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How to Know the Difference From Carpal Tunnel and Rheumatoid Arthritis

by
author image Aubrey Bailey
Aubrey Bailey has been writing health-related articles since 2009. Her articles have appeared in ADVANCE for Physical Therapy & Rehab Medicine. She holds a Bachelor of Science in physical therapy and Bachelor of Arts in psychology from the University at Buffalo, as well as a post-professional Doctor of Physical Therapy from Utica College. Dr. Bailey is also a certified hand therapist.
How to Know the Difference From Carpal Tunnel and Rheumatoid Arthritis
Close-up of a doctor holding a patient's hands. Photo Credit KatarzynaBialasiewicz/iStock/Getty Images

Many different diseases cause hand and finger pain. Carpal tunnel syndrome and rheumatoid arthritis are common diseases that affect your hands, but they are distinctly different conditions. Consult your doctor for an accurate diagnosis if you have pain, swelling or tingling in your hands or fingers that lasts more than a few days or affects your ability to use your hands.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is caused by pressure on the median nerve, located in the base of your palm. This nerve travels through a small tunnel, along with 9 tendons that move your fingers and thumb. The carpal tunnel is formed by small bones in the wrist and a ligament that forms a "roof" over the tunnel. The median nerve gives feeling to the thumb, index, middle and half of the ring finger. It also supplies muscles that move the fingers and thumb. Carpal tunnel syndrome causes pain, tingling and possibly numbness in these fingers. Over time, weakness can develop in muscles supplied by this nerve. Swelling is not a common symptom of carpal tunnel syndrome.

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Rheumatoid Arthritis

Rheumatoid arthritis occurs when your immune system mistakenly attacks healthy joints throughout the body. This disease frequently affects joints in the hands and fingers. Common symptoms include pain, stiffness, joint swelling, redness and warmth of the affected areas. Unlike carpal tunnel syndrome, rheumatoid arthritis affects all fingers and does not typically cause tingling or numbness.

Comparison

Carpal tunnel syndrome is commonly caused by repetitive use of the tendons that bend your fingers and wrist or by keeping your wrists in awkward positions -- fully bent forward or backward -- for long periods. This condition can also be caused by frequent use of vibrating tools. Rarely, carpal tunnel syndrome develops due to direct trauma to the wrist. Symptoms of this condition develop over time, often in one hand. Initially you may feel occasional pain or tingling in one of the affected fingers, particularly at night when your wrist is in one position for a long period. As the condition worsens, symptoms become more frequent.

Symptoms of rheumatoid arthritis, by contrast, often affect both hands simultaneously. Stiffness develops in the fingers early on with this condition, and is particularly prominent first thing in the morning. Severity of other symptoms varies based on the level of inflammation in the joints and is different for each person. However, progressive deformity of the wrist and finger joints is not uncommon with rheumatoid arthritis. Because rheumatoid arthritis is an immune system disorder, the entire body is affected by the disease. Other symptoms may include fatigue, loss of appetite and body aches.

Carpal Tunnel Syndrome Diagnosis

Carpal tunnel syndrome is typically diagnosed based on symptoms and the results of physical examinations. Symptoms increase when the wrist is bent in extreme positions -- typically forward, but sometimes backward as well. To test for carpal tunnel syndrome, the wrist is placed in a fully bent position for a minute and monitored for pain, numbness or tingling in the fingers. Doctors also tap over the median nerve in the wrist to see if symptoms occur. Electromyography -- electrical current administered with small needles along the path of the median nerve -- is often used to measure signal strength to assess the severity of carpal tunnel syndrome. Ultrasound is sometimes used to look for inflammation or enlargement of the median nerve.

Rheumatoid Arthritis Diagnosis

Rheumatoid arthritis is suspected based on symptoms of joint pain, redness, warmth, swelling and stiffness. Unlike carpal tunnel syndrome, rheumatoid arthritis is not diagnosed based on clinical symptoms alone. Blood tests are performed to measure levels of proteins called antibodies in the blood. Abnormal levels of a specific antibody -- anticyclic citrullinated peptide antibody -- are often present with rheumatoid arthritis as the disease mistakenly attacks healthy joint tissues. Rheumatoid arthritis also causes firm bumps called nodules to form on bony areas of the body, including the finger joints. X-rays are often used to determine the amount of joint damage present with rheumatoid arthritis.

Treatment

Carpal tunnel syndrome is first treated conservatively with rest and avoiding activities that make symptoms worse. Physical or occupational therapy is often prescribed for this condition. Treatments including splinting the wrist in a straight position, ultrasound, massage, range of motion exercises and strengthening. Severe nerve compression may require surgery. A small incision is made over the tunnel and the "roof" of the tunnel is cut to relieve pressure on the nerve.

Rheumatoid arthritis is treated medically with antiinflammatory medications such as naproxen (Aleve) and ibuprofen (Advil). Steroid medications such as prednisone are sometimes prescribed to treat the symptoms of this condition. Disease-modifying antirheumatic drugs such as methotrexate (Rheumatrex, Trexall) are sometimes used to slow the disease process. Symptoms of rheumatoid arthritis are also treated with rest and avoidance of aggravating activities. Physical or occupational therapy treatments are commonly prescribed for rheumatoid arthritis, including heat or paraffin wax to increase blood flow; exercises to decrease stiffness and improve movement; and education in activity modification to make daily tasks easier.

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