Carpal tunnel syndrome is a common cause of hand pain. The most common type of arthritis associated with carpal tunnel syndrome is rheumatoid arthritis. This article discusses the relationship.
Carpal tunnel syndrome occurs when the median nerve, one of the major nerves that provide sensation to the hand, is pinched in the carpal tunnel. The carpal tunnel is a narrow space located within the palm side of the wrist. The floor of the tunnel is formed by the bones of the wrist and the roof is created by a tough piece of tissue called the flexor retinaculum.
When the carpal tunnel becomes compressed for whatever reason, then pressure is placed on the median nerve. The patient will develop symptoms such as burning, numbness, pain, and tingling in the hand involving mostly the thumb, index, third, and middle part of the fourth finger. If the pressure continues without adequate treatment, then motor function- the ability to use the hand will also worsen.
The carpal tunnel can be narrowed as a result of many conditions. The most common type of arthritis associated with carpal tunnel syndrome is rheumatoid arthritis (RA).
Carpal tunnel compression occurs in RA because the lining of the wrist joint- the synovium- becomes inflamed. The process of inflammation leads to swelling. It is the swelling occurring within the tight confines of the carpal tunnel that leads to pressure on the median nerve.
The diagnosis is suspected by history. Further corroboration is established through physical examination by a rheumatologist. Since patients with RA often have hand pain due to other causes, carpal tunnel syndrome may be overlooked. Nerve conduction tests are also helpful for confirmation.
The initial treatment may consist of splinting as well as anti-inflammatory medications. In rheumatoid arthritis, though, this conservative approach rarely is enough.
If symptoms persist, then a corticosteroid injection into the carpal tunnel using ultrasound needle guidance is a good option. Data indicates that this procedure may be very helpful in alleviating the symptoms. Patients who do not respond to injection and splinting are probably candidates for surgery. Patients with RA may not be good candidates for endoscopic treatment because of the synovial overgrowth that occurs in the wrist. This makes visualization difficult for the surgeon.
In addition, patients with rheumatoid arthritis who have disease severe enough to cause carpal tunnel syndrome need more aggressive treatment of their RA.
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