Ask the Orthopedist
Not Very Handy
Carpal Tunnel and Arthritis Pain
By Scott M. Zimmer, MD
QUESTION
Is the pain in my hand and wrist carpal tunnel or arthritis?
ANSWER
Carpal tunnel syndrome and arthritis of the hand and wrist are two of the most common complaints I see as a hand and upper extremity surgeon. There are some common overlapping symptoms — such as pain and aching with gripping — but the two conditions are vastly different.
Carpal tunnel syndrome occurs when there is increased pressure on the nerve that gives sensation to most of the hand except your small finger. Think of the nerve (median nerve) as an electrical wire carrying impulses that can be affected by external compression (such as crimping a wire). Symptoms include numbness, aching pain in the fingers and up the forearm, and pain that commonly wakes you up at night.
Arthritis, better known as osteoarthritis, is simply the loss of cartilage between the two bones that make up a joint (a joint is where motion occurs). Our joints rely on this layer of cartilage to create fluid motion and absorb shock stresses. As the cartilage wears out, increased friction triggers pain, swelling and decreased motion. It is exactly like brake pads wearing out on a car.
Differentiating these two conditions is obtained by getting a symptom history, an examination and X-rays. Numbness, tingling and night pain are hallmarks of carpal tunnel. Arthritis usually can be localized to the base of the thumb where it attaches to the wrist or in the small joints of the fingers. Deformity and swelling of the joints occurs late in the arthritis process and may not be seen early on.
Treatment Options
Treatment of both conditions starts with making the correct diagnosis, followed with specialized supportive bracing. Anti-inflammatory medications can help, but only use them under the advice of your doctor if needed longer than a few days. Cortisone injections are very effective even though they often have a bad reputation.
Injections can especially control arthritis symptoms in the hand and wrist for many months or years prior to needing surgery. It is vital to see a hand specialist if numbness, tingling or radiating pain in the hand are occurring because nerve damage can occur if left untreated for a long time.
An orthopedic surgeon — in this case, a hand and upper extremity surgeon — is best able to properly diagnose and offer non-operative treatments prior to any surgery.
Have questions about musculoskeletal conditions such as arthritis, chronic pain, disorders and injuries? Send them to orthopedic surgeon Scott Zimmer, MD, at [email protected]. He may answer them in the next issue of Northeast Ohio Boomer and Beyond. Dr. Zimmer is founding director of Ohio Hand Center, Geauga Hospital Specialty Clinic, ohiohandcenter.com, 844-542-6363.
