonitis can cause symptoms such as:
- Pain, tenderness, and swelling in the affected area
- Difficulty moving or using the affected joint or limb
- A cracking or grating sensation when moving the affected tendon
Tendonitis can be misdiagnosed as carpal tunnel syndrome because they both cause pain and stiffness in the wrist and hand. However, there are some clues that can help differentiate them:
- Tendonitis usually affects one side of the wrist or hand, while carpal tunnel syndrome may affect both sides.
- Tendonitis causes pain and swelling along the course of the affected tendon, while carpal tunnel syndrome causes pain and numbness in the distribution of the median nerve.
- Tendonitis is aggravated by specific movements or activities that involve the affected tendon, while carpal tunnel syndrome is worsened by prolonged or repetitive wrist flexion or extension.
- Tendonitis does not cause night-time symptoms, while carpal tunnel syndrome often disturbs sleep due to pain and numbness.
The diagnosis of tendonitis is based on the clinical history, physical examination, and sometimes ultrasound or MRI. The treatment of tendonitis aims to reduce inflammation, relieve pain, and restore function. The treatment options include:
- Rest, ice, compression, and elevation (RICE) of the affected area
- Medications, such as NSAIDs, corticosteroids, or antibiotics (if infection is present)
- Physical therapy, to improve tendon flexibility and strength, and to correct biomechanical issues
- Surgery, to repair or release the damaged tendon, or to decompress the median nerve in cases of coexisting carpal tunnel syndrome
Conclusion
Carpal tunnel syndrome is a common condition that affects the median nerve in the wrist and hand, causing pain, numbness, tingling, and weakness. However, there are other conditions that can mimic or coexist with carpal tunnel syndrome, such as rheumatoid arthritis and tendonitis. These conditions have different causes, symptoms, and treatments, and they require accurate diagnosis and management. If you have any signs or symptoms of hand or wrist pain, you should consult your doctor for a proper evaluation and treatment plan.
