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.
Related Topics:
Technorati Tags: carpal tunnel syndrome, health and wellness, arthritis, chronic pain
