Carpal Tunnel Syndrome or Arthritis?
A number of commenters in recent weeks have pointed out that they have had carpal tunnel syndrome in addition to other problems such as whiplash injuries or elbow problems or other disease entities, which have caused pain, numbness, and weakness in their hands.
I want to stress the fact that it is possible to have carpal tunnel syndrome and also have other problems. Carpal tunnel syndrome is associated with such entities as arthritis, which can obviously cause pain in the hands and also contribute to or actually be associated with carpal tunnel syndrome. In deciding on treatment, certainly surgical treatment, judgment and experience are important. It is important to document all of these other problems and decide which one is contributing to the difficulty an individual has in using his or her hands.
An EMG is usually the definitive test for documenting the existence of carpal tunnel syndrome. It can be diagnosed clinically, but for documentation and verification EMG testing can document the findings and sometimes indicate severity. The carpal tunnel syndrome or these other disease problems can contribute and it is important to distinguish one from the other and make the best-informed decision.
Another cause of frequent hand and wrist pain is arthritis. Arthritis itself is derived from the Greek word "arthros" meaning joint and "itis" meaning inflammation so it specifically is inflammation of the joints.
There are various kinds of arthritis affecting the joints and they include osteoarthritis also known as degenerative arthritis, rheumatoid arthritis and the arthritis associated with other disease entities such as lupus and psoriasis. These are among the most well known. All have a component which causes inflammation and loss of joint integrity and eventually deformity. Those are the common aspects. The disease process differs. The medical and surgical treatments may also have common and differing approaches for each form of arthritis.
Osteoarthritis is certainly the most common form of arthritis. In some respects it has been considered a normal process of aging or "wear and tear." If we live long enough we will all wear out.
Osteoarthritis specifically involves the destruction of the normal cartilaginous surface, which lines the ends of bones. The composition of the collagen changes and friction follows eventually the cartilage is destroyed. Collagen is the significant component in cartilage.
As cartilage is destroyed, prostaglandin synthesis occurs, resulting in an inflammatory reaction. A phenomenon also occurs in which there is new bone formation (sclerosis or subcondral bone formation) in a layer beneath the joint. Increased bone formation results in osteophyte formation on the sides of the joint. These osteophytes are in essence, projections. We may also see bony prominences especially in the distal joints. These are typical of osteoarthritis and they have a specific name -- they are known as Heberden's nodes, named after William Heberden, the man who first described them.
I want to stress the fact that it is possible to have carpal tunnel syndrome and also have other problems. Carpal tunnel syndrome is associated with such entities as arthritis, which can obviously cause pain in the hands and also contribute to or actually be associated with carpal tunnel syndrome. In deciding on treatment, certainly surgical treatment, judgment and experience are important. It is important to document all of these other problems and decide which one is contributing to the difficulty an individual has in using his or her hands.
An EMG is usually the definitive test for documenting the existence of carpal tunnel syndrome. It can be diagnosed clinically, but for documentation and verification EMG testing can document the findings and sometimes indicate severity. The carpal tunnel syndrome or these other disease problems can contribute and it is important to distinguish one from the other and make the best-informed decision.
Another cause of frequent hand and wrist pain is arthritis. Arthritis itself is derived from the Greek word "arthros" meaning joint and "itis" meaning inflammation so it specifically is inflammation of the joints.
There are various kinds of arthritis affecting the joints and they include osteoarthritis also known as degenerative arthritis, rheumatoid arthritis and the arthritis associated with other disease entities such as lupus and psoriasis. These are among the most well known. All have a component which causes inflammation and loss of joint integrity and eventually deformity. Those are the common aspects. The disease process differs. The medical and surgical treatments may also have common and differing approaches for each form of arthritis.
Osteoarthritis is certainly the most common form of arthritis. In some respects it has been considered a normal process of aging or "wear and tear." If we live long enough we will all wear out.
Osteoarthritis specifically involves the destruction of the normal cartilaginous surface, which lines the ends of bones. The composition of the collagen changes and friction follows eventually the cartilage is destroyed. Collagen is the significant component in cartilage.
As cartilage is destroyed, prostaglandin synthesis occurs, resulting in an inflammatory reaction. A phenomenon also occurs in which there is new bone formation (sclerosis or subcondral bone formation) in a layer beneath the joint. Increased bone formation results in osteophyte formation on the sides of the joint. These osteophytes are in essence, projections. We may also see bony prominences especially in the distal joints. These are typical of osteoarthritis and they have a specific name -- they are known as Heberden's nodes, named after William Heberden, the man who first described them.
Osteoarthritis is a very common problem. Changes may start as early as the second decade in life and it is estimated that by the time individuals reach 70 years of age at least 85 percent of the population has evidence of arthritis. About 20-25 percent of people with osteoarthritis at age 60 have symptoms. So you see the enormity of the problem. In the 5th, 6th and 7th decades the arthritis really kicks in and as much as 85 percent of the population have arthritis and 20-25 percent have symptoms.
Osteoarthritis is a natural progression of living long, aging and wearing out of the joints cartilage thins or is eroded. Accompanying the erosion is increasing bone formation and density at the end of the bones known as sclerosis. Osteophyte (bony projections) also occur. Hence deformity, pain and stiffness follow. The whole process can occur and be accelerated by a traumatic event.
In the hand the two most common areas affected are the distal interphalangeal joints or end joints and also the basilar joint at the base of the thumb, the first metacarpal joint which is the part of that joint (basilar joint) subluxates or becomes dislocated out of place. An individual compensates and tries to use the other areas of the hand and which results in hyperextension at the MP joint or knuckle and a swan neck deformity of the thumb. These are classic kinds of deformities that are present in osteoarthritis.
The DIP joints as we mentioned before become swollen and irritated with Heberden's nodes. The approach to treatment is first if possible modify the activity. Resting or splinting. I find useful in certain joints. If it is possible to apply Band-aids around the joint to give some support and protection, band-aids are easier than using a large splint. Medication is also important starting with basic anti-inflammatory medicines such as acetaminophen (Tylenol), ibuprofen (Motrin or Advil) as well as aspirin, which is an old standard.
Gentle exercises for stretching and putting joints through their full range of motion, are recommended. Avoid aggressive exercising which may cause a rebound effect. There are also anti-inflammatory analgesic medications known as NSAID's -- nonsteroidal anti-inflammatory medicines prescription doses are available. Rheumatologists have additional potent drugs available.
I am not a big proponent of steroid injections. They might help initially when they are used for soft tissue anti-inflammatory effects. The injection of steroids is not beneficial to the cartilage. Cartilage has no direct blood supply. Nutriments come by way of the diffusion from the neighboring tissues and therefore once the cartilage is injured or destroyed it does not regenerate.
Ultimately there is a surgical approach. These joints can be removed and it is possible to replace them with prosthetic joints. They are very effective in providing some movement. Also especially for the end joints and fingers there is arthrodesis or fusion. Even though there is no movement the painful aspect is removed and the person is able to use the hand more effectively and it is cosmetically acceptable.
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Technorati Tags: carpal tunnel syndrome, health and wellness, arthritis, chronic pain
12 Comments:
When my patients have the symptoms of carpal tunnel syndrome we always check all the way up the nerve pathway to the neck. It is quite possible that the source of the symptoms is from the neck. Conditions such as Disc Degeneration and Osteoarthritis of the cervical spine can cause the same symptoms as CTS.
I have had Carpal Tunnel and symptoms. I also have a fight with low thyroid after doing radioactive iodine 3 different times. While I no longer have hyper thyroid, now I suffer in the other direction. Meds are not helping. I also developed neuopathy of the ring and pinky finger. Can thyroid cause that?
I think I have carpal tunnel syndrom but my mom says its noting. I have random pain in my left hand when there is any presure on it it hurts. whenever I dont use my left hand the pain goes away but the pain always comes back.
I have minor carpal tunnel but have also been diagnosed with De Puytren's which is becoming irritating. Also osteoarthritis in spine and knees. Is there a correlation between the osteo and the De Puytren's? In the past I've had neuromas removed from my feet as well. Any connection? Thanks
I saw a specialist for pain in my thumb. I was told after x-ray that I have Carpal Metacarpal Syndrome. Osteoarthritis. I apparently have no cartlidge left inbetween the two joints. He recommened surgery. I also saw a Rhemotologist and she recommends therapy. How will therapy help if there is no cartlidge?
for the past 5 years I've experienced these "sudden attacks" in my ring finger and pinky top joints. It starts out with an awarenes then when I look the finger is swollen and redish bluish under the skin and throbs. It will last for about an hour and the next day is still sore and slightly discolored under the skin.
Does anyone have this??
I curently have pain in my fingers, wrists, elbows & my neck. The upper part of my neck feels as if there is a knot there. The pain from my neck is causing a problem when I turn my neck. I also have some tingling in my hands as I type this. I have not been diagnosed yet with CTS, but am starting to feel that's what it is.
To anonymous who has cts: Check with doctor. EMG test to document problem.
To anonymous with Dupuytren: Dupuytren's contracture is thickening of Palmar Foscia- different problem from arthritis-inflammation and degeneration of joints.
To anonymous who has Carpal Metacarpal Syndrome: Your joint is damaged permanently. Better off with joint replacement.
To anonymous with discoloration on fingers: Discoloration is suggestive of vasculitis. Also, you describe joint problems? Arthritis. Check with doctors.
To anonymous with neck pain: Neck pain usually not CTS- may have more than 1 problem. Check with doctor. EMG test to help.
i play alot of video games and type alot iv been doing this probeblyabout 7 years of my life and im only 16 is it normal for me to have pain on my figer joints, not a lot of pain but a
minor discomfort. they feel a little stiff sometimes
i dont really go on this website alot so ill give you my email if you an tell me whats up thanks
Stiffness/soreness could result from repetitive activity. Give your hand and finger a rest.
Today I developed a coldness in my left elbow, wrist, knuckles, knee, and my right wrist. It wasn't a numbness (lack of feeling) tingling, or prickling, they felt frozen. Just wondering what could have caused itm
I have been experiencing severe joint stiffness in my hands, but mostly my left thumb and pinkie fingers. They stick in a bent position and I have to straighten them with my other hand. I also have joint pain in both hands. I have been diagnosed with osteoarthritis, and my rheumatologist put me on Cymbalta, which isn't really helping. Can anything be done about the "sticking" joints? Thank you for your help.
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