Chances are that you know someone who has complained of carpal tunnel syndrome or done so yourself. While this condition is increasingly common, people often confuse other wrist pain with the specific diagnosis of carpal tunnel. Tendonitis, sprains, and other car accident injuries are commonly mistaken for carpal tunnel due to similar symptoms. If you are experiencing wrist pain, it is important to understand what exactly may be causing it and follow through with the appropriate treatment plan. Read on to learn about the difference between carpal tunnel and tendonitis.
Anatomy of the Wrist
Carpal tunnel syndrome is a condition commonly known to cause numbness, tingling, and pain in the hand and through the forearm. The main cause of the condition is when the median nerve, one of the hand’s major nerves, is squeezed or compressed as it travels through the wrist.
The carpal tunnel refers to a narrow passageway in the wrist that is about an inch wide in most adults. The floor and sides of this tunnel are made up of small wrist bones known as carpal bones, while the roof is a strong band of connective tissue called the transverse carpal ligament. The rigid boundaries of the carpal tunnel mean there is little capacity for this opening to increase or decrease in size.
Within the carpal tunnel is the median nerve, one of the main nerves that serves the hand. It originates as a group of nerve roots in the neck that come together to form a single nerve in the arm. The median nerve travels from the upper arm, across the elbow, and into the forearm before passing through the carpal tunnel at the wrist to reach the hands and fingers. Along the way, it branches out into several smaller nerves, with a large number separating at the palm.
These nerves allow for individual feeling in the thumb, index finger, middle finger, and half of the ring finger. The muscles around the base of the thumb are also controlled by this nerve. Along with the median nerve, the carpal tunnel is a pathway for the nine tendons that bend the fingers and thumb, known as flexor tendons.
The hands and wrist also contain 29 separate bones, connected with various tissues to enable ease of movement and the dexterity required in the human hand.
Carpal Tunnel Syndrome
When the carpal tunnel is narrowed or the tissue that surrounds the flexor tendons swells, it can place pressure on the median nerve and reduce its blood supply. This pressure, similar to a pinched nerve, can cause numbness, tingling, pain, and weakness from the wrist and into the hand. Typically, this pressure develops gradually over time and is a long-lasting issue.
While women and older adults are most likely to be diagnosed with carpal tunnel syndrome, a variety of factors can lead to the development of the condition. These include:
- Genetics. Some people may inherit a naturally narrow carpal tunnel from family members, or other anatomic differences that change the amount of space for the median nerve. This difference in wrist anatomy can make a person more sensitive to compression and more likely to develop carpal tunnel.
- Repetitive motions. Repeating the same wrist or hand motions for a prolonged period of time is likely to aggravate the tendons in the wrist and cause swelling that pressures the nerves. This is very common in people who use a computer mouse and keyboard daily or play certain sports.
- Hand and wrist position. Activities that involve extreme flexion and extension of the hand and wrist can increase pressure on the nerve and, over time, lead to carpal tunnel syndrome.
- Pregnancy. Hormone changes as a result of pregnancy can cause swelling in the wrists.
- Related health conditions. Diabetes, rheumatoid arthritis, and thyroid gland imbalances are all conditions associated with a higher risk of carpal tunnel syndrome.
In some cases, a sudden injury to the wrist can also lead to carpal tunnel syndrome if the nerve is impacted.
Tendonitis
Tendonitis refers to the inflammation or irritation of a tendon, the thick fibrous cord that attaches muscle to bone, and the resulting pain and tenderness. This condition can occur anywhere in the body where there is a joint, with one of the most common locations being the wrist. There are six primary tendons in the wrist that work to help control the wrist, hands, and fingers, which are primarily affected by this condition. When certain tendons are the ones causing pain, there may be a name given to the form of tendonitis. Some common examples include:
- DeQuervain’s tendonitis, which is marked by pain and swelling in the tendons that control the thumb.
- Trigger finger or trigger thumb, when the tendon sheath is inflamed and it becomes difficult to bend or straighten a given finger or thumb.
- Ulnar tendinitis, or irritation of the tendons on the pinkie side of the hand.
The majority of tendonitis is a result of repetitive motions and activities using the wrist. The condition is common in athletes who use their wrists, people who type often, and those who care for infants and lift them throughout the day. Other risk factors include:
- Being female or older than 40 years old.
- A history of tendon injuries or pain in the elbow.
- Any job or hobby that requires repetitive wrist motions, like a hairstylist or cake decorator.
- Health conditions like diabetes, osteoarthritis, rheumatoid arthritis, or gout.
- Poor arm, wrist, and hand positioning during typing and texting.
- Using wrists for strenuous activity without proper conditioning.
- Smoking.
When the wrists are used constantly or incorrectly for long periods, it causes irritation to the sheath that surrounds your tendon. The sheaths themselves become irritated and inflamed, which can impact their natural lubrication and make it difficult for the tendons to glide smoothly. This can lead to compression on the tendon and difficulty making wrist and finger movements without pain.
Symptoms of Tendonitis vs. Carpal Tunnel Syndrome
While carpal tunnel syndrome and tendonitis have different causes and impact different parts of the wrist and hand, they can often have similar symptoms and be confused for one another. Both will include wrist pain, tenderness, swelling, and difficulty performing certain movements. However, there are additional symptoms that can help you determine which issue you are suffering from.
The primary indicator of carpal tunnel syndrome is a feeling of numbness, tingling, or burning in the hand and fingers. This may feel similar to when you sit in one position for too long and your foot or leg “falls asleep.” The fact that a nerve is being compressed is what sets carpal tunnel apart and causes this issue.
Other symptoms commonly associated with carpal tunnel include:
- Pain focused on the palm side of the wrist.
- Occasional shock-like sensations that may radiate through the thumb, index finger, middle finger, and ring ringer.
- Pain or tingling that travels up the forearm toward the shoulder.
- Weakness or clumsiness in the hands that makes it difficult to perform fine movements, like buttoning clothing.
- Constantly dropping things due to a loss of strength or feeling in the hand.
The symptoms of carpal tunnel syndrome typically develop slowly over time, without a single incident or injury bringing them on. They may come and go for a period of time before becoming more constant. Many people also find signs of carpal tunnel to be worse at night, as they sleep with their wrists bent and place more pressure on the nerve unknowingly. People with carpal tunnel syndrome often report waking up due to this pain and numbness. During the day, symptoms are more likely to occur when using their hands in a flexed position, like driving or reading a book. Most people report that moving or shaking the hands helps to relieve symptoms.
Pain related to tendonitis tends to be more acute, often brought about by a particular injury or movement rather than developing gradually.
Signs of tendonitis include:
- Pain focused on either side of the wrist, possibly extending into the pinky finger.
- Visible swelling of the wrist.
- Lumps or bumps appearing around the tendons.
- Pain that increases with movement.
- Stiffness and a popping sensation when moving the joints.
- Difficulty with certain movements like opening jars, turning doorknobs, or lifting pets and small children.
- If you are experiencing wrist pain, the sensations of numbness or tingling and what movements are impacted are often the first signs as to whether you are experiencing carpal tunnel syndrome or tendonitis. Other conditions, like arthritis or a wrist fracture, may be considered as well during the diagnostic process.
Treatment Options for Carpal Tunnel vs. Tendonitis
Because the root of each condition is different, the treatment plan for carpal tunnel and tendonitis will also differ, though early conservative treatments may have overlap.
Treatment for Carpal Tunnel
Without treatment, carpal tunnel syndrome will continue to worsen over time, and much of the intervention focuses on slowing or stopping the further progression of the condition. When treated early, non-surgical options are usually enough to relieve symptoms and avoid further compression.
The most common early treatments for carpal tunnel are:
- NSAIDs. In addition to managing pain, over-the-counter medication like ibuprofen and naproxen, contain anti-inflammatory properties that can relieve nerve compression in the short term.
- Braces and splints. At night, a brace or splint can help prevent bending of the wrist and keeps it in a neutral position that does not compress the median nerve. If you perform any activities during the day that aggravate the condition, this can also be useful.
- Lifestyle modifications. If it is possible to avoid certain activities that flex the hands and wrists, this may be recommended, or modifications may be recommended. This can involve making your worksite more ergonomic or improving posture to reduce stress on the wrists.
- Nerve gliding. Exercises can help the median nerve move more freely. A physical therapist can create a program aimed specifically at nerve gliding.
- Steroid Injections. Corticosteroid, or cortisone, is an anti-inflammatory agent that can be injected directly into the carpal tunnel to relieve symptoms for some period of time.
If these methods do not relieve carpal tunnel symptoms, your doctor may recommend surgery as an option. The surgical procedure is known as a carpal tunnel release and involves cutting the transverse carpal ligament to relieve pressure on the nerve and increase the size of the carpal tunnel itself.
Treatment for Tendonitis
Most cases of tendonitis are acute and can be treated through simple home remedies, including NSAIDs, rest, splinting, and elevation or compression. It is recommended to avoid lifting heavy objects or performing any activities that worsen the issue for a short period, but it is not a progressive condition and wrists will usually return to normal.
Physical therapy is often recommended in the case of tendonitis to help the wrist gain strength and flexibility. This is particularly useful when a job or hobby is the underlying cause of the condition, as physical therapy can help teach better methods of using the wrist to prevent future injuries or a recurrence of tendonitis.
If conservative treatments do not relieve tendonitis, there is a potential that surgery could be performed. These procedures would clean away any damaged tissue in the tendon sheath, or make tiny cuts in the sheath to release the tendon and allow it more room to move. This is much less common than surgery for carpal tunnel syndrome.
Whether you think you are suffering from tendonitis or carpal tunnel syndrome, AICA Jonesboro is here to help provide you tips for maintaining good orthopedic help. Our staff includes chiropractors, physical therapists, orthopedists, and other specialists who can assess your symptoms and perform a physical examination of your wrist to get an accurate diagnosis and a treatment plan based on your needs. Once we understand your condition, we will enact a personalized plan that helps you to find relief from pain and regain the ability to perform daily tasks. If you need surgical treatment, you will be able to continue working with the AICA Jonesboro team without transferring care. Contact us today to get started.