Two Conditions Often Misdiagnosed as Carpal Tunnel Syndrome

Understanding Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) refers to a compression of the median nerve as it travels through the wrist at the carpal tunnel. This nerve provides feeling and movement to parts of the hand. When it becomes compressed, it can cause numbness, tingling, weakness, and muscle damage in the hand and fingers. According to research, CTS impacts around 3% to 6% of the general population. It is also one of the most common nerve compression disorders.

There are some commonly known causes and risk factors for CTS. Repetitive hand motions, pregnancy, obesity, rheumatoid arthritis, and diabetes can all increase someone's risk. There also seems to be a genetic component as well. The most frequent symptoms are pain, numbness, and tingling in the thumb, index, middle, and ring fingers.

While CTS may seem easy to diagnose due to somewhat clear symptoms, it is often confused with other conditions. Two particular conditions that are regularly misdiagnosed as CTS are cervical radiculopathy and cubital tunnel syndrome.

Cervical Radiculopathy

Cervical radiculopathy refers to the compression or irritation of nerves exiting the cervical spinal cord. It most frequently occurs due to disc herniations or bone spurs that press on the nerve. This typically causes neck pain that radiates outward into the shoulder, arm, and even hand. The specific location of pain depends on where along the spinal cord the nerve is impacted.

Cervical radiculopathy can be tricky to differentiate from carpal tunnel syndrome. Both conditions involve numbness, tingling, weakness, and pain in the hands and fingers. However, if the symptoms impact the whole hand or whole arm, this points more towards a nerve compression in the neck rather than the wrist. The pattern and location of symptoms provides insight into the root cause.

Distinguishing Symptoms

Here are some key things that help distinguish cervical radiculopathy from carpal tunnel syndrome:

• Neck, shoulder, or arm pain - CTS generally does not cause pain outside the hands and wrists
• Whole hand or whole arm numbness - CTS normally causes symptoms in parts of the hand/fingers
• Muscle wasting in the hand - More indicative of nerve compression than CTS
• Nocturnal symptoms - CTS symptoms often worsen at night
• Positive Spurling's test - Helps identify nerve root compression in the neck

Causes

The most common causes leading to someone being misdiagnosed with CTS when they actually have cervical radiculopathy include:

• Disc herniations in the cervical spine
• Bone spurs or osteoarthritis in the cervical spine
• Narrowing of the cervical spine canal (cervical stenosis)
• Whiplash injuries
• Poor posture

Treatments

Cervical radiculopathy is often treated conservatively through methods like:

• Rest/immobilization with a neck brace
• Ice/heat
• Anti-inflammatory medications
• Physical therapy
• Trigger point injections
• Epidural steroid injections

For moderate to severe cases that do not improve with conservative care, cervical surgery may be considered. This might involve procedures like an anterior cervical discectomy and fusion.

Cubital Tunnel Syndrome

Cubital tunnel syndrome is the second most common nerve compression disorder in the upper extremity. It involves compression of the ulnar nerve where it passes behind the inner elbow. This is known as the cubital tunnel.

When the ulnar nerve becomes compressed, irritated, or injured, it can cause similar symptoms to carpal tunnel syndrome. These include pain, numbness, tingling, and weakness along the ring and pinky fingers. Sometimes the outside of the hand and forearm are also impacted.

Distinguishing Symptoms

There are a few key things that help differentiate cubital tunnel syndrome from carpal tunnel syndrome:

• Elbow pain - CTS does not cause elbow pain
• No thumb involvement - CTS always impacts the thumb
• Pinky and ring finger symptoms - Indicates ulnar nerve versus median nerve
• Symptoms worsen when bending elbow - Compresses cubital tunnel

Causes

Some things that frequently lead to someone being misdiagnosed with CTS when they actually have cubital tunnel syndrome include:

• Repeated elbow bending or leaning on the elbow
• Trauma such as an elbow fracture
• Space-occupying masses like bone spurs or cysts
• Thickened ligaments or muscles in the elbow

Treatments

Treatment for cubital tunnel syndrome often starts conservatively through:

• elbow padding and protective gear like elbow pads
• nighttime elbow braces to keep the arm straight
• NSAID medications
• activity modification
• physical therapy
• elbow injections

Those who do not see improvement with conservative treatment may need to consider ulnar nerve decompression or transposition surgery.

Diagnosing the Underlying Cause

Given the similarities in symptoms, it can be tricky even for doctors to distinguish between carpal tunnel syndrome, cervical radiculopathy, and cubital tunnel syndrome. All three involve varying degrees of hand and finger numbness, tingling, weakness, and pain. However, a careful clinical examination along with certain diagnostic tests can get to the root cause.

Clinical Examination

A doctor will perform a physical exam testing range of motion, sensation, muscle strength and look for signs of muscle atrophy. They will check the neck, elbows and wrists while asking about any aggravating or relieving factors.

Diagnostic Tests

Some tests that can help confirm a diagnosis when clinical examination alone is uncertain include:

• Electromyography (EMG) Measures electrical activity of muscles and nerves
• Nerve conduction studies Measures speed signals travel through a nerve
• X-rays Images bones and joints to check for fractures, arthritis or bone spurs
• MRI Provides images of soft tissues like nerves, muscles, ligaments

These tests can detect nerve damage and pinpoint areas of compression to guide appropriate treatment.

Takeaway Points

• Carpal tunnel syndrome involves compression of the median nerve at the wrist leading to hand and finger symptoms
• Cervical radiculopathy involves compression of spinal nerves in the neck causing arm and potentially hand symptoms
• Cubital tunnel syndrome involves compression of the ulnar nerve at the elbow resulting in pain, numbness or tingling into the ring/pinky fingers
• All three conditions can be tricky to distinguish, requiring a careful history, physical exam and possibly diagnostic tests to confirm
• Getting the right diagnosis is crucial for pursuing appropriate, targeted treatment to address symptoms

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.