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These Two Conditions Are Often Misdiagnosed As Carpal Tunnel Syndrome

Most people have heard of carpal tunnel syndrome and with good reason. According to a 2022 report by Penn Highlands Healthcare System, more than 16.9 million Americans experience carpal tunnel syndrome per year. 

The bad news: carpal tunnel syndrome cannot be totally avoided if you’re predisposed to the condition. Stretching the fingers and wrists before, during, and after repetitive movements can help slow or stop the progression, but cannot prevent it entirely.

The good news: carpal tunnel syndrome is highly treatable, often with conservative, non-surgical methods. If a patient does need surgery, it is typically a simple outpatient procedure, usually with local anesthesia and light sedation, that lasts approximately five to ten minutes. In many cases, the only post-surgical restriction is a 10-pound weight-carrying limit during the healing process.

So what is carpal tunnel syndrome and how can it be prevented? Hand and upper extremity specialist Dr. Timothy Dooley of Great Basin Orthopaedics covers the basics, shares some little-known facts and debunks a few myths.

What is Carpal Tunnel Syndrome?

The carpal tunnel, comprising the median nerve and nine tendons from the forearm through to the hand, controls finger movement. When the nerve is compressed and becomes swollen, numbness, tingling, pain and/or weakness can occur in the hand. These are the four main symptoms of carpal tunnel syndrome.
Carpal tunnel syndrome can often be diagnosed with a simple physical exam. Other tests, including an electrodiagnostic study, can be performed as well to understand the severity of the condition, and to rule out other possible causes.

What two conditions are often misdiagnosed as carpal tunnel syndrome?

While Carpal Tunnel Syndrome is a prevalent condition, it's essential to note that similar hand-related symptoms may be caused by other conditions. Two conditions often misdiagnosed as carpal tunnel syndrome are rheumatoid arthritis and tendonitis.

Carpal Tunnel Syndrome vs Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease that primarily affects the joints, including those in the wrist and hand, which leads to inflammation, pain, and joint damage. This condition is commonly misdiagnosed as carpal tunnel syndrome as they share very similar symptoms: discomfort, weakness, numbness, tingling, reduced function, and morning stiffness in the wrists and hands. 

Rheumatoid arthritis and carpal tunnel syndrome differ primarily in the location of their symptoms. While rheumatoid arthritis often starts in the small joints of the hands and wrists, it can affect joints throughout the entire body. Alternatively, carpal tunnel syndrome only affects the hands and wrists. Also, unlike carpal tunnel syndrome, rheumatoid arthritis is a systemic disease, meaning it can affect multiple systems in the body, including joints, skin, eyes, heart, and lungs. It often presents with systemic symptoms such as fatigue, fever, and weight loss, while carpal tunnel syndrome is localized to the joints in the wrists and hands.

Carpal Tunnel Syndrome vs Tendonitis

Tendonitis is another condition that presents with symptoms similar to carpal tunnel syndrome. Tendonitis occurs when the tendons in the wrist or hand become inflamed, which can result in pain, swelling, and limited range of motion. These symptoms can be similar to the weakness, pain, and reduced function associated with carpal tunnel syndrome. 
Carpal tunnel syndrome and tendonitis differ slightly in the location and presentation of their symptoms. Tendonitis typically involves localized pain near the affected tendon and is aggravated by specific movements. Alternatively, carpal tunnel syndrome primarily affects the fingers and palm side of the hand, often worsening at night or during repetitive wrist and hand movements. 

These are just two of several conditions that are often misdiagnosed as carpal tunnel syndrome due to similar presentation of symptoms. For a precise diagnosis and appropriate treatment, consult with an orthopaedic specialist.

What are the most common activities that cause carpal tunnel syndrome?

Carpal tunnel syndrome can develop due to genetics, medical conditions, and injuries, but it is most often associated with activities that involve repetitive hand and wrist motions such as typing, data entry, and assembly line work. Prolonged wrist flexion is also associated with carpal tunnel syndrome – keeping the wrist flexed for extended periods, especially with improper positioning, can increase pressure within the carpal tunnel and cause compression of the median nerve. This is a common issue for individuals who spend extended periods at their computers.

Other common activities that can contribute to the development of carpal tunnel syndrome include: using vibrating power tools and machinery, practicing forceful hand activities such as heavy lifting, and participating in hand-intensive sports. Sports with a high incidence of carpal tunnel syndrome include handball, swimming, bodybuilding, rowing, golf, archery, rock climbing, and racquet sports.

How can I prevent carpal tunnel syndrome? 

Prevention is challenging. Carpal tunnel syndrome can be caused by factors that are not entirely avoidable, such as medical conditions, trauma, and injury. Genetics can also make you predisposed to the condition, increasing your likelihood of developing carpal tunnel syndrome from daily activities. However, while it cannot be entirely avoided, there are measures you can take to mitigate its development and progression. 

Engage in regular hand and wrist stretches before, during, and after repetitive activities.
Regular stretching can help build wrist strength and reduce pressure within the carpal tunnel. It is also a good idea to take frequent breaks during activities that involve repetitive wrist and hand movements to alleviate inflammation in the wrist.

Maintain ergonomic hand and wrist positions when using tools or working at a computer. 
This is especially important if you spend a lot of time at the computer and frequently use a mouse and keyboard. Some keyboards, mice, and office chairs are designed to improve wrist and hand posture by promoting a natural hand and wrist position, reducing the likelihood of nerve compression and inflammation.

Use wrist splints, especially at night. 
Carpal tunnel syndrome is most often associated with movement, and most people don’t realize that their sleeping posture can also have a significant influence on its development. During sleep, the elbows and wrists are flexed, putting pressure on the nerve in the carpal tunnel. This can cause tingling, pain, and weakness upon waking up. A wrist splint can help keep the wrist in a neutral position and reduce pressure on the median nerve.

Do I need surgery if I have carpal tunnel syndrome? 

Caught early, carpal tunnel syndrome can be addressed with conservative treatment options such as nonsteroidal anti-inflammatories, corticosteroid injections, and wrist splinting, which keeps the nerve from being compressed. However, the longer you have symptoms, the more likely you are to need surgery. Left untreated for an extended period of time, permanent nerve damage can occur.

If surgery is necessary, there are two main methods used to treat carpal tunnel syndrome: open release and endoscopy. Both relieve the pressure on the median nerve, with the main difference being the size of the incision. Open-release surgery is generally recommended for more severe cases of carpal tunnel syndrome and requires a larger incision. However, both procedures are considered outpatient surgeries, and patients can typically resume light activities within a few days to a week. 

The decision to undergo surgery should be made in consultation with an orthopaedic specialist who can evaluate the severity of your condition and discuss the benefits and risks associated with each surgical approach.

What should I do if I suspect carpal tunnel syndrome?

Rule number one: Don’t wait. See a specialist. 
Early intervention is key in managing carpal tunnel syndrome effectively, and the right diagnosis will guide your path to pain relief and improved functionality. If you are experiencing persistent numbness, tingling, pain, or weakness in the hands and wrists, call Great Basin Orthopaedics at 775.786.1600 to schedule a consultation.