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Is it Carpal Tunnel Syndrome or Tendonitis?

Know the Difference in Your Wrist Pain

By Jon J. Hanlon, M.D., Orthopaedic Surgery, Hand and Upper Extremity, with Hedley Orthopaedic Institute and on the medical staff at St. Luke’s Medical Center and Tempe St. Luke’s Hospital

The heavy usage of handheld devices and computers has increased the cases of chronic wrist pain. Many times, sufferers misdiagnose their own wrist pain for tendonitis or carpal tunnel syndrome. Although these two conditions share similar pain symptoms, they are very different medical problems. The following provides an overview of each condition.

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is a painful progressive condition caused by the compression of a key nerve in the wrist.

What is Tendonitis?

Tendonitis literally means inflammation of the tendon.

Common Symptoms

Symptoms

Carpal Tunnel

Syndrome

Tendonitis

Wrist pain, wrist muscle pain.

X

X

Weakness and tingling of the fingers (pins and needles).

X

X

Tightness and pain in the forearm, wrist and hand.

X

X

Numbness in the palm of the hand and fingers.

X

X

Swelling sensation.

X

X

Burning sensation.

X

X

Itching sensation.

X

Pain starts gradually in one or both hands.

X

In severe cases, unable to distinguish between hot and cold by touch.

X

Pain felt on the front and back side of the hand and wrist.

X

Tenderness directly over the affected tendon.

X

Common Causes

Carpal Tunnel Syndrome occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers (but not the little finger). It also controls impulses to some small muscles in the hand that enable the fingers and thumb to move. The carpal tunnel is a narrow passageway of ligament and bones at the base of the hand that houses the median nerve and tendons. Thickening from irritated tendons can narrow the tunnel even more, thus compressing the median nerve. Other causes of compression include congenital predisposition, trauma to the wrist, over-active pituitary gland, hypothyroidism, rheumatoid arthritis, fluid retention, or a cyst/tumor in the canal.

Tendonitis is almost always an overuse injury. When people begin a new exercise or activity, or repeat an activity frequently, tendons can become irritated. Tendon problems are most common in those between the ages of 40 and 60 years. In this age group, most people can still exert the same force as when they were younger, however their tendons are not as pliable or forgiving as before.

Preventive Measures and Treatment Options

For Carpal Tunnel Syndrome, wearing splints, performing stretching exercises and taking frequent rest breaks are effective preventive measures. However, the early diagnosis of CTS is essential to avoid permanent damage to the median nerve. Non-surgical treatments include:

  • Resting the affected hand and wrist
  • Applying cool packs to ease inflammation
  • Avoiding activities that may worsen symptoms
  • Immobilizing the wrist in a splint
  • Taking medication to ease pain

Surgical treatments for CTS include open release surgery and endoscopic surgery. These are the most common surgical procedures in the United States for the treatment of CTS.

For tendonitis, the most effective preventive measure is to avoid aggravating, repetitive movements. Once tendonitis is diagnosed, the next step is to lessen those aggravating, repetitive movements that triggered the condition. Also, appropriate treatment(s) must be followed, which may include applying an ice pack, taking anti-inflammatory medicines, and receiving cortisone injections. It should be noted that some types of tendonitis, such as Achilles, are rarely injected with cortisone due to the concern of possibly rupturing the tendon.

Preventing CTS or Tendonitis in an Office Setting

The American Society of Hand Therapists (ASHT) provides the following recommendations to prevent CTS while at a workplace. These tips also apply to preventing tendonitis.

Position computer keyboards at a proper height. The height of many computer keyboards creates tension in the wrists because of the need to bend wrists in order to hit all of the keys.

Use a mouse pad with a padded wrist rest. When using a computer, use a padded wrist rest so that wrists sit comfortably on the table in front of the keyboard.

Stretch hands and wrists every 30 minutes.Stop working every 30 minutes and take time out to stretch both hands and wrists. Spread hands and fingers wide and then form a tight fist. Repeat this five times. Rotate wrists five times in one direction, then five times in the other direction. Stretch fingers and wrist backwards to maintain flexibility. Repeat this five times. These exercises will keep hands and wrists flexible and decrease the chances of acquiring CTS or tendonitis.

Use a headset when speaking on the phone.Holding the telephone all day with a wrist extended can cause undue stress on the wrist. If it is required to spend a lot of time on the phone, consider using a hands-free headset. Not only will the headset help prevent CTS or tendonitis, but it can also alleviate neck and upper back pain.

Keep wrists straight as much as possible. While performing repetitive gripping activities, make every effort to keep wrists straight. Research has shown that straight wrists produce the least amount of pressure in the carpal tunnel.

Jon J. Hanlon, M.D., is board-certified in orthopaedic surgery. He is a Fellow of the American Association of Hand Surgery and a Fell of the American Academy of Orthopedic Surgeons. He specializes in treating hand and upper extremity problems, including but not limited to: nerve problems (such as carpal/cubital tunnel syndromes and nerve lacerations), tendonitis, tendon lacerations, fractures joint replacement surgery, hand, wrist and elbow arthritis. For more information, contact Hedley Orthopaedic Institute.

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