Are You Sure it's Carpal Tunnel Syndrome?

Basal joint arthritis of the thumb is sometimes misdiagnosed as CTS.

Carpal tunnel syndrome affects more than 8 million Americans who undergo repetitive use of their hands and wrists in daily living, according to statistics.

“But many patients with arthritis in the basal joint of the thumb are misdiagnosed as having carpal tunnel syndrome,” said board-certified hand surgeon John Krebs, MD, of the Center for Orthopedics in Sheffield Village, Ohio, in a press release. “If patients come in complaining of pain in the hand or wrist, it’s probably tendinitis or arthritis.”

Nearly one in five US adults—46 million people—has arthritis, according to a study published in the journal Arthritis and Rheumatism. “Basal joint arthritis, affecting the carpo-metacarpal (CMC) joint of the thumb, is probably the most common form of arthritis in the upper extremities,” Krebs said. “Symptoms of CMC arthritis include pain and weakness in the lower part of the thumb near the wrist.

“With carpal tunnel syndrome, the main complaint is numbness that wakes the patient up at night or that gets worse with certain activities,” Krebs said. “It’s not necessarily pain in the thumb. If you’re going to have pain, it’s going to be in the whole hand, and there could be numbness involving the thumb, index finger and middle finger.

“CMC arthritis is usually related to repetitive strain from activities involving a lot of pinching or gripping motions,” Krebs said. “When pain relievers, cortisone injections and physical therapy fail, CMC arthroplasty can replace the basal joint, relieve the pain and restore normal strength and function.

“We often see basal joint arthritis in women who do handwork that involves fine, intricate detail, such as sewing, knitting, crocheting, needlepoint and embroidery,” Krebs said.

“Plumbers and mechanics often develop CMC arthritis through repetitive use of wrenches,” he said. “It’s common among people who work with tools that require grip strength and pinch strength.”

Usually, CMC arthritis occurs in people in their early ’40s and up. But a recent phenomenon—texter’s thumb—caused by the repetitive strain of text messaging, is affecting younger people as well.

“Every pound of pressure caused by pushing a keypad with the thumb is magnified at the base of the thumb,” Krebs said. “Multiply this by hundreds of keystrokes a day and the risk of thumb arthritis increases.” A recent British study by Virgin Mobile, a UK mobile phone provider, showed that 38% of mobile phone users suffer from sore wrists and thumbs from texting.

CMC arthritis can develop gradually. When conservative treatments fail, surgeries such as arthroplasty may be able to help. In the press release, Krebs highlightthe case of as in the case of Tim Haywood, a 61-year-old jeweler from Elyria, Ohio. Krebs diagnosed Haywood with CMC arthritis in 2004. He had cortisone shots for about six months, but once the pain got worse it was time for surgery.

"Mr. Haywood had all the right indications for surgery," says Dr. Krebs. "Conservative treatments had failed. The beauty of this surgery is that we’re literally taking out the arthritis and we don’t have to put in any kind of metal or plastic joint. We’re using the patient’s own tissue to reestablish the joint motion and relieve the pain."

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