Carpal Tunnel vs. Arthritis: Similarities and Differences

When your wrist or hand starts to tingle and burn, it can be difficult to pinpoint the exact cause of the pain, whether it's a result of carpal tunnel syndrome or arthritis. The anatomy of the hand is a tight space, and there are a lot of joints, nerves that can become swollen or pinched. Carpal tunnel syndrome and arthritis are similar conditions that can both result from overuse of the wrist and hands.

What Is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a condition that develops when the small space in the carpal tunnel is reduced even more by swelling or inflammation. Overuse or misuse of the wrist can cause inflammation in the tendons that pass through the carpal tunnel (an anatomical structure in the wrist and hand). This inflammation can lead to compression of the median nerve (one of the major nerves supplying the upper body) and result in repetitive strain injury.

Carpal Tunnel Anatomy

The carpal tunnel is an opening created between the transverse carpal ligament and the carpal bones. The median nerve passes through this tunnel. It begins in the shoulder and is rooted in the upper part of the spine. The nerve doesn't branch out in the upper arm, but passes through the elbow to help provide movement and sensation in the forearm.

When the median nerve reaches the carpal tunnel, most branches pass through the tunnel, but the palmer branch passes over it. This is why the palm of the hand is typically not involved in carpal tunnel syndrome pain. Along with the median nerve, nine tendons pass through the carpal tunnel, putting the nerve at further risk of inflammation or compression.

Key Symptoms

As the median nerve is compressed—either by swollen tendons or by some other injury or inflammatory process—pain and even numbness may occur. The most common symptoms of carpal tunnel syndrome include:

• Pain
• Numbness
• Tingling
• Discomfort gets worse at night or wakes you from sleep
• Pain that radiates to the forearm
• Weakness or clumsiness in the hand, especially in the thumb
• Reduced sensation

The symptoms experienced in carpal tunnel syndrome are limited to the areas affected by the sections of the media nerve that pass through the carpal tunnel. This includes the first three fingers and a part of the fourth finger closest to the thumb. Pain can also be at the center of the wrist or even the whole hand.

Primary Causes

Carpal tunnel syndrome is pretty common, affecting one out of every five people. Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself.

Contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture, an overactive pituitary gland, an underactive thyroid gland, and rheumatoid arthritis. Mechanical problems in the wrist joint, repeat use of vibrating hand tools, fluid retention during pregnancy or menopause, or the development of a cyst or tumor in the canal can also contribute to this condition. Often, no single cause can be identified.

Several risk factors are associated with the development of carpal tunnel syndrome, including:

• Female sex
• Obesity
• Diabetes
• Pregnancy
• Rheumatoid arthritis
• Hypothyroidism
• Connective tissue diseases
• Pre-existing median mononeuropathy
• Genetics
• Aromatase inhibitor use

Workplace factors may contribute to existing pressure on or damage to the median nerve. The risk of developing CTS is more commonly reported in those performing assembly line work—such as manufacturing, sewing, finishing, cleaning, and meatpacking—than it is among data-entry personnel.

What Is Arthritis?

Arthritis is a family of conditions that affects the joints, causing pain and inflammation. There are more than 100 types of arthritis, and it's the leading cause of disability in the United States, affecting more than 50 million adults and 300,000 children. The most common types of arthritis are osteoarthritis and rheumatoid arthritis.

While pain, swelling, and stiffness are the hallmarks of arthritis, these conditions can also lead to permanent joint changes and disability. Some types of arthritis like rheumatoid arthritis even affect connective tissues in areas of the heart and lungs.

Osteoarthritis

Osteoarthritis, also known as wear-and-tear arthritis, can present with no symptoms or very severe symptoms ranging from pain to limited movement. In this condition, the smooth cushion between bones (cartilage) breaks down and joints can get painful, swollen and hard to move. It can happen at any age, but it commonly starts in the 50s and affects women more than men. Osteoarthritis starts gradually and worsens over time.

This is the most common form of arthritis and is known to affect certain joints more than others, including the joints between each section of your fingers and the joint that connects your fingers to the rest of your hand. Osteoarthritis can also impact joints in the knees, hips, and lower spine.

Rheumatoid Arthritis

Rheumatoid arthritis is a form of arthritis and an autoimmune disease where the immune system attacks healthy cells in the body, causing inflammation. Rheumatoid arthritis can cause inflammation so widespread and intense that it can interfere with daily activities. To diagnose this condition, pain and inflammation have to continue for at least six weeks.

RA mainly attacks the joints, usually many joints at once. It commonly affects joints in the hands, wrists, and knees. In a joint with RA, the lining of the joint becomes inflamed, causing damage to joint tissue. This tissue damage can cause long-lasting or chronic pain, unsteadiness, and deformity.

It can be detected by the presence of certain antibodies and inflammatory markers in the blood. People with rheumatoid arthritis may also have:

• Joint erosions
• Rheumatoid nodules
• Cardiovascular disease
• Osteoporosis

Key Symptoms

Osteoarthritis and rheumatoid arthritis have similar symptoms, but there are a few key differences.

Both osteoarthritis and rheumatoid arthritis can affect the hands. However, osteoarthritis often affects the joint closest to the tip of the finger, while rheumatoid arthritis usually spares this joint. And while rheumatoid arthritis can appear in any joint, its most common targets are the hands, wrists, and feet.

Mild morning stiffness is common in osteoarthritis and often goes away after just a few minutes of activity. Sometimes people with osteoarthritis also notice the same type of stiffness during the day after resting the joint for an hour or so. In rheumatoid arthritis, however, morning stiffness doesn't begin to improve for an hour or longer. Occasionally, prolonged joint stiffness in the morning is the first symptom of rheumatoid arthritis.

Differences Between Carpal Tunnel and Arthritis

While several forms of arthritis and carpal tunnel syndrome can all cause hand and wrist pain, there are certain features of each disease that distinguish the two. Carpal tunnel syndrome pain is primarily the result of nerve compression, while arthritis is swelling and inflammation of the joint itself.

Can You Tell Which Condition You Have?

Joint swelling in arthritis may also cause compression of the nerves in the hand or wrist, which can then cause numbness, tingling, and pain. Your healthcare provider will perform a few specific tests to pinpoint the problem.

Treatment Similarities and Differences

A few treatments can help you whether you suffer from carpal tunnel syndrome or arthritis, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
• Wearing a splint or brace to support the wrist and hand and limit painful movements
• Cortisone injections
• Physical therapy exercises to relieve pressure and strengthen the affected area
• Changing your environment or activities to compensate for pain or loss of function

In some cases, however, carpal tunnel syndrome becomes so severe that surgery is necessary to treat the problem. An outpatient surgery is performed, usually under local anesthesia, to increase the size of the space within the carpal tunnel and relieve the pressure on the median nerve by cutting the transverse carpal ligament at the base of the palm. This surgery usually relieves all symptoms of carpal tunnel syndrome once the incision is healed—about 10 to 14 days.

Arthritis may also become severe enough to warrant surgery, but the procedure is very different. Reconstructive surgery is sometimes required when deformity is severe in osteoarthritis, and joint replacement may be required for people with severe rheumatoid arthritis. Rheumatoid arthritis may also be treated with medications like disease-modifying anti-rheumatic drugs (DMARDs). Methotrexate is a DMARD commonly used to treat rheumatoid arthritis. Biologics like adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade) can also be used for this condition. These medications suppress the immune system to prevent further damage.

When to See a Healthcare Provider

You may be wondering when carpal tunnel and arthritis pain progress from annoyance to a medical problem. How concerned you should be about either of these conditions depends on how much it impacts your daily activities and how much pain you are having. If carpal tunnel pain is waking you at night or your arthritis is preventing you from holding certain items and performing daily activities, it's probably time to see a healthcare provider.

It's important to note that the earlier you seek treatment for carpal tunnel syndrome and arthritis pain, the better your outcomes are usually.

A Word From Verywell

Pain from carpal tunnel syndrome and arthritis can be debilitating and affect your daily functioning. Knowing the exact cause of your pain can help you get the appropriate treatment as soon as possible and improve your outcomes and potentially preserve your mobility. Carpal tunnel and arthritis pain are caused by different issues, but can both cause severe pain and even deformity. Talk to your healthcare provider about your symptoms and what kinds of treatment are appropriate for you. By managing the cause of your pain, you can avoid letting the pain disrupting your daily life.