Carpal Tunnel vs. Arthritis: How to Tell the Difference

From womansworld.com

Both conditions are more common in women and can cause similar symptoms 

Not that long ago, carpal tunnel syndrome was all over the news. Blame the modern age and repetitive tasks like typing for the surge in nerve pain in our hands and wrists. Though the condition has retreated a bit from the headlines, it’s no less common today, affecting up to five percent of Americans. But it can sometimes have similar symptoms to arthritis, especially in the early stages, and as a result, it can be hard to diagnose carpal tunnel syndrome. So, when it comes to carpal tunnel vs. arthritis, how do you know which might be causing painful joints? We talked to top hand surgeons to break down the differences between the two and reveal the best treatments for each.

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What causes carpal tunnel vs. arthritis?

Carpal tunnel syndrome, most often caused by overuse, is the compression of the median nerve as it goes into the hand, explains Kate Wilkins Nellans, MD, MPH, board-certified, fellowship-trained Hand Surgeon practicing out of North Shore University Hospital and Long Island Jewish Medical Center at Northwell Health. “As it crosses the wrist, the nerve goes through a narrow passageway that can lead to symptoms like numbness and tingling—and sometimes a deep ache shooting up your arm.”

Osteoarthritis arthritis, on the other hand, is caused by wear and tear of joints and cartilage over a lifetime, she continues. “One of the most commonly affected areas for women is at the base of the thumb, so tasks that require gripping and grasping, like opening a jar, can be difficult.”

What about an inflammatory condition like rheumatoid arthritis? “You’ll likely feel more global stiffness and swelling in multiple joints like your hips and ankles,” she explains, adding that if this is the case, the best place to start is by seeing a rheumatologist.

How to tell the difference between carpal tunnel and arthritis

The biggest tell-tale sign of carpal tunnel syndrome is that wrist pain is almost always worse at night, reveals Dr. Nellans. “That’s largely because when we sleep, our hands are often curled under our chin. That position, with the wrist flexed, is really putting a lot of extra pressure on the median nerve.” If you wake up needing to shake out your hand, that’s another red flag. “You might feel tingling, similar to when your foot falls asleep.”

Another reason carpal tunnel pain is often exacerbated when we hit the hay is because our extremities tend to swell at night. In fact, the circumference of our hands and fingers typically enlarges by about 10 percent overnight, she notes. “So when that already tight area swells up and puts pressure on the nerve, pain often worsens.”

Why these conditions are more common in women

A combination of environmental factors and good old-fashioned biology likely predisposes women to both conditions. “We tend to do more activities that require pinching, gripping, grasping and turning, which wear down the joints and lead to osteoarthritis,” she shares. “Women also have significantly looser ligaments than men, and that excess motion is grinding down at the joint over a lifetime, and is particularly bad for the cartilage.”

As for carpal tunnel, our bone structure is a little bit different than a man’s—specifically the space at the wrist is slightly smaller for us, she says, explaining that the tunnel is covered by something called the transverse carpal ligament, and as we age, it gets thicker. “And as it thickens, there’s really no place for the nerve to go, causing pain.”

Can arthritis lead to carpal tunnel syndrome?

Yes, notes Scott Fried, MD, hand and upper extremities orthopaedic surgeon and president of Doctor In The House. “In some patients, arthritis can actually change the shape or contour of the hand and wrist. When there is less room for the median nerve to go through the carpal tunnel, it can cause increased pressure, leading to carpal tunnel syndrome.”

But it’s important to note the reverse is not true: Carpal tunnel doesn’t increase the chance of developing arthritis. The good news is that both conditions are easily treated, he promises.

How to ease carpal tunnel syndrome

Here, Dr. Nellans shares a few tried-and-true strategies to help alleviate the pain and swelling caused by carpal tunnel syndrome.

Use a wrist brace at night

The first line of defence is simply wearing a brace at night. “It doesn’t have to be tight,” she assures. “It just has to keep the wrist out of the flexed position, and it can be really helpful.” She adds that you don’t need to pick up a pricey, specially made brace. In fact, you can easily find one on Amazon. One option: FEATOL Wrist Brace for Carpal Tunnel.

Prop your phone up

People often exacerbate carpal tunnel pain by holding their phone in an awkward position at night while they’re in bed, she says. “I recommend getting something to prop up your phone instead—they make these little triangles out of foam that you can set your phone on so you’re not placing your hand in an awkward position.”

Ask about steroid injections

If you’re in a lot of pain, steroid injections can settle down the nerve as well as the inflammation inside the joint, she notes. “These injections deliver the medication right where it needs to be.” Talk to your doctor to learn if this treatment may be an option for you.

Consider surgery

If you’re in extreme pain, you may want to get X-rays as well as nerve conduction studies (NCS) and electromyography (EMG). “These are tests a hand surgeon might recommend to confirm a diagnosis and give you an idea if surgery is necessary,” she says.

What does carpal tunnel surgery entail? “We take the covering that sits on top of the nerve and open it up. It’s actually one of my favourite surgeries to do, because you watch the blood flow back into the nerve and expand into the space you have provided—the nerve is so much happier.”

The great news is that after surgery, relief is almost immediate. “Patients may feel pain from the incision itself, but it’s a very quick recovery,” she assures. “I think that’s why I like hand surgery so much—we can do these minor interventions and have a huge impact on patients’ quality of life.”

How to ease wrist arthritis pain

Here, Dr. Nellans’ tips to tame arthritis flare-ups that affect the wrist joint quickly:-

Take over-the-counter meds

Anti-inflammatory medications like Aleve and Motrin are shown to ease arthritis aches. But it’s important to note that they do not alleviate the nerve pain associated with carpal tunnel, she reveals. Consult your physician before embarking on any new treatment plan.

Soothe aches with ice and heat

For an acute injury, ice is important in the short term. But over the long haul, heat helps bring better blood flow into the area, Dr. Nellans explains. “If it feels good to put ice on aching joints because your hands are sore at the end of a long day, do that. But if they feel really stiff in the mornings, heat can help joints become a little more flexible.”

Pick up ergonomic tools

Avoiding strenuous activities that put pressure on your joints is mission number one, notes Dr. Nellans. But it’s just as important to pinpoint tools that will make everyday tasks easier. “Look for devices that help you open those tight jars, for example, or get cooking implements with softer, bigger handles so you’re not working so hard—these small changes can make a huge difference.” (Check out a few joint-friendly tools here).

What works for both conditions?

Along with enjoying an anti-inflammatory Mediterranean diet—full of veggies, legumes, fruits, nuts and fish—Dr. Fried recommends soothing both carpal tunnel and arthritis pain with the over-the-counter gel Voltaren. “It really calms painful inflammation.” What could be better than a doctor’s endorsement? “My son is a stuntman in Hollywood, and he swears by it.”

https://www.womansworld.com/wellness/carpal-tunnel-vs-arthritis-symptoms-and-pain-relief-tips

Hand and wrist arthritis: You have great options for relief

From novanthealth.org 

Charleston orthopaedic surgeon discusses treating the most common form of arthritis

Whether we type for a living or deliver heavy boxes all day, our hands and wrists can take a beating.

More than 50 million people in the U.S. have arthritis, a condition that damages the joints. Its most common form, osteoarthritis, is a chronic and degenerative disease that affects sensitive cartilage where bones connect to form a joint (think the wrist and knuckles).

Dr. Eric Angermeier

“It's a disease that does not discriminate much and affects a broad swath of people,” said orthopaedic hand and wrist surgeon Dr. Eric Angermeier, co-founder of the Hand Institute of Charleston - Mount Pleasant. To make an appointment, click here.

Angermeier explains how we come to suffer from arthritis and the treatment options that can bring pain relief.

What is arthritis?

The fundamental common element in all types of arthritis is that the cartilage breaks down. And as that cartilage thins and eventually goes away, what you have are two raw bone ends bumping into each other. That often means a lot of pain.

And, as Angermeier explains, a lot of hand and wrist arthritis is determined by genetics rather than wear and tear. Some people just have joints that wear out faster than others. That said, symptomatic arthritis peaks in our 60s or 70s because people are still active and using their hands a lot and aggravating their arthritis.

And while there is no cure for arthritis, advancing technology is helping surgeons rebuild joints to reduce pain and improve function while also promoting a faster recovery.

Are there certain professions that are more difficult for those affected by arthritis?

It really comes down to genetics in a lot of cases. If you have a direct injury to the cartilage of your joints, that can hasten the wear-and-tear of the cartilage. So, if you're in an occupation like construction, you’re more likely to have injuries to the cartilage that may accumulate over time.

But the flipside of that is you may have been one of these folks who was going to get arthritis anyway. If you’re a heavy manual labourer and happen to have arthritis, you're going to hurt a lot more because you're using your hands for heavier activities.

So it's a chicken-or-the-egg kind of situation. We used to think that heavy manual activities may have caused arthritis, but now we think that people with bad arthritis are probably going to get arthritis anyway, and it's the heavy manual activity that's aggravating it.

There are some outliers. If you’ve run ultra-marathons for many years, you're more likely than the average person to have arthritis and wear out your cartilage over time. But a lot of hand and wrist arthritis is determined by genetics and normal use. This is everyone from folks who enjoy gardening and crocheting all the way up to people working construction.

How can we prevent arthritis?

As we age and our cartilage wears out, the joints tend to get stiffer. One thing you can do to counteract the effect of osteoarthritis is to develop a daily regimen of finger stretching and wrist stretching that will help to maintain your range of motion. Even though the arthritis continues to progress, you'll be more functional.

But as yet, we don't have any known treatments, supplements, stretches, braces or other technologies that slow the progression of arthritis or prevent it. We truly don't have any tools to prevent osteoarthritis. Fortunately, we have many opportunities to treat it or help modify the symptoms of arthritis.

Two of the most common supplements are chondroitin and glucosamine (both found naturally in cartilage). You see both of these advertised a lot for people with arthritis, but there is no quality research that indicates that any supplement, those included, slows or prevents the development of osteoarthritis.

Although chondroitin and glucosamine do not prevent arthritis, there is some limited evidence that they can reduce arthritic pain in some patients and are generally felt to be safe. I just wouldn’t recommend spending a lot on supplements that don’t seem to be helping.

Who is a candidate for hand surgery, and how invasive is it?

You should always pursue non-operative treatment first. Usually, we'll try a steroid injection or two to see if we can get symptoms under control. But when that fails to yield adequate relief of pain and stiffness, the most commonly performed surgery for arthritis in the hand and wrist is a carpometacarpal [CMC] joint arthroplasty. It's essentially a reconstruction of the joint at the base of the thumb.

We've developed a minor outpatient procedure that is done through a single small incision, and we replace the bone-on-bone contact at the arthritic joint with an internal sling made from a tendon. The base of the thumb sits in a hammock-type structure that helps to prevent it from rubbing the arthritic bones.

This can significantly alleviate pain and improve strength and function. It’s one of the most satisfying procedures that we have to offer as hand surgeons because it can restore a tremendous amount of hand function.

The thumb represents about 50% of the overall function of the hand, so if you can get the thumb functioning pain-free and with more strength, that can change the quality of life for the patient.

What are the risks of surgery?

There's a very low risk of complications with this procedure and a very high rate of positive outcomes.

These procedures have become more and more minimally invasive, involving just a single incision at the base of the thumb, which helps speed recovery, causes less pain and lessens the risk of infection.

When should somebody make an appointment with an orthopaedic surgeon?

If there's anything bothering your hand or your wrist, I'd strongly encourage you to see a hand surgeon. I think the threshold should be pretty low to get things checked out. Hand and wrist arthritis is highly treatable and often with good results. And there are many different options available depending on where the arthritis is, the age of the patient and how active they are.

https://www.novanthealth.org/healthy-headlines/hand-and-wrist-arthritis-you-have-great-options-for-relief

Here are some options to treat arthritis in your hands and wrists

From eastidahonews.com

By the age of 85, 50% of all women and 25% of men will have osteoarthritis (OA) of the hands or wrists. When you consider how much a person uses their hands throughout their lives, these statistics are not surprising.

“The joints are like ball bearings,” explains Dr. Jhade Woodall, a hand and wrist surgeon practicing at Eastern Idaho Regional Medical Centre. “They can wear out for a lot of reasons. Some of the joints in the hand get very worn out or misaligned. Idaho is a place where the hardworking population just wears out their ball bearings, but we are able and willing to help them. We have great outcomes.”

                                                                      Stock image

Osteoarthritis is a degenerative disease that, over time, breaks down the protective cartilage on the end of bones, causing them to rub together at the joints. Most people are familiar with the common symptoms of OA: joint stiffness, swelling and pain. Although there is no cure for arthritis, there are still benefits to seeking medical care early on, and there is a wide range of treatment options available to control symptoms and get relief.

“Typically, in the early stages of arthritis, we start treatment with acetaminophen gel, rest and physical therapy,” says Dr. Woodall. “Steroid injections are common and effective, especially when combined with physical therapy. Some people can get years of relief with a single steroid injection.”

There are also new, minimally invasive surgical options.

“The newest thing I offer is joint denervation — cutting the nerve that provides peripheral sensation to the joint,” explains Dr. Woodall. “It’s mainly used to treat wrist arthritis, but it’s starting to be used in knuckles too.”

“The procedure is minimally invasive — a small skin incision. Healing time is much shorter than the months of recovery needed after a joint replacement. Patients just take it easy for a couple weeks and then they are back to full function. If there is true joint destruction, no matter the type of arthritis, denervation is a reasonable treatment option to explore.”

As OA progresses in the hands and wrists, functionality is affected. Patients lose strength and dexterity. It is common for the fingers to bend and twist, and for nodules to form on the bones, deforming the fingers and hands. Even so, says Dr. Woodall, surgical treatment to reduce pain and preserve motion is still an option for some patients.

“Bones can be removed. Joints can be fused to reduce pain, or joints can be replaced to retain mobility. The treatment is tailored to the patient. I talk to the patient, find out what they can and cannot do with their hand to determine how aggressive to be with procedures. For instance, joint fusion removes motion, but it can result in stronger grip strength because of reduced pain.

“Some people shy away from surgery, believing that surgery will make the pain worse. Often, however, once patients have surgery performed on one hand, they return to have surgery on the other hand. Surgery can significantly reduce pain for a long period of time,” he says.

Dr. Woodall is enthusiastic about helping his patients. “I like to make people feel better. Arthritis patients often think they have to live with the pain, that nothing can help them. But that’s not the case. People don’t have to live with debilitating arthritis.”

https://www.eastidahonews.com/lifestyles/here-are-some-options-to-treat-arthritis-in-your-hands-and-wrists/ 

Treatment Options for Patients with Wrist Arthritis

From williamsonsource.com

Wrist arthritis is incredibly common, with one in seven Americans suffering from the ailment. But the good news is there are many effective, non-invasive or minimally-invasive treatment options available.

Todd Wurth, M.D. is an upper extremity specialist with Bone and Joint Institute of Tennessee treating nerve-related disorders, fractures, and arthritis in the shoulder, elbow, wrist, and hand. He shares valuable insights into what wrist arthritis is and how to treat it. 

Wrist Arthritis Types

Like any joint, there are three types of wrist arthritis:

1. Osteoarthritis: Wear and tear arthritis, which develops with time and age.
2. Inflammatory arthritis: A condition where the body’s immune system will attack joints. Those conditions can include rheumatoid arthritis and lupus.
3. Post-traumatic arthritis: Occurs after a fracture or serious ligament injury in the wrist that results in instability and arthritis. This is the most common type of wrist arthritis that Bone and Joint Institute treats.

When to See a Doctor for Wrist Arthritis

When the condition starts to negatively impact your life, such as affecting your ability to do things you want or need to do, that’s when you should consider seeing an expert.

Here’s a look at the treatment options for wrist arthritis:

Intermittent Wrist Splinting

This treatment option is non-invasive and good for patients who have mild discomfort or swelling. Arthritis is a condition where you may have good weeks and bad weeks. Some weeks you might have times when you have no problems at all and feel no need to wear the splints. Then you have weeks where you have pain with weather changes or overuse and choose to wear the splints to get back on track. This puts the patient in charge of their needs based on their comfort levels.

Anti-Inflammatory Medication 

Oral medications available to help include Advil and Aleve, but there are also topical medications that work well because the wrist joint is not considered a deep joint. Topical medication is especially good for those who struggle with oral anti-inflammatory drugs, such as individuals on blood thinners or patients with an ulcer or other stomach conditions.

Cortisone Injections

Another initial treatment option before surgery is a cortisone injection in the wrist. Cortisone is a potent anti-inflammatory. Your medical provider will inject a small but concentrated dose that goes directly to the site of the arthritis. 

It does not cure the problem, but it can provide significant relief of symptoms. The length of the relief an injection provides will vary based on the arthritis and the patient. The more severe the arthritis, the less relief time you may get with cortisone injections.

Dr. Wurth generally recommends getting one injection in any joint in the body no more than every six months. If you do them too close together, such as every two months, it isn’t good for the soft tissue and in some instances can speed up the arthritic process. However, utilizing cortisone injections with six months between treatments will not create any adverse reactions or conditions.

Wrist Denervation

If a patient’s condition reaches a point where all of the previous options are not helping and they can’t do what they want or need to do in a day, that’s when providers might start discussing surgical options. Surgery for wrist arthritis can vary depending on the location in the wrist where the arthritis is located.

The most minimally-invasive procedure is wrist denervation. The wrist has two nerves that supply it with pain pathways. These nerves do not serve crucial muscle functions to the body like those in the arm and forearm, which means they can be dissected and removed to prevent signals of pain delivered from joints around your hand and wrist. This procedure is for people who have mild to moderate arthritis in their wrists, but patients with more severe pain might not get the most relief from this method.

To find out whether an individual will benefit from wrist denervation, Dr. Wurth has patients visit his clinic in Franklin and does a nerve block with a long-acting local anaesthetic. The nerve block lasts 12 hours near those two nerves in the wrist that would be impacted by the wrist denervation. Once the nerve block is in place, he advises patients to go out and do what they love and try to use their wrists – play golf, work in the yard, or do something that will aggravate the wrist while monitoring how it feels over the next 12-24 hours. If they have a positive response to this, then the wrist denervation may work well for them. 

While wrist denervation often offers mild relief of symptoms, it is not permanent relief and does not stop the arthritic process, which can get worse with time. The procedure, however, has historically offered many patients years of relief.

Wrist Arthroscopy

Patients that are not candidates for wrist denervation can be evaluated for wrist arthroscopy. During this process, the surgeon scopes the wrist and removes damaged tissue or foreign objects from the joint. This is a more common option for patients with inflammatory-related arthritis.

Proximal Row Carpectomy

For advanced arthritis, Dr. Wurth looks at procedures where he removes a couple of carpal bones in the arthritic portion of the wrist. While removing bones from the wrist sounds unnerving, a patient’s wrist has many carpal bones that will adjust naturally to the surgically-altered wrist to accommodate the change with rehabilitation. 

Limited Wrist Fusions

Limited wrist fusion involves taking out one bone that is arthritic and then fusing other bones together. The procedure still allows patients to flex and extend their wrists while offering good pain relief. 

Total Wrist Fusion

Total wrist fusion is reserved for more extensive arthritic conditions or arthritis associated with instability.  The procedure does not allow patients to flex or extend their wrist but still allows them to rotate their forearm/wrist.  For patients presenting with a wrist fusion as an option for relief, Dr. Wurth instructs patients to wear a wrist splint full-time to get a feel for what their mobility will be like after the wrist fusion.

Wrist Replacements

Wrist replacements are reserved for special conditions. Generally, they serve as an option for patients with lower mobility demands and are largely not suitable for patients that need their wrists for higher-demand activities such as lifting heavier objects. This procedure is usually best for patients with immune-related arthritis and multiple-joint arthritis. 

Preventing Wrist Arthritis

If you’ve fallen and have significant swelling around the wrist and pain that has lasted more than two weeks, it’s worth getting an X-ray. Dr. Wurth sees many patients who come in and have experienced a fall. In the aftermath, they visited an urgent care facility or the ER and the X-ray showed everything was normal. Dr. Wurth recommends patients spend two weeks in a wrist splint and repeat the x-ray in two weeks if pain and swelling persist.

Dr. Wurth also warns that wrist fractures can be sneaky because they might not show up on X-ray initially, and then when you repeat the x-ray later on they suddenly become evident. 

Lots of patients visit Bone and Joint in their 30s and 40s with arthritis in their wrist and when the medical professional does the x-ray, they see a fracture that never healed. These patients can often share an instance from decades ago where they fell and suffered a wrist injury, yet the x-ray didn’t show anything. 

From a prevention standpoint, it’s always best to pay close attention to wrist injuries and listen to your body. Ongoing pain is often trying to tell you something.

https://williamsonsource.com/treatment-options-for-patients-with-wrist-arthritis/

Reducing the pain, increasing function with wrist arthritis

From royalexaminer.com

Wrist arthritis is common in older adults. Often, it develops as the result of past trauma or fracture, but there are simple steps that can reduce pain and increase function.

• Apply heat, cold, or both. An electric heating pad or warm water soaks can ease pain and stiffness. An ice pack or cold water soak can reduce pain from a flare-up caused by too much activity.
• Contrast baths can also be helpful. Soak hands in warm water for 10 minutes. Then switch to cold water for one minute. Or cycle back and forth for half an hour and end with warm water.
• Apply a topical prescription pain relievers gel like Voltaren or Solaraze.
• Over-the-counter pain relievers can help. Acetaminophen (Tylenol and others) and Advil have the lowest risk of side effects.
• Wear a splint to limit movement during a wrist-intensive activity.
• If pain persists, ask your doctor about anti-inflammatory medication or corticosteroid injections.
• Some surgical techniques are available when severe pain is unresponsive to other treatments, including total wrist replacement. Wrist fusion can help younger people with advanced arthritis, but the trade-off is loss of joint mobility.

https://royalexaminer.com/reducing-the-pain-increasing-function-with-wrist-arthritis/

Ask the doctor: Could I have arthritis in my wrist?

From independent.ie
By Dr Jennifer Grant

Q I am a 40-year-old woman and have been having pain in my right wrist on and off for a couple of years. It is exacerbated by working with a mouse, but also is present when I don't work at a desk for a long period of time. I also get joint pain in my hips, etc, but nothing I would worry about as it disappears when I exercise regularly. Is there a possibility that I have arthritis in my wrist? If so, how do I get that checked out.

A It sounds like you may have a simple repetitive strain injury as you describe the computer mouse as an exacerbating factor for your wrist pain. I wonder if you have tried using ergonomic supports?

Most people who work long hours at a desk are likely to be at risk of repetitive strain injury. However, an ergonomically coordinated computer workstation can help reduce your risk. Ensure there is adequate room for the keyboard and mouse (if you have to keep one). There is a fine balance between being too far away from the keyboard or too cramped. Getting the distance right will mean you will be able to maintain good posture and body alignment, which are key elements to any computer workstation.

Ensure your computer screen is at eye level by adjusting the height of your chair and/or table. This promotes correct posture and helps to keep your wrists and hands in-line with your forearms (i.e. neutral alignment). Improving your hand muscle strength by performing thumb stretches for 10 seconds periodically can also be helpful.

You can attend an occupational therapist, physiotherapist or someone with training in this area for a full assessment and advice.

You mentioned your wrist pain is not always brought on by working at your desk. Think about what other activities at home that may be exacerbating your pain. You are probably right-handed and use the right wrist more than the left. Do you have a newborn infant or toddler at home who requires a lot of handling?

Other medical conditions to consider are the possibility of gout, rheumatoid arthritis or osteoarthritis. If you have a family history of any of these diseases, you are at higher risk. There is a certain amount of mild joint pain and stiffness that can be expected over 50 years old. These are considered 'age-related change' and are often seen on scan. But if the pain is persistent over a number of months and is starting to progress, then it may be osteoarthritis (OA).

The classic symptoms of OA are pain and stiffness. There are many different types of arthritis but OA is the most common form. Joint pain is typically worse after joint use, exercise or towards the end of the day. There may be a limitation in range of motion of the joint.

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Typically, OA affects one joint initially whereas rheumatoid arthritis affects multiple joints on both sides of the body in a symmetric pattern. As OA progresses, the joint becomes painful at night, resulting in sleep disturbance and often bone swelling surrounding the joint. An X-ray will help identify moderate to severe joint involvement but an MRI scan is better at identifying early OA changes.

For the majority of patients, there is usually one or more risk factors present that ultimately lead to the development of OA over time. If your pain persists or gets worse, you should attend your GP for a full history, clinical examination and investigations.
⬤ Dr Jennifer Grant is a GP with Beacon HealthCheck

https://www.independent.ie/life/health-wellbeing/ask-the-doctor-could-i-have-arthritis-in-my-wrist-39357362.html