Carpal tunnel syndrome is one of the most common hand problems. But because the disease shares many of the same symptoms with other health conditions, it is sometimes misdiagnosed. Read on to learn about the two conditions that are often misdiagnosed as carpal tunnel syndrome, causes of carpal tunnel syndrome, how it is diagnosed and treated!
Carpal tunnel syndrome is caused by a bottleneck in the tendon compartment of the wrist. This pinches the median arm nerve, which supplies different areas of the hand. Typical symptoms are numbness, abnormal sensations, pain, later paralysis and functional disorders.
ICD codes for carpal tunnel syndrome: G56
Quick overview
- Symptoms: The hand goes to sleep at night , abnormal sensations, pain, later functional limitations, paralysis, reduced sense of touch.
- Diagnostics: Queries on typical symptoms and possible risk factors, function and pain tests, measurement of nerve conduction velocity.
- Causes and risk factors: Long-term wrist strain, predisposition, rheumatism, injuries, water retention, diabetes, obesity, kidney failure.
- Treatment: nightly immobilization with a splint, cortisone treatment, if necessary surgical expansion of the carpal tunnel.
- Course and prognosis: Complete healing with timely therapy, irreversible signs of paralysis possible if treatment is delayed.
- What are two conditions that are often misdiagnosed as carpal tunnel syndrome?: arthritis is a condition commonly misdiagnosed as carpal tunnel syndrome….
- Prevention: treat pre-existing conditions, reduce obesity, avoid one-sided stress.
What is carpal tunnel syndrome?
With carpal tunnel syndrome, an important tendon compartment, the so-called carpal tunnel, is narrowed in the wrist. It constricts a nerve that supplies certain areas of the hand. Possible consequences are discomfort, pain and signs of paralysis.
The carpal tunnel is formed by the carpal bones and a stabilizing band of connective tissue. Some hand tendons and the middle arm nerve (medial nerve) run in its middle. This runs from the shoulder over the upper and lower arm. In addition to two other nerves, it controls muscle movements and enables the sense of touch in the hand.
If the tunnel narrows, the nerve is strained and irritated by the pressure. Then the typical symptoms of carpal tunnel syndrome appear, such as numbness, pain and later even signs of paralysis.
CTS is more common in women than men and tends to develop between the ages of 50-54 and 75-84 years.
How often is carpal tunnel syndrome misdiagnosed and why?
Carpal tunnel syndrome is often misdiagnosed and testing is a problem. The reason it is often misdiagnosed is that it shares symptoms with other conditions. Symptoms of carpal tunnel syndrome, such as pain, numbness, tingling, and difficulty gripping, are also symptoms of other conditions.
What are the symptoms of carpal tunnel syndrome
In the early stages, those affected often do not take carpal tunnel syndrome seriously. However, the longer the nerve is pinched in the wrist, the more likely it will be permanently damaged. It is therefore important to have the first signs of carpal tunnel syndrome clarified neurologically.
Early symptoms
Hands falling asleep at night: A typical sign of carpal tunnel syndrome in the early stages is fingers falling asleep at night. In the beginning it is usually sufficient to relocate the hand. Very severe pain occurs later, extending up to the arm and shoulder. Those affected often wake up at night with aching fingers.
Doctors also refer to this phenomenon as brachialgia paraesthetica nocturna. In the morning the fingers are swollen and stiff.
Abnormal sensations: The carpal tunnel syndrome is usually announced by tingling abnormal sensations on the palms of the hands. Later, they gradually extend to part of the fingers.
The median arm nerve supplies the inner surfaces of the thumb, index and middle fingers, and the thumb side of the ring finger. This is where the classic symptoms develop. The pinky side of the ring finger and the pinky itself are not affected by carpal tunnel syndrome because they are supplied by a different arm nerve.
Pain: Initially, pain only occurs after the wrist has been particularly stressed. This includes, for example, gardening, renovating or cleaning. At a later stage, the symptoms also appear suddenly without any recognizable reason, i.e. “spontaneously”.
Deteriorated sense of touch, clumsiness: The tactile and sensitive senses of the fingers also deteriorate with carpal tunnel syndrome. Those affected then have difficulty, for example, in buttoning up a piece of clothing or picking up small objects.
Later stage symptoms
Loss of sensitivity: If the pressure on the nerves persists for a long time, they will become increasingly damaged. Soon the unpleasant sensations in the fingers will disappear. In return, they become largely insensitive. Paralysis occurs later.
Muscle wasting in the thumb: A muscle in the thumb, which is controlled by this nerve, then gradually atrophies. A visible dent develops on the ball of the thumb (thumb ball atrophy).
Muscle atrophy in the thumb severely limits its function. If the thumb can no longer be spread, the patient finds it difficult, for example, to pick up something or to grasp a bottle.
At this stage, the nerve is already severely damaged. If therapy is only started now, it is often too late – the damage to the nerve can no longer be reversed. Lifelong numbness in the palm and paralysis of the thumb are possible consequences.
Symptoms on both hands?
Symptoms usually develop on both hands one after the other. However, there are sometimes months or even years in between.
Since the dominant hand is more heavily loaded, carpal tunnel syndrome usually occurs there first – i.e. on the right hand in right-handed people. The symptoms are usually more pronounced here than in the other hand.
Two conditions that are often misdiagnosed as carpal tunnel syndrome
Arthritis is a condition commonly misdiagnosed as carpal tunnel syndrome. Arthritis can affect all fingers, while SCC cannot affect the little finger. Another key difference is that CTS tends to be worse at night and arthritis is not affected by the weather. So while the two share symptoms, there are key differences between the conditions. In particular, rheumatoid arthritis (RA) is easily confused with CTS in the early stages.
Another condition that shares symptoms is wrist flexor tendonitis. The signs and symptoms of the conditions are similar. Both may have tingling, pain, and numbness in the hands or fingers. Although they may sound similar, the “say” comes from the location of the pain or discomfort. CTS occurs on the palm side of the wrist, and the tingling may move to the thumb, index, and middle fingers. On the other hand, tendonitis occurs on the other side of the wrist with numbness in the little finger. If you experience symptoms in your little finger, it may not be CTS because carpal tunnel syndrome does not extend to your little finger.
These are just two conditions that are often misdiagnosed as carpal tunnel syndrome. That’s why it’s so important to talk to your doctor and get an accurate diagnosis.
What has the same symptoms as carpal tunnel?
Other conditions that may share some of the same symptoms as carpal tunnel syndrome include:
- Pinched nerves
- Ligament damage
- Neuropathy
- Wrist injury
How is carpal tunnel syndrome tested?
The first step in diagnosing carpal tunnel syndrome is determining your personal medical history. The doctor asks the patient, among other things, about their symptoms and possible risk factors such as physical work, previous illnesses and illnesses in the family.
The next step is a physical examination. The doctor checks the following aspects, among others:
The muscles of the ball of the thumb: The doctor can tell by touch whether the muscle has already receded.
Thumb function: The function of the thumb is also examined. For example, the doctor asks the patient to hold a bottle. It is typical of carpal tunnel syndrome that the patient is no longer able to spread the thumb well or at all.
Sensitivity: The doctor tests the sense of sensitivity by stroking the patient’s palm with a cotton swab. If this does not perceive the touch, the surface sensitivity is disturbed.
Sense of touch: To test the sense of touch, the patient is given the task of picking up coins or paperclips.
Provocation tests
Hoffman-Tinel test: This carpal tunnel syndrome test involves tapping the skin over the carpal tunnel. If this causes pain and discomfort in the patient, this is a sign of carpal tunnel syndrome.
Phalen’s sign: For this test, the patient places their hands together, backs of the hands together. The wrist is strongly bent. If the pain increases, this also speaks for carpal tunnel syndrome.
Neurological carpal tunnel syndrome test
However, carpal tunnel syndrome can only be diagnosed with certainty on the basis of a neurological examination.
In order to exclude other diseases with similar symptoms, the doctor often also examines the elbow region as well as the neck and shoulder area. There is also a possibility that the median arm nerve is constricted at these points.
Electroneurography: With the help of electroneurography, the doctor measures how quickly the median arm nerve transmits received stimuli and transmits them to a muscle. In a so-called surface ENG, electrodes are stuck to the skin. The conduction velocity of the median arm nerve is then compared to that of a healthy nerve. This examination is painless.
In some cases, an exact measurement with a surface ENG is not possible. This is the case, for example, when the nerve does not run normally. For a needle ENG, small needles are then inserted directly near the nerve, with the help of which the measurement is taken. That might hurt a bit. However, the study is relatively short. After that, there are usually no further complaints.
In addition, imaging methods provide information on the condition of the carpal tunnel and possible causes of problems. They are used when necessary:
Ultrasound: The ultrasound examination can be used to determine how narrow the carpal tunnel is.
X- ray: With an X-ray examination, the doctor checks whether arthrosis-like changes narrow the wrist.
Magnetic resonance imaging: If the doctor suspects that a tumor is causing the symptoms, this can be clarified with magnetic resonance imaging.
What causes carpal tunnel syndrome?
There are a number of possible triggers for carpal tunnel syndrome and various risk factors that increase the likelihood of it.
Narrow carpal tunnel: People who naturally have a rather narrow carpal tunnel fall ill more often. For this reason, women are generally more likely to get carpal tunnel syndrome than men.
Heredity: Congenital anatomical narrowing is probably the reason why carpal tunnel syndrome is particularly common in some families.
Wrist strains: People who do physical work are more likely to be affected than those who do not do physical work. People who operate machines with strong vibrations and those whose wrists are constantly exposed to high stress, such as upholsterers or farmers, have a particularly high risk.
Injuries: Carpal tunnel syndrome develops easily after an injury near the wrist, particularly a broken spoke.
Inflammation: Another possible cause is inflammation and swelling of the tendon sheaths, which also lie in the carpal tunnel and then press on the nerve.
Rheumatism: Inflammation in the joints mainly affects rheumatism patients. Every second rheumatic patient therefore develops carpal tunnel syndrome. This is often the first sign of an incipient rheumatic disease.
Chronic kidney weakness: In people who often have to have dialysis due to kidney weakness, carpal tunnel syndrome easily develops on the arm that is connected to the dialysis machine.
Water retention: If more water is stored in the joints, the ligaments thicken. This reduces the space in the carpal tunnel. There are various triggers for this, for example an overactive or underactive thyroid gland, diabetes mellitus, obesity or hormonal changes caused by pregnancy or menopause.
How is carpal tunnel syndrome treated?
Milder cases of carpal tunnel syndrome can be relieved without surgery. For example, by immobilizing the affected hand with a splint overnight. If inflammation is the cause of the narrowing of the carpal tunnel, cortisone can help – in the form of tablets, sometimes also as an injection. Some sufferers take painkillers for carpal tunnel syndrome.
In some cases, carpal tunnel syndrome requires surgery.
How does carpal tunnel syndrome progress?
In principle, everyone is at risk of developing carpal tunnel syndrome. Both hands are usually affected sooner or later. Both the symptoms and the course of carpal tunnel syndrome vary greatly from patient to patient.
In general, symptoms progressively worsen as the disease progresses and worsen after heavy exertion, during pregnancy, and after arm injuries.
The symptoms caused by carpal tunnel syndrome rarely remain constant over a long period of time. Some patients have only moderate symptoms for years, which are interrupted by long periods without symptoms. In such cases, those affected often go to the doctor late. The nerve is then usually already irreversibly damaged.
How long those affected are ill and unable to work after an acute flare-up is individual and depends on various factors, such as occupation and therapy.
With timely and successful surgery, it is possible for carpal tunnel syndrome to be completely cured. The pain usually disappears the day after the procedure. The patient then trains mobility as well as the sense of touch and sensation again.
Training hands after surgery
It is essential that you regularly carry out the exercises recommended by your doctor and/or physiotherapist and have a neurologist monitor the healing process after the operation.
Depending on the severity of the disease, the healing process sometimes takes several months.
Complications such as bleeding and infection are rare in carpal tunnel surgery. However, in some cases additional surgery is necessary.
Unable to work due to severe nerve damage
If the nerve is severely damaged, complete healing is no longer possible. The patients then suffer permanently from sensory disturbances in the hand and from paralysis in the area of the thumb. This sometimes severely restricts everyday and professional life and in individual cases leads to disability.
So be sure to see a doctor at the first sign of carpal tunnel syndrome. The earlier the treatment begins, the better the chances of recovery!
How can carpal tunnel syndrome be prevented?
There are many factors that trigger carpal tunnel syndrome – not all of them can be eliminated. However, it is important to treat previous illnesses such as inflammation, overactive or underactive thyroid glands and diabetes mellitus, and to avoid being overweight and thereby reduce the risk.
If possible, also avoid movements and postures that are too one-sided, for example placing your hands permanently on the computer or the tabletop. Varied and relieving movement sequences enable body-friendly work even in risky occupations.
Conclusion
As we have described above, the symptoms of some other diseases are also similar to those of carpal tunnel syndrome. If you experience any of these symptoms and are concerned about the two conditions that are often misdiagnosed as carpal tunnel syndrome, without wasting time consult your doctor.
