Carpal Tunnel Syndrome and Rheumatoid Arthritis
by Dr. C.H. Weaver M.D. updated 11/2018
Carpal tunnel syndrome (CTS) is a common complication of rheumatoid arthritis (RA). CTS occurs more frequently with RA because inflammation and swelling can cause compression of the median nerve. (1,2)
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is an “entrapment neuropathy” characterized by pain, numbness, and weakness in the wrist and hand that may radiate up the arm and into the fingers.
At the wrist, the median nerve which extends from the forearm through the wrist to the palm of the hand passes through the carpal tunnel which serves to protect the nerve and tendons. The median nerve is responsible for movement of the thumb and fingers and controls sensation to their palm side. The symptoms of CTS result from pressure on the median nerve in the carpal tunnel.
What are the symptoms of Carpal Tunnel Syndrome?
Symptoms of CPT typically begin gradually in the palm of the hand and fingers and are characterized as a burning, tingling, or itching sensation. An individual may feel like their fingers are swollen and lack normal strength. As CTS progresses a reduced grip strength, and decreased nerve sensation may become apparent. Carpal tunnel syndrome tends to affect the dominant hand first and cause the most severe symptoms in this hand.
What causes Carpal Tunnel Syndrome?
In addition to rheumatoid arthritis CTS is often worsened or caused by a combination of several factors, including repeated flexing and other movements of the wrist and fingers, sprains or fractures, continued use of vibrating hand tools and fluid retention during pregnancy or menopause. People with diabetes, an underactive thyroid gland or other disorders that directly affect the nerves are also more prone to developing CTS.
How is Carpal Tunnel Syndrome diagnosed?
Physical exam may reveal decreased sensation of the hand when pricked or touched lightly and tapping the wrist along the nerve may produce an electrical sensation. Definitive diagnosis of CTS can be confirmed with nerve conduction studies and electromyography. Sometimes doctors will use ultrasound which can identify a swollen or enlarged median nerve.
How is Carpal Tunnel Syndrome Treated?
Once CTS is diagnosed, treatment is essential to prevent nerve damage, which can become permanent. In patients with RA who develop carpal tunnel syndrome, the condition is most commonly treated with anti-inflammatory drugs or cortisone injections to reduce inflammation.
Splinting may also be used to immobilize the wrist, typically during the nighttime to prevent flexing of the wrist. When symptoms do not resolve with conservative measures, surgery to decompress the pressure on the median nerve may be necessary.