Carpal Tunnel vs. Arthritis

Carpal tunnel syndrome typically affects the hands, while arthritis can affect almost any joint of the body.

• Carpal tunnel syndrome results from irritation of the median nerve in the wrist. In contrast, arthritis is a general term used for any joint disorder that features inflammation (for example psoriatic arthritis, rheumatoid arthritis, gouty arthritis).
• Carpal tunnel syndrome typically affects the thumb, index and middle fingers of the hands, while arthritis can affect almost any joint of the body.
• Carpal tunnel syndrome causes pain (usually a burning pain) in the thumb index and middle fingers and may also be associated with hand weakness, paresthesias (like tingling or numbness), and decreased sensation of touch. Arthritic symptoms, on the other hand, occur in joints almost anywhere in the body. Arthritis can cause a wide range of symptoms such as limited function and pain in the joints, joint stiffness, swelling and, in some patients, joint deformity is present - arthritis is a form of rheumatic diseases while carpal tunnel is not.
• The cause of carpal tunnel syndrome is unclear, but has risk factors of pregnancy, arthritis and/or inflammation of the wrist, diabetes, hypothyroidism, alcoholism, and wrist trauma while the causes of arthritis depends upon the form of arthritis. For example, joint injury (trauma), abnormal metabolism (gout), inheritance (osteoarthritis), infections (for example, Lyme disease) and an overactive immune system (for example, rheumatoid arthritis and systemic lupus erythematosus).
• Carpal tunnel treatment may include anti-inflammatory medication such as ibuprofen, direct injection of steroid medication, wearing a wrist splint or brace, and surgical treatment that involves surgical release of the ligament that covers the carpal tunnel to take the pressure off of the nerve. In contrast treatments for arthritis are quite variable and depend upon the particular form of arthritis.
• Carpal tunnel treatments to produce relief of discomfort may include NSAID’s and steroid injections like some forms of arthritis, but usually does not include other arthritis treatments. Arthritis treatments include oral supplements like glucosamine, and chondroitin and/or fish oil or dietary changes to reduce gouty arthritis or methotrexate to treat rheumatoid arthritis. Additionally, some joints can be injected with hyaluronic acid while others simply require total joint replacement (most commonly, knee and hip arthritis – major surgery with rehabilitation and exercises).
• Carpal tunnel usually has a better prognosis than many of the forms of arthritis; some forms of arthritis can be crippling and irreversible whereas carpal tunnel usually can be effectively treated with medication or even with the minor surgery to release pressure on the median nerve.

• Carpal tunnel syndrome is an irritation of the median nerve in the wrist that leads to numbness, tingling, pain, and weakness in the hand. The median nerve travels down the forearm and enters the hand after passing through the wrist tunnel (carpal tunnel) that is located in the central part of the wrist.
• The syndrome typically affects the thumb, index, and middle fingers and is often particularly troublesome at night.
• Carpal tunnel syndrome affects a low percent of the population and is most common in middle-aged women.
• Any condition that causes increased direct pressure on the median nerve in the wrist can lead to carpal tunnel syndrome. Many people with carpal tunnel syndrome have no identifiable cause.
• Carpal tunnel syndrome is diagnosed based on the complaints of the individual combined with physical tests and often electrical tests. No single test is definitive for diagnosis of carpal tunnel syndrome. Rather, the person's complaints and test findings together lead to its diagnosis.

• Arthritis is a joint disorder featuring inflammation. A joint is an area of the body where two bones meet. A joint functions to allow movement of the body parts it connects.\
• Arthritis literally means inflammation of one or more joints. Arthritis is frequently accompanied by joint pain. Joint pain is referred to as arthralgia.
• Arthritis is classified as one of the rheumatic diseases. These are conditions that are different individual illnesses, with differing features, treatments, complications, and prognosis. They are similar in that they have a tendency to affect the joints, muscles, ligaments, cartilage, and tendons, and many have the potential to affect internal body areas as well.
• There are many forms of arthritis (over 100 have been described so far, and the number is growing). The forms range from those related to wear and tear of cartilage (such as osteoarthritis) to those associated with inflammation as a result of an overactive immune system (such as rheumatoid arthritis). Together, the many forms of arthritis make up the most common chronic illness in the United States.
• Arthritis sufferers include men and women, children and adults. More than half of those with arthritis are under 65 years of age. A majority of Americans with arthritis are women.

Carpal Tunnel Symptoms

The following are symptoms associated with carpal tunnel syndrome. You may still have carpal tunnel syndrome if you have only a few symptoms.

• Numbness, pain (usually a burning pain), and tingling in your thumb, index, and middle fingers
• Tingling, numbness, or pain, which may move up your arm to your elbow
• Hand weakness
• Dropping objects
• Difficulty feeling and handling small objects

Symptoms are usually worse at night and are sometimes temporarily relieved by "shaking out" your hands.

Arthritis Symptoms

Symptoms of arthritis include limited function and pain in the joints.

• Inflammation of the joints from arthritis is characterized by joint stiffness, swelling, redness, and warmth.
• Tenderness of the inflamed joint can be present. Loss of range of motion and deformity can result.
• Certain forms of arthritis can also be associated with pain and inflammation of tendons surrounding joints.
• Arthritis can affect any joint in the body, including the knees, hips, fingers, wrists, ankles, feet, back, and neck. The pain may be intermittent or constant.
• Some types of arthritis cause acute episodes of symptoms (flare-ups).

Some forms of arthritis are more of an annoyance than a serious medical problem. However, millions of people suffer daily with pain and disability from arthritis or its complications.

Moreover, many of the forms of arthritis, because they are rheumatic diseases, can cause symptoms affecting various organs of the body that do not directly involve the joints.

Therefore, signs and symptoms in some patients with certain forms of arthritis can also include fever, gland swelling, weight loss, fatigue, feeling unwell (malaise), and even symptoms from abnormalities of organs such as the lungs, heart, or kidneys.

Carpal Tunnel Causes

The following are risk factors associated with the development of carpal tunnel syndrome:'

• Pregnancy
• arthritis and other causes of inflammation of the wrist
• Endocrine disorders such as diabetes and hypothyroidism
• Wrist fracture
• Alcoholism

Carpal tunnel syndrome is rare in children.

The relationship between work and carpal tunnel syndrome is unclear. Positions of extreme wrist flexion and extension are known to increase pressures within the carpal canal and apply pressure on the nerve. This is particularly true with repetitive strain injury to the wrist. Intensity, frequency, and duration of work activity and their relationship to carpal tunnel syndrome are unclear.

Arthritis Causes

The causes of arthritis depend on the form of arthritis. Causes include

• injury (leading to degenerative arthritis),
• abnormal metabolism (such as gout and pseudogout),
• inheritance (such as in osteoarthritis),
• infections (such as in the arthritis of Lyme disease), and
• an overactive immune system (such as rheumatoid arthritis and systemic lupus erythematosus).

Treatment programs, when possible, are often directed toward the precise cause of the arthritis.

More than 21 million Americans have osteoarthritis. Approximately 2.1 million Americans suffer from rheumatoid arthritis.

Risk factors for arthritis include the following:

1. Age: The risk of developing many types of arthritis, including osteoarthritis (the most common type), increases with age.
2. Genetics: Most types of arthritis, including osteoarthritis, rheumatoid arthritis, gout, and ankylosing spondylitis, have a genetic (inherited) component.
3. Gender: Most types of arthritis are more common in females. Some types, such as gout and ankylosing spondylitis, are more common in men.
4. Overweight and obesity: Excess weight predisposes to many types of arthritis due to added wear and tear on the joints.
5. Injuries: Injured joints are more likely to develop osteoarthritis.
6. Infection: Many infections can attack the joints and cause arthritis.
7. Occupation: Occupations involving repetitive movements can predispose to the development of osteoarthritis and other musculoskeletal conditions.

Carpal Tunnel Treatment

• Carpal tunnel syndrome is not primarily an inflammatory process. However, pain is a common complaint, and anti-inflammatory medications are sometimes used to try to treat the pain.
• Anti-inflammatory medications such as ibuprofen (Advil) may provide some relief but are unlikely to cure carpal tunnel syndrome.
• Direct injection of steroid medication by your doctor into the carpal canal has been shown to be an effective treatment for some people with carpal tunnel syndrome. This is a procedure that can be done in the doctor's office with only minimal discomfort.
• Home care for carpal tunnel syndrome is straightforward and can often provide relief for mild cases of carpal tunnel syndrome.
• Wear a wrist splint (can be purchased at most drugstores) to keep the wrist in an optimal position at rest. Splinting is usually tried for a period of four to six weeks. Some people wear their splints at night only and others wear their splints both day and night, depending upon when the symptoms are at their worst. If no relief is found at four to six weeks, the splints are not likely to help.
• When nonsurgical treatment has failed or for more advanced cases, surgical treatment of the carpal tunnel syndrome may be considered.
• The goal of surgery is to take pressure off the nerve at the wrist.
• Surgery is typically done at an outpatient center. The surgeon will make a small cut over the palmar side of the wrist and then release the ligament that covers the carpal tunnel. By releasing the ligament, the size of the carpal tunnel increases and pressure is relieved on the nerve in the carpal tunnel.
• Overall, surgery is very safe, but some risks do exist, including infection, wound healing difficulty, stiffness, wound pain, and nerve injury. Some people experience immediate relief in their hand once the pressure on the nerve is eliminated with surgery. Other people do not experience immediate relief due to more long-standing and severe pressure on the nerve.
• After surgery, a dressing is placed over the surgical wound. The fingers are left free for immediate use. Most people feel comfortable to use their hand for light activities within a day or two after surgery. People can return to light jobs three to four weeks after surgery and heavy work about six weeks after surgery.
• Physical therapy can be particularly useful after carpal tunnel surgery. Therapy can reduce swelling, stiffness, and pain after surgery. Therapy can also help to restore strength after surgery. Not everyone needs therapy after surgery, but for some, it can be very helpful.

Arthritis Treatment

• The treatment of arthritis depends on which particular form of arthritis is present, its location, severity, persistence, and any underlying background medical conditions of the patient. Each treatment program must be customized for the individual patient.
• Treatment programs can incorporate home remedies, nonprescription and prescription medications, joint injections, and surgical operations. Some treatment programs involve weight reduction and avoiding activities that exert excessive stress on the joint.
• The goal of treatment of arthritis is to reduce joint pain and inflammation while preventing damage and improving and maintaining joint function.
• Treatment may not be necessary for arthritis with minimal or no symptoms. When symptoms are troubling and persist, however, treatment might include pain and antiinflammatory medications as below. Furthermore, heat/cold applications and topical pain creams can be helpful.
• As a first step, rest, heat/cold applications, and topical pain creams can be helpful.
• For osteoarthritis, the over-the-counter food supplements glucosamine and chondroitin have been helpful for some, though their benefits are still controversial according to national research studies. These supplements are available in pharmacies and health-food stores without a prescription.
• If patients do not benefit after a three-month trial, I tell them that they may discontinue these supplements. The manufacturers sometimes make claims that these supplements "rebuild" cartilage. This claim has not been adequately verified by scientific studies to date.
• For another type of dietary supplementation, it should be noted that fish oils have been shown to have some anti-inflammation properties. Moreover, increasing the dietary fish intake and/or fish oil capsules (omega-3 capsules) can sometimes reduce the inflammation of arthritis.
• Obesity has long been known to be a risk factor for osteoarthritis of the knee. Weight reduction is recommended for patients who are overweight and have early signs of osteoarthritis of the hands, because they are at a risk for also developing osteoarthritis of their knees. Of note, even modest weight reduction can be helpful.
• Pain medications that are available over the counter, such as acetaminophen (Tylenol), can be very helpful in relieving the pain symptoms of mild osteoarthritis and are often recommended as the first medication treatment. Since acetaminophen has fewer gastrointestinal side effects than nonsteroidal anti-inflammatory drugs (NSAIDS), especially in elderly patients, acetaminophen is generally the preferred initial drug given to patients with osteoarthritis.
• Some patients get significant relief of pain symptoms by dipping their hands in hot wax (paraffin) dips in the morning. Hot wax can often be obtained at local pharmacies or medical supply stores.
• It can be prepared in a special warming device for use at home and be reused after it hardens as a warm covering over the hands by peeling it off and replacing it into the melted wax.
• Warm water soaks and wearing nighttime cotton gloves (to keep the hands warm during sleep) can also help ease hand symptoms. Gentle range of motion exercises performed regularly can help to preserve function of the joints. These exercises are easiest to perform after early morning hand warming.
• Pain-relieving creams that are applied to the skin over the joints can provide relief of daytime minor arthritis pain. Examples include
  • capsaicin (ArthriCare, Zostrix, Capsagel),
  • diclofenac cream (Voltaren gel),
  • salicin (Aspercreme),
  • methyl salicylate (Bengay, Icy Hot), and
  • menthol (Flexall).
• For additional relief of mild symptoms, local ice application can sometimes be helpful, especially toward the end of the day. Occupational therapists can assess daily activities and determine which additional techniques may help patients at work or home.
• There are a few forms of arthritis, such as gout, that can be impacted by dietary changes.
• Finally, when arthritis symptoms persist, it is best to seek the advice of a doctor who can properly guide the optimal management for each individual patient.
• For many patients with arthritis, mild pain relievers such as aspirin and acetaminophen (Tylenol) may be sufficient treatment.
• Studies have shown that acetaminophen given in adequate doses can often be equally as effective as prescription anti-inflammatory medications in relieving pain in osteoarthritis.
• Since acetaminophen has fewer gastrointestinal side effects than NSAIDS, especially among elderly patients, acetaminophen is often the preferred initial drug given to patients with osteoarthritis.
• Pain-relieving creams applied to the skin over the joints can provide relief of minor arthritis pain. Examples include
  • capsaicin,
  • salicin,
  • methyl salicylate, and
  • menthol.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications that are used to reduce pain as well as inflammation in the joints. Examples of NSAIDs include
  • aspirin (Ecotrin),
  • ibuprofen (Motrin),
  • nabumetone (Relafen),
  • meloxicam (Mobic),
  • diclofenac (Voltaren),
  • celecoxib (Celebrex),
  • piroxicam (Feldene), and
  • naproxen (Naprosyn).
• It is sometimes possible to use NSAIDs temporarily and then discontinue them for periods of time without recurrent symptoms, thereby decreasing the risk of side effects. This is more often possible with osteoarthritis because the symptoms vary in intensity and can be intermittent.
• The most common side effects of NSAIDs involve gastrointestinal distress, such as
  • stomach upset,
  • cramping diarrhea,
  • ulcers, and even
  • bleeding.
• The risk of these and other side effects increases in the elderly. Newer NSAIDs called cox-2 inhibitors have been designed that have less toxicity to the stomach and bowels.
• Some studies, but not all, have suggested that the food supplements glucosamine and chondroitin can relieve symptoms of pain and stiffness for some people with osteoarthritis. These supplements are available in pharmacies and health-food stores without a prescription, although there is no certainty about the purity of the products or the dose of the active ingredients because they are not monitored by the FDA.
• The U.S. National Institutes of Health (NIH) is studying glucosamine and chondroitin in the treatment of osteoarthritis. Their initial research demonstrated only a minor benefit in relieving pain for those with the most severe osteoarthritis. Further studies, it is hoped, will clarify many issues regarding dosing, safety, and effectiveness of these products for osteoarthritis.
• Patients taking blood-thinners should be careful taking chondroitin as it can increase the blood-thinning effect and cause excessive bleeding. Fish oil supplements have been shown to have some anti-inflammation properties, and increasing the dietary fish intake and/or taking fish oil capsules (omega-3 capsules) can sometimes reduce the inflammation of arthritis.
• Cortisone is used in many forms to treat arthritis. It can be taken by mouth (in the form of prednisone [Deltasone] or methylprednisolone [Medrol]), given intravenously, and injected directly into the inflamed joints to rapidly decrease inflammation and pain while restoring function. Since repetitive cortisone injections can be harmful to the tissue and bones, they are reserved for patients with more pronounced symptoms.
• For persisting pain of severe osteoarthritis of the knee that does not respond to weight reduction, exercise, or medications, a series of injections of hyaluronic acid (Synvisc, Hyalgan, and others) into the joint can sometimes be helpful, especially if surgery is not being considered. These products seem to work by temporarily restoring the thickness of the joint fluid, allowing better joint lubrication and impact capability, and perhaps by directly affecting pain receptors.
• Arthritis that is characterized by a misdirected, overactive immune system (such as rheumatoid arthritis or ankylosing spondylitis) frequently requires medications that suppress the immune system. Medications such as methotrexate (Rheumatrex, Trexall) and sulfasalazine (Azulfidine) are examples.
• Newer medications that target specific areas of immune activation are referred to as biologics (or biological response modifiers). Sometimes combinations of medications are used. All of these medications require diligent, regular dosing and monitoring.

Arthritis Surgery

• Surgery is generally reserved for those patients with arthritis that is particularly severe and unresponsive to the conservative treatments. Surgical procedures can be performed to relieve pain, improve function, and correct deformity. Occasionally, joint tissue is surgically removed for the purpose of biopsy and diagnosis. Doctors who specialize in joint surgery are orthopedic surgeons.
  • Joint surgery using a viewing tube with a cutting instrument is called arthroscopy.
  • Osteotomy is a bone-removal procedure that can help realign some of the deformity in selected patients, usually those with knee disease.
  • Removal of inflamed joint lining tissue is called synovectomy.
  • In some cases, severely degenerated joints are best treated by fusion (arthrodesis) or replacement with an artificial joint (arthroplasty).
  • "Total joint replacement" is a surgical procedure whereby a destroyed joint is replaced with artificial materials. For example, the small joints of the hand can be replaced with plastic material.
• Large joints, such as the hips or knees, are replaced with metals.
• Total hip and total knee replacements are now commonplace. These can bring dramatic pain relief and improved function.

Carpal Tunnel Prognosis

• The prognosis for carpal tunnel syndrome is very good.
• Mild cases can respond to nonsurgical care, such as bracing and steroid injection.
• Advanced cases can be treated very effectively with surgery.

Arthritis Prognosis

• It is the ultimate goal of scientific arthritis research that optimal treatment programs are designed for each of the many form of arthritis. This field will continue to evolve as improvements develop in the diagnosis and treatment of arthritis and related conditions.
• In the future, medications may be available that can protect the cartilage from the deteriorating consequences of osteoarthritis. New treatments, such as antiinflammatory lotion and patches (diclofenac [Flector]) are becoming available for relief of joint pain symptoms.
• Innovative cartilage research will open the door for new approaches to an old problem. Investigators are evaluating the effectiveness of over-the-counter food supplements. Better treatment options are being developed as we understand more about our immune system and genetics.
• Scientists throughout the world are studying many promising areas of new treatment approaches for inflammatory forms of arthritis, such as rheumatoid arthritis. These areas include more biologic treatments that block the action of the special inflammation factors, such as tumor necrosis factor (TNFalpha) and interleukin-1 (IL-6).
• Many other drugs are being developed that act against certain critical white blood cells involved in rheumatoid inflammation. Also, new NSAIDs with mechanisms of action that are different from current drugs are on the horizon.
• Better methods are becoming available to more accurately define which patients are more likely to develop more aggressive disease.
• Gene profiling, also known as gene array analysis, is being identified as a helpful method of defining which people will respond to which medications. Studies are underway that are using gene array analysis methods to determine which patients will be at more risk for more aggressive disease.
• Finally, genetic research and engineering is likely to bring forth many new avenues for earlier diagnosis and accurate treatment in the near future. This is all occurring because of technology improvements. We are at the threshold of tremendous improvements in the way rheumatoid arthritis is managed.