Carpal tunnel syndrome is a condition with a problematic screening and is often misdiagnosed. It is misdiagnosed because it mimics various condition’s signs and symptoms. In this article, we will look at the two conditions that are often misdiagnosed as carpal tunnel syndrome. First, understand what carpal tunnel syndrome is.
What is carpal tunnel syndrome (CTS)?
The carpal tunnel is a narrow passage located in the wrist. It is a small tunnel-like structure. Its formation is by the carpal bones at the base of the hand and a ligament called the transverse carpal ligament. The carpal tunnel serves as a protection for several important structures, including the median nerve and tendons of various muscles that control the movement of the fingers.
Here are the key components within the carpal tunnel:
- Median Nerve: It is a major nerve in the arm that runs from the forearm into the hand. It provides sensation to the thumb, index finger, middle finger, and half of the ring finger.
- Flexor Tendons: Within the carpal tunnel, there are several tendons that connect to the muscles in the forearm. They control the movement of the fingers and thumb. These tendons are responsible for flexing the fingers and allow you to grip objects.
Carpal Tunnel Syndrome (CTS) is one of the common medical conditions that affects the wrist and hand. It occurs when the median nerve, which runs from the forearm into the hand, becomes compressed as it passes through the narrow passage in the wrist called the carpal tunnel. This compression may result from factors like repetitive hand movements, wrist injuries, or underlying medical conditions that lead to swelling and inflammation in the wrist.
Signs & Symptoms of Carpal Tunnel Syndrome:
- Numbness and tingling: People with CTS often experience numbness, tingling, or a “pins-and-needles” sensation in the thumb, index finger, middle finger, and half of the ring finger.
- Weakness: As the condition progresses, weakness in the hand may develop, making it difficult to grip objects, problems performing fine motor tasks, or hold things for long periods of time.
- Pain: It can cause pain in the wrist, palm, and fingers, which may radiate up the forearm and even to the shoulder in some individuals.
- Night-time symptoms: Many individuals with CTS experience that their symptoms worsen at night. They may wake up with numbness or pain in their hands.
Two conditions that are often misdiagnosed as carpal tunnel syndrome:
Arthritis and thoracic outlet syndrome are the two conditions that are often misdiagnosed as carpal tunnel syndrome.
Arthritic conditions include osteoarthritis, rheumatoid arthritis, and gout. All of these arthritic conditions are different from carpal tunnel syndrome but they overlap in some signs and symptoms. Let’s compare all arthritic conditions with carpal tunnel syndrome:
Carpal Tunnel Syndrome (CTS):
- Location of Symptoms: CTS primarily affects the wrist and the hand. Symptoms typically concentrate in the palm, thumb, index finger, middle finger, and half of the ring finger.
- Numbness and Tingling: One of the hallmark symptoms of CTS is numbness and tingling. It is often present as a “pins-and-needles” sensation, in the fingers mentioned above. These sensations may radiate up the forearm.
- Pain Characteristics: In CTS, pain is often described as aching or burning, and it may be intermittent. It is triggered by activities that involve repetitive hand movements, such as typing or gripping.
- Weakness: Weakness in the hand is a common feature of CTS. It can make it problematic to grip objects or perform fine tasks.
- Diagnostic Tests: It involve clinical tests like Tinel’s sign, Phalen’s test, NCV & EMG to assess median nerve function and compression.
Osteoarthritis of the Hand/Wrist:
- Location of Symptoms: Osteoarthritis typically affects the joints, including those in the hand and wrist. The pain and stiffness with this are usually present in the affected joints.
- Joint Stiffness: Osteoarthritis causes stiffness in joints, especially in the morning or after periods of inactivity. The stiffness tends to improve with joint movement.
- Swelling and Enlarged Joints: Arthritis often leads to joint swelling, tenderness, and, osteophytes around the affected joints.
- Diagnostic Tests: It involves clinical evaluation, medical history, physical examination, and imaging studies like X-rays, MRI, or ultrasound. These are necessary to assess joint damage, cartilage loss, and signs of arthritis.
Carpal tunnel syndrome v/s OA:
To differentiate between CTS and osteoarthritis in the hand and wrist:
- Consider the location of the symptoms: CTS affects the wrist and hand, while OA involves the affected joints within the hand and wrist.
- Note the nature of the pain and stiffness: CTS pain is often aching or burning, typically present with numbness and tingling. Osteoarthritis pain tends to be present in the affected joints. Its characteristic feature is stiffness that improves with movement.
- Cause: RA is an autoimmune condition where the body’s immune system attacks the synovium. This autoimmune response leads to inflammation in multiple joints throughout the body, including the hands and wrists.
- Joint pain, stiffness, and swelling are common in RA. This pain is typically symmetrical, affecting joints on both sides of the body.
- Morning stiffness that lasts for more than an hour is a hallmark feature of RA.
- RA can affect various joints, not just the wrists and hands. It may involve other symptoms like fatigue and systemic inflammation.
- Diagnostic Tests: It involves clinical evaluation, history, physical examination, and blood tests such as rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies. Imaging studies like X-rays and MRI may also be useful to assess joint damage and inflammation.
Carpal Tunnel Syndrome v/s RA:
To differentiate between CTS and RA in the hands and wrists:
- Consider the distribution of symptoms: CTS symptoms are present in the wrist and hand, while RA affects multiple joints, often symmetrically, and may involve joints in other parts of the body.
- Nature and duration of pain and stiffness: CTS pain is often aching or burning, and localized to the wrist and hand. Whereas, the characteristic features of RA are joint stiffness, swelling, and systemic symptoms, with morning stiffness being a key feature.
- Location of Symptoms: Gout typically affects the joints, most commonly the big toe, although it can also affect other joints. It’s a form of inflammatory arthritis that results from the buildup of uric acid crystals in the joints.
- Cause: Caused by the buildup of uric acid crystals in the joints. The condition typically develops when the body either produces too much uric acid or is unable to effectively eliminate it.
- Pain Characteristics: The characteristic features of gout are sudden and severe pain in the affected joint(s). The pain is often excruciating, and it usually comes on rapidly, often at night.
- Swelling and Redness: Gout attacks are present with joint swelling, redness, and warmth in the affected area.
- Duration of Symptoms: Gout attacks can last for several days to a couple of weeks. Between attacks, the affected joint may return to normal.
- Risk Factors: Gout is linked to dietary factors (consumption of foods high in purines), genetics, and medical conditions that affect uric acid metabolism.
- Diagnostic Tests: A definitive diagnosis of gout is by aspirating fluid from the affected joint and identifying the presence of uric acid crystals under a microscope. Blood tests can also measure serum uric acid levels.
Carpal Tunnel Syndrome v/s Gout:
To differentiate between gout and carpal tunnel syndrome:
- Consider the location of symptoms: Gout primarily affects joints, while CTS affects the wrist and hand.
- Examine the nature and duration of pain: Gout presents with sudden, severe, and episodic joint pain, while CTS pain is typically more chronic and is present with numbness and tingling.
II. THORACIC OUTLET SYNDROME
Carpal tunnel syndrome (CTS) and thoracic outlet syndrome (TOS) are two distinct medical conditions that can both cause symptoms in the upper extremities, particularly the arms and hands. While they share some similarities, they have different causes, symptoms, and diagnostic features that can help differentiate between the two:
- Location of Symptoms: TOS can affect the neck, shoulder, and upper extremities, including the arms and hands.
- Numbness and tingling in the fingers, often affecting the pinky finger and ring finger.
- Weakness in the hand and arm, particularly with overhead activities.
- Pain in the neck, shoulder, and upper chest, which can radiate down the arm.
3. Arm Position: TOS symptoms increase by certain arm positions or activities, such as raising the arms overhead or holding them in an elevated position for extended periods.
4. Types of TOS:
Vascular TOS: There are two main types of TOS. One type, known as vascular TOS, is characterized by symptoms related to compression of blood vessels (veins or arteries) as they pass through the thoracic outlet.
Neurogenic TOS: The other type, called neurogenic TOS, is characterized by symptoms related to compression of the brachial plexus, a network of nerves that control arm and hand movements.
5. Diagnostic Tests: Diagnosis of TOS typically involves a combination of clinical evaluation, medical history, physical examination, and sometimes imaging studies such as X-rays, MRIs, or vascular studies to assess the specific type of TOS and its underlying causes.
Carpal Tunnel Syndrome v/s TOS:
To differentiate between CTS and TOS:
- Consider the distribution of symptoms: CTS primarily affects the wrist and hand, while TOS symptoms can involve the neck, shoulder, and upper chest in addition to the arms and hands.
- Note the triggering factors: CTS symptoms are often present with repetitive hand movements, while TOS symptoms may worsen with certain arm positions or activities.
- Consult a healthcare professional: If you are experiencing symptoms in your upper extremities, it’s important to seek medical evaluation and diagnosis from a healthcare provider who can perform the necessary tests and examinations to determine the underlying cause and recommend appropriate treatment options.
In this article, we discussed two conditions that are often misdiagnosed as carpal tunnel syndrome. These two conditions are Arthritis and Thoracic outlet syndrome (TOS). These conditions show a lot of overlapping signs and symptoms with CTS. This overlapping makes it difficult to diagnose accurately. Always take a piece of medical professional advice for an accurate diagnosis and appropriate treatment.
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