The wrist is a highly complex joint that can be affected by several different musculoskeletal conditions [1]. Pain, discomfort, weakness, or decreased range of motion in the wrist can significantly impact daily life and may cause distress. Two of the most common wrist conditions are arthritis, of which there are multiple types, and carpal tunnel syndrome [2]. These two conditions share some symptoms, and it may not be immediately clear what the underlying cause is in some cases. It is important to understand the differences between wrist arthritis and carpal tunnel syndrome in order to properly manage one’s condition.
The overall wrist joint is actually composed of many joints due to the sheer number of bones involved – the two forearm bones and eight small, pebble-sized bones called the carpals. The joint surface(s) of each bone must be properly covered by articular cartilage for smooth functioning [1]. Many of the movable joints in the body involved just two joint surfaces; the wrist contains many more joint surfaces that form multiple joints within the wrist. Tendons, ligaments, nerves, muscle, and blood vessels also must exist and function within the wrist and hand. Like with other joints, injury, inflammation, and disease can all damage or disrupt these tissues.
Arthritis is more commonly discussed in the context of other joints but can affect the wrist as well. The three most common types of wrist arthritis are osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. In the first type, gradual deterioration of cartilage in the wrist leads to less and less cushioning and protection for the bones. In the second type, the body’s immune system becomes dysfunctional and attacks cartilage and connective tissue, leading to deformity and inflammation. Finally, the third type occurs when injury to the joint causes damage to cartilage. Common symptoms of arthritis are pain, swelling, stiffness, and weakness [1].
Carpal tunnel syndrome often causes pain and weakness as well [2]. Symptoms may also be aggravated after periods of inactivity, which can also be the case for rheumatoid arthritis [1,3,4]. However, it also can cause numb, tingling, and/or burning sensations in the hand and arm. Carpal tunnel syndrome occurs when the median nerve, which passes through the wrist, is compressed by surrounding tissue, impairing normal sensory and motor signaling. This pressure may be due to inflammation of soft tissue (for example due to overuse), extreme wrist position, other underlying conditions, and more [2,4]. In fact, it is associated with rheumatoid arthritis, resulting in additional challenges with diagnosis [2].
There are multiple key differences between the symptoms and signs of wrist arthritis vs. carpal tunnel syndrome that can help physicians and patients accurately identify the cause of wrist problems and implement treatment. Wipperman & Goerl (2016) provide a good summary of findings in a medical history and physical examination that can aid a differential diagnosis. Carpal tunnel syndrome does not typically affect range of motion, whereas wrist arthritis often does [2]. In addition, further testing in the form of imaging is extremely useful [2,4,5]. Bone damage and decreased joint space is visible on x-rays; these changes can be caused by arthritis but not carpal tunnel syndrome [4,5]. Electrophysiological tests and ultrasound can examine for signs of median nerve damage [4]. Finally, an MRI can provide information about the soft tissues in the wrist, such as if tissues are impacting on the median nerve, if there is arthritic damage to cartilage, and if there is nerve scarring [4,5].
An accurate diagnosis of wrist arthritis vs. carpal tunnel syndrome is critical for optimizing long-term outcomes. Carpal tunnel syndrome can be controlled if treated in the early stages, but later stages have a higher risk of irreversible damage [4]. Though there is no cure for arthritis, there are multiple strategies available for managing symptoms and slowing its progression [1].
References
[1] Jennings, C. D. & Brubacher, J. W. “Arthritis of the Wrist.” Diseases & Conditions | OrthoInfo | American Academy of Orthopaedic Surgeons. April 2016. https://orthoinfo.aaos.org/en/diseases–conditions/arthritis-of-the-wrist/
[2] Wipperman, J. & Goerl, K. Carpal Tunnel Syndrome: Diagnosis and Management. American Family Physician. 2016;94(12):993-999. PMID: 28075090
[3] Mayo Clinic Staff. “Rheumatoid Arthritis.” Diseases & Conditions | Patient Care & Health Information | Mayo Clinic. May 2018. https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648
[4] Pidgeon, T. S., Faust, K., & Jennings, C. D. “Carpal Tunnel Syndrome.” Diseases & Conditions | OrthoInfo | American Academy of Orthopaedic Surgeons. March 2022. https://orthoinfo.aaos.org/en/diseases–conditions/carpal-tunnel-syndrome/
[5] “Arthritis Diagnosis.” Johns Hopkins Medicine. (n.d.). https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/arthritis-diagnosis