Common Conditions Misdiagnosed as Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is a common condition that occurs when the median nerve, which runs through a narrow passageway in the wrist called the carpal tunnel, becomes compressed. The median nerve is responsible for providing sensation to the thumb, index finger, middle finger, and part of the ring finger. It also controls some of the muscles that allow the thumb to move.

According to the AMA, carpal tunnel syndrome is one of the most common nerve disorders, affecting about 10 million people in the US.

Causes of Carpal Tunnel Syndrome

CTS can be caused by various factors that lead to swelling or irritation of the tendons within the carpal tunnel, putting pressure on the median nerve. According to the Cleveland Clinic, these factors include:

• Repetitive hand movements: Activities that involve repetitive wrist and hand movements, such as typing or using tools, can increase the risk of developing CTS.
• Wrist injuries: Fractures or sprains can cause swelling and narrow the carpal tunnel.
• Medical conditions: Conditions like diabetes, rheumatoid arthritis, and thyroid imbalances are linked to a higher risk of CTS.
• Genetics: Some people are born with a naturally smaller carpal tunnel, which increases the likelihood of nerve compression.
• Arthritis: Inflammatory conditions like rheumatoid arthritis can cause swelling and changes in the tissues around the wrist, increasing the likelihood of CTS.
• Ganglion Cysts: These noncancerous lumps that develop along the tendons or joints of your wrists and hands can press on the median nerve within the carpal tunnel, leading to symptoms of CTS.

Symptoms

The symptoms of CTS usually develop gradually and can worsen over time if not addressed. John Hopkins Medicine lists the most common symptoms:

• Numbness and tingling: These sensations often occur in the thumb, index finger, middle finger, and part of the ring finger. Many people report that their symptoms are worse at night, possibly due to wrist positioning during sleep.
• Pain in the wrist or hand: Pain may extend from the wrist up to the forearm or even the shoulder. It is often aggravated by activities that involve gripping or flexing the wrist and can worsen at night.
• Weakness in the hand: Individuals with CTS may find it difficult to perform tasks that require fine motor skills, such as buttoning a shirt. In severe cases, they may even drop objects due to weakened grip strength.
• Swollen Feeling in the Fingers: Many people with CTS describe a sensation of swelling in the fingers, even though visible swelling may not be present. This "swollen" feeling can contribute to discomfort and difficulty in hand movement.

Why Misdiagnosis Happens

CTS shares symptoms with several other conditions that affect the hand and wrist, making it easy to misdiagnose. For example, both CTS and certain forms of arthritis can cause hand pain and numbness. Additionally, tendonitis can mimic the symptoms of CTS, particularly when it affects the tendons in the wrist. 

Misdiagnosis is common because the symptoms of CTS overlap with those of other conditions, and without a proper diagnosis, patients may receive ineffective treatments.

Common Conditions Misdiagnosed for CTS

Understanding the conditions that are frequently mistaken for carpal tunnel syndrome is crucial for accurate diagnosis and effective treatment. 

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease that primarily targets the joints, causing inflammation, pain, and swelling. It affects about 1.5 million Americans, as per the Arthritis Foundation. 

Unlike osteoarthritis, which results from wear and tear, RA occurs when the immune system mistakenly attacks the body’s tissues, including the joints in the hands and wrists.

The symptoms of rheumatoid arthritis (RA) can be distinct, but they often affect the wrists and hands, which can sometimes lead to confusion with other conditions. Here are the symptoms:

• Pain and swelling in multiple joints, particularly in the hands, wrists, and fingers.
• Morning stiffness lasting longer than 30 minutes.
• Symmetrical joint pain, meaning both hands or both wrists are usually affected.
• Fatigue, low-grade fever, and overall feeling of being unwell.

Rheumatoid arthritis is often misdiagnosed as CTS because both conditions can cause hand pain and numbness. However, RA tends to affect multiple joints and is accompanied by systemic symptoms such as fatigue and fever, which are not present in CTS. Additionally, RA-related pain is more likely to be symmetrical, affecting both hands equally, whereas CTS often starts in one hand.

Tendonitis

Tendonitis is the inflammation of a tendon, the fibrous tissue that connects muscle to bone. When tendonitis occurs in the wrist or hand, it can cause pain and limit the range of motion, making it difficult to use the hand for everyday tasks.

Tendonitis causes discomfort in the hand and wrist by affecting the tendons, with symptoms such as:

• Localized pain along the affected tendon, often worsening with movement.
• Swelling and tenderness in the area of inflammation.
• Stiffness in the hand or wrist, especially in the morning or after periods of inactivity.
• A sensation of creaking or grating in the tendon during movement.

Tendonitis is often confused with CTS because both conditions can cause wrist pain and discomfort during hand use. However, tendonitis typically causes localized pain in a specific area of the wrist or hand, while CTS symptoms are more widespread and related to nerve compression.

For those unsure about their condition, using an online Symptom Checker can provide initial guidance, though it should not replace professional medical advice.

However, it's important to remember that this tool is not a substitute for professional medical advice. Always consult a healthcare provider for a definitive diagnosis and treatment plan.

Other Conditions That Could Be Misdiagnosed as CTS

There are several other conditions that can be mistaken for CTS due to similar symptoms:

• Cervical Radiculopathy: A condition caused by compression or irritation of nerves in the cervical spine, leading to radiating pain, weakness, numbness, or tingling in the hand and arm. Symptoms may overlap with those of CTS but are typically related to issues in the neck rather than the wrist or hand.
• Osteoarthritis: A degenerative joint disease that causes pain and stiffness in the hand and wrist. Unlike CTS, osteoarthritis pain is usually localized to the joints and may involve visible swelling and reduced range of motion.
• Gout: A form of arthritis caused by the buildup of uric acid crystals in the joints, leading to sudden and severe pain, often in the hands. Gout attacks can mimic CTS symptoms but are typically more intense and localized to specific joints.
• Diabetic Neuropathy: Nerve damage caused by diabetes, leading to symptoms like numbness, tingling, and pain in the hands. Diabetic neuropathy usually affects both hands and may also impact other areas of the body.

How to Accurately Diagnose Carpal Tunnel Syndrome

Accurate diagnosis of carpal tunnel syndrome is essential for ensuring that you receive the correct treatment and avoid unnecessary procedures. Since CTS shares symptoms with several other conditions, a thorough evaluation is required to pinpoint the exact cause of your discomfort.

Healthcare providers use a variety of tools and tests to diagnose CTS accurately. Some of the most common methods include:

• Physical Exam: During a physical exam, your doctor will check for signs of CTS, such as numbness in the fingers, weakness in the hand, and tenderness in the wrist. They may perform specific tests like the Tinel’s sign, where tapping on the median nerve in the wrist causes tingling, or the Phalen’s test, where bending the wrist causes symptoms to appear.
• Electrodiagnostic Studies: These tests measure the electrical activity in the muscles and nerves to determine if the median nerve is functioning properly. Nerve conduction studies and electromyography (EMG) are common electrodiagnostic tests used to confirm a CTS diagnosis and assess the severity of the condition.
• Imaging Tests: While not always necessary, imaging tests like ultrasound or MRI can be used to visualize the structures in the wrist and rule out other causes of symptoms, such as a cyst or a tumor compressing the median nerve.