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Is the Pain in Your Hand Carpal Tunnel or Arthritis?

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Examining the hand of a senior patient

Carpal tunnel syndrome and arthritis are two of the most common complaints seen by orthopedic surgeons specializing in the hand and upper extremity care. While there are some common overlapping symptoms, such as pain and aching with gripping, 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 palm of the hand except your small finger. “Think of the nerve (median nerve) as an electrical wire carrying impulses and it can be affected by external compression (such as crimping a wire),” says Jordan Grier, MD, orthopedic hand surgeon at University Hospitals.

“Numbness, tingling, aching in the hand and fingers, and pain that wakes you up at night are hallmarks of carpal tunnel,” says Dr. Grier. Initially, this pain may seem to come and go, but as the condition worsens, it becomes more prevalent with numbness involving the thumb, index and middle finger.

Arthritis, most commonly osteoarthritis, is caused by the loss of cartilage between the two bones that make up a joint. Our joints rely on this layer of cartilage to create smooth motion and absorb shock stresses. As the cartilage wears out, increased friction occurs triggering pain, swelling, and decreased motion. “I always tell my patients it is exactly like wearing the tread off of your tires” says Dr. Grier.

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Arthritis in the hand can usually be traced to the base of the thumb or in the small joints of the fingers. Deformity and swelling of the joints often occur later in the arthritis process. Arthritis of the hand can also result in decreased finger motion, and trouble with gripping and pinching objects.

Finding the Right Treatment Plan

Treatment of both conditions starts with the correct diagnosis, including a full history of symptoms, a physical examination and X-rays of the affected areas. Nerve tests can be performed to help determine if you have carpal tunnel syndrome or if another problem may be causing your symptoms.

The first line of treatment is often specialized supportive bracing. Anti-inflammatory medications can help, but only use under the advice of your doctor if needed longer than a few days. Cortisone injections are also very effective. Injections can especially control arthritis symptoms in the hand and wrist for many months or years prior to needing surgery.

Other treatment options include stretching exercises where the fingers are pulled back towards the top of the wrist, allowing you to feel the stretch in the palm of your hand. Hold this position for approximately 15-20 seconds then repeat. Other over the counter remedies includes vitamin B6 which may help nerve recovery and can be beneficial in the early stages of carpal tunnel syndrome. Wearing a wrist splint at night may also help. These splints keep the wrist from bending while we sleep which may prevent the numbness and aching from occurring, allowing us to have a restful night sleep.

If conservative measures do not seem to provide relief, it may be time to seek medical treatment. It is very important 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 specializing in the hand and upper extremities is best able to properly diagnose and offer non-operative treatments prior to doing any surgery.

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