Conditions that doctors may initially misdiagnose as carpal tunnel syndrome include arthritis, tendinitis, and other nerve compression issues.
Carpal tunnel syndrome is a nerve disorder that may cause numbness, pain, or weakness in the hand and forearm. It occurs due to pressure on the median nerve that runs through the wrist.
The term “misdiagnosis” refers to when a doctor mistakenly diagnoses someone with a condition different from the one they actually have. This may happen when two conditions share similar symptoms.
This article highlights some potential conditions that doctors may misdiagnose as carpal tunnel syndrome, information about the typical diagnostic process, and when to speak with a doctor.
Doctors may misdiagnose arthritis as carpal tunnel syndrome since both conditions can affect the hands.
However, carpal tunnel syndrome is a nerve disorder, and arthritis affects the joints. These conditions may also cause different symptoms.
The Arthritis Foundation outlines the following key differences between carpal tunnel syndrome and arthritis:
| Carpal tunnel syndrome | Arthritis | |
|---|---|---|
| Affected area: | wrist and first three-and-a-half fingers | joints |
| Symptoms: | • numbness • tingling • shock-like sensations • pain that radiates up the forearm toward the shoulder • weakness in the hand | • morning joint stiffness • swollen joints • aching joint pain, especially after using the hands more than usual • bony nodules around the joints |
| Reasons for difficulties with function: | • numbness • muscle weakness | • pain • bone and joint deformities |
According to the Arthritis Foundation, shaking out the hands can temporarily relieve symptoms in early stage carpal tunnel syndrome. This action does not have the same effect on arthritis symptoms. Doctors may use this test to help differentiate the conditions.
It is important to note that people can experience carpal tunnel syndrome and arthritis at the same time, making diagnosis more challenging.
Tendinitis is inflammation of the tendons — cord-like structures that attach muscles to bones. According to the American College of Rheumatology, tendinitis often affects the wrists.
Doctors may misdiagnose tendinitis as carpal tunnel syndrome since both conditions can cause wrist pain and result from repetitive hand use.
Someone with tendinitis may experience tenderness in the affected area and sudden, severe pain that intensifies during movement.
According to the American Society for Surgery of the Hand, De Quervain tenosynovitis is a type of wrist and thumb tendinitis that causes pain on the thumb side of the wrist.
This pain typically worsens when a person uses their thumb and wrist at the same time, such as when opening jars or turning doorknobs.
Symptoms of wrist tendinitis that may help doctors differentiate it from carpal tunnel syndrome include:
- swelling
- a tender bump
- popping sensations around the tendon
Other conditions that may cause similar symptoms to carpal tunnel syndrome include:
- Wrist fracture: A fractured wrist may cause pain and difficulty moving or using the hand. Some people may have tingling or numbness.
- Cervical spondylosis: Cervical spondylosis can cause a narrowing of the space surrounding the spinal cord and nerve roots, which may lead to numbness and weakness in the arms, hands, and fingers.
- Pronator teres syndrome: This condition
involves compression of the median nerve at the elbow. Symptoms may include tenderness in the upper part of the forearm, near the elbow, and sensory changes in the palm and first three fingers.
Although carpal tunnel syndrome shares symptoms with various other conditions, a doctor will perform a physical examination and may order tests to rule out certain causes of the symptoms.
According to the American Academy of Orthopaedic Surgeons, the diagnostic procedure for carpal tunnel syndrome begins with a physical examination. A doctor may:
- press on or tap along the median nerve on the palm side of the wrist to check for tingling in the fingers
- bend and hold the wrists in a flexed position to check for numbness or tingling in the hands
- lightly touch the hands and fingertips with special instruments to test sensitivity
- check for signs of muscle weakness or atrophy in the base of the thumb
Doctors can diagnose many cases of carpal tunnel syndrome using a person’s medical history and the results of the physical exam. However, further tests may help to reduce the risk of misdiagnosis.
Electrodiagnostic tests
Electrodiagnostic tests help doctors assess the function of the median nerve and can give insights into the following:
- the severity of carpal tunnel syndrome
- the location of nerve compression
- which nerves are affected
- other underlying medical conditions affecting the median nerve
A doctor may order nerve conduction studies, which assess how effectively the nerves in the hand and arm transmit signals.
They may also use an electromyogram, which measures electrical activity in the muscles. This can help doctors detect nerve and muscle damage.
Imaging tests
Doctors may order one or more of the following tests to help diagnose carpal tunnel syndrome or determine its severity:
In some cases, a person may have a carpal tunnel syndrome diagnosis but begin to notice new or different symptoms. Some potential signs of misdiagnosis may include:
- joint swelling or stiffness
- aching joint pain that worsens after using the hands
- discoloration and tenderness around the joints
- misaligned joints
- bony nodules on the fingers and knuckles
- pain that worsens when using the thumb and wrist simultaneously
- a tender bump on the wrist
- popping sensations in the wrist
- tenderness in the upper section of the forearm
- severe bruising on the hand or wrist
- pain elsewhere in the body, such as the shoulder, neck, or back
If someone notices the above symptoms after a diagnosis of carpal tunnel syndrome, they should contact their doctor to see if their treatment plan needs to change.
People should speak with a doctor if they experience symptoms of carpal tunnel syndrome, such as:
- pain, discomfort, or unusual sensations in the:
- thumb
- fingers or fingertips
- hand
- wrist
- forearm
- shoulder
- weakness in the hand
- difficulty performing fine motor skills
People should also contact their doctor if they believe they do not have carpal tunnel syndrome or new symptoms develop. The doctor may conduct another physical exam and arrange for follow-up tests to help determine the cause.
In some cases, people may wish to get a second opinion from a new doctor if they believe they do not have carpal tunnel syndrome.
Can doctors mistake MS for carpal tunnel?
Multiple sclerosis (MS)
It is possible for doctors to mistake MS for carpal tunnel syndrome due to the overlap in symptoms.
The United Kingdom’s MS Society highlights a case in which someone with MS initially had a misdiagnosis of carpal tunnel syndrome due to tingling in her index, middle, and ring fingers.
Can carpal tunnel pain radiate to the shoulder and neck?
Carpal tunnel syndrome can cause pain or tingling that radiates up the forearm toward the shoulder. However, pain in the neck can also indicate a pinched nerve elsewhere, bad posture, or an injury.
Carpal tunnel syndrome is a common nerve disorder that may cause numbness, pain, or weakness in the hand and forearm.
However, these symptoms can also occur with other conditions. Doctors may sometimes misdiagnose people with carpal tunnel when they actually have another condition, such as arthritis or tendinitis.
Symptoms that may indicate a different underlying cause include joint pain, swelling, stiffness, bone deformities, and popping sensations in the wrist. People can contact a doctor if they think they have a misdiagnosis.