Carpal tunnel syndrome is one of the common complications of rheumatoid arthritis.
- The condition occurs more frequently with rheumatoid arthritis because inflammation and swelling can increase the pressure in the carpal tunnel and cause the compression of median the nerve.
- This may interfere with hand strength and sensation and cause a decrease in hand function along with symptoms, such as numbness and pain.
What is carpal tunnel syndrome?
Carpal tunnel syndrome is described as an “entrapment neuropathy” characterized by pain, numbness, and weakness in the wrist and hand that may radiate to the arm and fingers.
- The median nerve that extends from the forearm passes through the wrist to the palm of the hand through a narrow tunnel called the carpal tunnel, which serves to protect the nerve and tendons.
- This nerve is responsible for the movement of the fingers (mainly index and middle finger) and thumb and controls sensation to their palm side.
- When there is increased pressure or compression on the median nerve in the carpal tunnel, it leads to carpal tunnel syndrome.
What are the symptoms of carpal tunnel syndrome?
Symptoms typically begin slowly in the palm of the hand and fingers and are characterized by a burning, tingling, or aching sensation. The patient may feel their fingers are swollen, and they lack normal strength. These symptoms appear in the morning after a person wakes up, but they could happen during the night and interrupt their sleep.
When the syndrome progresses, it results in reduced grip strength and decreased nerve sensation. The syndrome usually tends to involve the dominant hand first and causes the most severe symptoms in this hand.
What other causes can lead to carpal tunnel syndrome?
In addition to rheumatoid arthritis, a combination of several factors can cause or worsen carpal tunnel syndrome, including:
- Repeated flexing movements of the wrist and fingers, sprains, or fractures
- Continued use of vibrating hand tools
- Fluid retention during pregnancy or menopause
- People with diabetes, an underactive thyroid gland, or other disorders that directly affect the nerves may develop carpal tunnel syndrome
This syndrome affects middle-aged to older individuals more than younger people. Females are three times more affected than males.
How is carpal tunnel syndrome diagnosed?
The diagnosis of carpal tunnel syndrome is based on a physical exam, which may reveal a decreased sensation of the hand when pricked or touched lightly, and tapping the wrist along the nerve may produce an electric current-like sensation.
A definitive diagnosis of carpal tunnel syndrome can be made with the help of nerve conduction studies and electromyography.
Sometimes, doctors will use ultrasound to identify a swollen or enlarged median nerve.
How is carpal tunnel syndrome treated?
Once the diagnosis of carpal tunnel syndrome had been made, treatment is necessary to prevent any nerve damage, which can become permanent.
In patients with rheumatoid arthritis, who develop carpal tunnel syndrome, the condition is mostly treated with anti-inflammatory drugs or cortisone injections to reduce inflammation.
Splinting could be used especially during the nighttime to immobilize and prevent flexing of the wrist.
If the symptoms do not resolve with conservative measures, surgery to decompress the pressure on the median nerve could be required.
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American Academy of Orthopaedic Surgeons. Carpal Tunnel Syndrome. https://orthoinfo.aaos.org/en/diseases--conditions/carpal-tunnel-syndrome/
Medline Plus. Carpal tunnel syndrome. https://medlineplus.gov/ency/article/000433.htm
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