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Wrist Pain: Carpal Tunnel Versus Tendonitis

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Sometimes it feels like everyone is supposed to be on the lookout for the symptoms of carpal tunnel syndrome, no matter what he or she does for a living. Supposedly, typing can cause it and next year we’ll probably start hearing that checking your iPhone too often can cause it, too. But not every twinge of discomfort or wrist pain is really carpal tunnel syndrome. In fact, the condition happens far less often than people think.   

Wrist Woes
Carpal tunnel syndrome develops when the main nerve in the wrist is compressed and compromised. In medical jargon, it’s called an entrapment neuropathy, a condition where nerves are squashed or damaged. The median nerve runs from the forearm through the wrist, sending impulses to move the hand and fingers as well as transmitting sensory information back up to the brain. The nerve travels through an area of bone and cartilage in the wrist to get from the arm to the hand, and when that tunnel of cartilage starts pressing down on the nerve because of swelling or injury, it prevents it from sending and receiving information correctly. 

The first symptoms are usually light burning, numbness, or itchiness on the hand and fingers, especially the thumb, index, and middle fingers. Sometimes people feel the need to “shake out” their hands to try to relieve the pressure. As the condition progresses, the pain becomes worse and begins to radiate up the arm to the shoulder. The pain and discomfort usually get worse after repetitive motions or heavy exertion and is often worse at night or after sleeping. Ultimately, those who suffer from carpal tunnel syndrome may have permanent numbness and weakness in their hands, to the point where it’s difficult to hold or carry objects or even make a fist. In some severe cases, people lose the ability to tell hot from cold by touch. 

Luckily, true carpal tunnel syndrome is far less common than most people think. Even though it’s often associated with office workers, a 2001 study by the Mayo Clinic found that seven hours of daily computer use doesn’t raise a person’s risk for the condition at all. According to the National Institute of Neurological Disorders and Stroke, carpal tunnel syndrome is usually the result of a genetic predisposition. People whose wrists and bone structure are naturally smaller are more susceptible to the compression of the median nerve that causes the syndrome. It’s also possible to develop carpal tunnel syndrome after an unrelated injury to the wrist, because swelling can cause enough compression to affect the nerve. Pregnant women often develop carpal tunnel symptoms because of the pressure of fluid retention, but it usually goes away after childbirth. Women in general are three times more likely than men to develop carpal tunnel problems, according to the National Institutes of Health. There are jobs that are more closely associated with carpal tunnel syndrome, but they are invariably jobs that require true repetitive and forceful wrist or hand motions, like jobs involving vibrating power tools, repetitive assembly line work, and carrying heavy objects. 

Tendon Tension
So what’s an office worker with wrist pain to do? There are many repetitive stress injuries caused by typing and normal daily activities and a much more likely diagnosis is tendonitis. Repetitive movements can stress the tendons that attach hand and arm muscles to the bone. When tendons are overworked, they can accumulate tiny rips, tears, and irritations. Tendonitis in the wrist can mimic many of the symptoms of carpal tunnel syndrome, so it’s no surprise that the two conditions are often confused. Tendonitis can also cause wrist pain, aching, numbness, and loss of strength and agility. The swelling from tendonitis can even sometimes end up actually causing carpel tunnel problems, since the swelling can put pressure on the medial nerve. 

Pain on the palm side of the wrist accompanied by numbness or tingling fingers is likely carpal tunnel syndrome. Pain on the other side is usually tendonitis. Another way to narrow down the problem is to evaluate the pinkie finger—if the pinkie finger is experiencing any of the numbness or tingling sensations, the problem is another nerve, not carpel tunnel syndrome, since the median nerve doesn’t supply the pinkie fingers. 

Any kind of constant pain or neurological symptoms deserve a trip to the doctor, where tests can determine what kind of problem is causing the pain and how to fix it. For either condition, the course of action is usually to prescribe shots of steroids to relieve pressure on the nerve and provide immediate relief. Some people wear wrist splints to hold their wrists still, which can alleviate some of the pressure. Over-the-counter pain relievers can also help, as well as stretching, acupuncture, and other lifestyle changes. For severe carpal tunnel syndrome, surgery is sometimes needed in order to cut some of the ligaments that press on the median nerve. Surgery is usually only recommended for people who have had severe syndromes for more than six months, since it only works for about 70 percent of people. 

It’s important to get an accurate diagnosis, because carpal tunnel surgery doesn’t work on tendonitis since freeing the nerve won’t do anything about healing the overused tendons themselves. If the problems are caused by an underlying condition like diabetes or rheumatoid arthritis, then treating the underlying problem is the only way to alleviate the pain. For those who think they might be at risk for either condition, take stretch breaks while working, avoid bending your wrist all the way in either direction, and try to relax your grip when cooking, typing, writing, or doing other manual tasks. 

There are dozens of repetitive motions that can cause muscle fatigue and discomfort, and dozens of repetitive stress disorders that can result. If it’s not tendonitis or carpal tunnel, it’s tennis elbow or shoulder impingement syndrome. Every time this computer user is confronted with sore, achy hands, I try to remember that a simple explanation is often the most likely … like writer’s cramp.  

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