Rheumatoid arthritis carpal tunnel

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes squeezed at the wrist.

The median nerve controls sensations to the palm side of the thumb and first two fingers, as well as impulses to small muscles in the hand that allow the fingers and thumb to move.

The carpal tunnel - a narrow passageway formed by ligament and bones at the base of the hand contains the median nerve and tendons.

Sometimes swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm. Although painful sensations may indicate other conditions, carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies.

Symptoms consist of burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent.

The symptoms often appear at night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to "shake out" the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away.

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; overactivity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal. In some cases no cause can be identified.

Rheumatoid arthritis is one of the most common arthritis causes of carpal tunnel syndrome. When it is not well controlled, it may lead to the formation of pannus- large amounts of inflamed tissue- that grow and compress the median nerve. General measures such as steroid injection, splinting, and physical therapy usually help. Tighter control of the disease is also indicated.

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