Wrists - carpal tunnel or RA?

You may recall that wrist pain has been one of my main problems to date. But it had disappeared about 95% after a flare up in early Feb. Slowly but surely I'm getting pain again and this morning it's pretty lousy in my right wrist and achy in my left. But the location of the pain has changed. Before Xmas it was in the top of my wrists - right across the middle. Then it moved to the ulnar region on the sides of both and was equally bad on both sides. The last flare up was there. Now it's more subtle and is on the under side of both wrists - but much more pronounced on right wrist which I'm unable to move about this morning. Again the pain goes up into my knuckles but also is on the inside of my hand up into the pads of my fingers. It feels tingly like sherbert but my fingers are same as usual - bit swollen on the joints themselves and always very stiff in the mornings. My ankles are almost identical but the pain on both sides is on the bony outside parts although there's an ache into my toe pads.

When I told the physio that the underside of wrists were sore about 5 weeks ago when she last saw me - she looked puzzled and said that wasn't really where the wrist joint was so might be something else. Now I'm wondering if this is carpal tunnel rather than RA - and if so what should I do about it?

26 Replies

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  • Tilda,

    I know you have difficulties seeing your rheumys so suggest you go see your GP.

    There is a test that he/she can do without any machines which shows if it is carpal tunnel. If it is proved to be then there is an operation which sorts it (at least it did in my case) it's literally called 'carpal tunnel release'.

    Hope this helps.

    Judi

  • Thanks Judi - does it sound like Carpal Tunnel from the way I've described it to you? I mentioned it to my GP yesterday but he just frowned and didn't examine but as I mentioned ankles in same breath he probably just thought "oh dear the RA is coming back I'd better get her seen by the rheumy asap" rather than specifically looking for other things. That's the trouble with not having a rheumy nurse or anyone else I can ask - I end up asking the GP so many things each time and then feel like I'm plaguing him. Also a problem if everything gets put down to RA and they stop looking at any other aspect of our health. TTx

  • Hi Tilda, It is entirely possible to have carpal tunnel and RA. Carpal tunnel swelling is most usually the result of repetative motion, and using a keyboard is one of the most common sources, as we tend to hold the wristsd in the same position for long periods of time.

    Plus, the RA has already irritated the area. but there is a test to differentiate carpal tunnel. Ice helps for a bit.

    by the way, Happy Easter, happy chocolate bunny day! L.xxx

  • What I found with carpal tunnel was when I was reading a newspaper (i.e. both hands up in the air) I got pins and needles in my fingers and wrists/arms and when I put them down it stopped. Also pain at night when I was sleeping - I found dangling the arm down the side of the bed helped with the pain. Also putting wrists under cold running water or wrapping a cold, wet towel around them for a while also helped. I believe that carpal tunnel syndrome is due to swelling in the carpal tunnel itself and I found that the cold reduces the swelling a bit. I have seen somewhere that its another possible RA effect.

    The strange thing is that when I had the carpal tunnel release op. the surgeon told me that I only had carpal tunnel in the right wrist and he said that it could be something else in the left but didn't tell me what. Whatever he thought it was the surgery stopped it.

    The other strange thing was that when my rheumy consultant did an electrical test before the op. he told me that the readings were worse for my left hand. I did tell him that it was my right which gave me the most pain or bother (it almost seemed as though he didn't believe me).

    With regard mentioning to your GP (or rheumy team) more than one item, yes, totally agree I have had to re-mention or re-ask the question again on many occasions (since I realised that sometimes they 'forget' to answer my question) I think perhaps they go for what they feel is the most problematic.

    Judi

  • Thanks Judi - yes I do feel very tingly and pins and needle-ish it's true but also horrible flashes of toothache like pain just under my thumbs and in side of palm under my little fingers like intense neuralgia. Ah well I can't face seeing my GP again for this so if it flares up - as seems to be heading for - then I'll gulp down the Naproxen and Tramadol and tell him on Monday when he might hopefully have some news from the rheumy re my meds. The thing that makes me think it's RA is that my ankles and toe pads feel very similar. TTx

  • Tilda, don't you get this coming Monday as a bank holiday in your part of the world ? I know Scotland varies sometimes .... think it's the August bank holiday (or is it May bank holiday?)

    I did have problems with the feeling of hot needles in ,my feet when I was put on cyclosporin (don't think thats spelt right) and whilst my rheumy consultant had never heard of this before I knew it had to be those because when I left them off for a few days the feeling of hot needles stopped, I restarted them again and they started again. So went back on to mtx. as I had been before. Have you been taking any new meds?

    Judi

  • Oh yes I was forgetting that! Well I guess it will be Tuesday then - my GP said his auto reply said back on Monday. I don't know if the surgery is shut on Monday or not. Often our school holidays don't even cover Easter Monday and it has to be taken as a bank hol one day closure. I guess its because Scotland works to a 4 term year and Easter varies so much each year. This Sunday is also our wedding anniversary so very timely really!

    It is quite sinister isn't it when everything aches and prickles? - I feel like I'm one of those space powder things with little exlposions happening from my elbows up and down in my feet a bit too? But the pain is manageable now a few hours have passed - it was in the night and for a few hours on waking that my wrist was really mean again. Pushing things seems to really hurt the most, same with ankles. Oh well.

  • Our surgery is closed til 8 am on Tuesday. One thing I notice with ra is that you can have intolerable pain and the next day it may have gone altogether . Happy wedding anniversary

    Cx

  • PS and no new meds at all - just MTX and Amitriptyline which I've been taking for about 8 months. TTx

  • I also have that tingly sensation reading news paper or leaning on elbow, told the Rheum about it and she asked how often I said occasionally, and she said not to worry about it, it doesn't bother me it's just a strange sensation. It did bother me until she said not to worry unless it was constant.

    Also, regarding wrist pain, I have had several injections in my wrist and since I have stopped working ( all day on mouse) it hasn't flared. The injections really helped. Image guided only Tilda.

    When the inflammation goes down in your blood, the pain does ease and for me the new pains stopped, but the damage that was done was done! My rheumy says also that wrists hav to be very bad for surgery and it is last resort, that was my ankle, which was my most most awful pain before I got on correct Dmards.

    Have to run, so many docs to see, so little time. Joke! Just going to see guy re thyroid, chi ching!

    Gina.

  • Good luck with the endo Gina - hope they can remedy the overactive thyroid for you. I have constant tingling in both elbows up to fingers just now - but it's the pain that worries me more. I have to wait until Monday now but I will start on naproxen and tramadol if pain doesn't improve soon - that said I can walk, just did my Wii exercises and only a little bit of wincing on the way with wrists and ankles. It's when I'm still the bu**er gets me most!

    I read a really helpful article in one of the old NRAS mags about exercise and RA and it clarified to me that keeping on top of everything when possible is a bit like getting the right meds in time - it holds stuff at bay. I've also realised that despite increase in pain, tingling and a few hours of morning stiffness (prior to Wii Fit) I am not depressed today - as I think I would be if it was just the MTX. Mind you yesterday was dreadful - I couldn't stay awake or hardly muster a smile (poor OH) so maybe got it all out of my system then?!

    TTx

  • Hi Tilda,

    If you have carpal tunnel, then to begin with a wrist splint should alleviate it.

    The classic symptom is pins and needles in your whole hand, caused by the "tunnel" closing on the nerves and trapping them.

    You would get pins and needles at night too, and as mentioned above, arm-dangling helps.

    Its common in early RA and easily sorted. But its also common in women of a certain age who don't have RA.

    Your pains sound to me more like joint inflammation than carpal symptoms. It must be infuriating for you, as you work with your hands. Good luck on Monday or Tuesday!

  • Thanks Phoebe. As I keep saying it's not THAT bad really - my hands and wrists have been far more painful and more swollen in the recent past. It's just what someone here said about how we get all optimistic that things are better and then when they creep back it's a bit devastating is all. The tingly thing is most disconcerting but then so is the deep heat I'm getting again all the time everywhere now from lower neck down. Also the white freezing cold fingers are really not good just now and all these things feel connected. Maybe it all to do with being at a certain age as I'm certainly in the midst (or possibly passed) all that. I have a nasty suspicion they are connected by the RA though. Hmm I really do need to speak to the rheumy about all this I feel. TTx

  • i had carpal tunnel surgery in both wrists a few years back. my main symptoms were achey wrists , cramp like feelings in the palms of my hands and tingly / pins and needles in my fingers. it always seemed worse at night and really disrupted sleeping and like others suggested dangling the arm over the edge of the bed seemed to help. i also found smearing arnica gel over my hands before bed eased it. if you do need the op its nothing really, more of an inconvenience not being able to use it lol.

  • Thanks Pinkdee. I'm not worried by the prospect of an op for this if it would help but just confused by the fact that my wrists have been terrible previously in different places and carpal tunnel was never mentioned - and also by the fact that my ankles seem to be pretty must the same way although less tingly. I will try dangling them a bit although for some reason my fingers usually stiffen up horribly when I dangle them down.

    But I was kept up by the one wrist quite badly last night and thought about the position it was in - it was elevated on a pillow so maybe that makes sense that it would be more sore. I must start using my resting splint more often too but it just seems to drive me nuts by about 3am. Maybe it's carpal tunnel and RA ;-( ??!

    TTx

  • hello Tilda,

    my occupational health nurse picked up that I had carpel tunnel and made up some night splints for me, it seemed to do the trick and as the RA became under control so did the carpel tunnel. Sometimes they still get numb throught the night but as I;m sure I've mentioned before I rest my hands over rolled up socks as recommened by nurse.

    The inflammation will cause carpel tunnel I'm sure, as Pheobe says 'tunnell closing on the nerves and trapping them'' had it when I was pregnant as well which is common. I was under the impression it mostly settles itself unless damaged..... xx

  • Oh that's cheering at least Williby - hoping I'll be on more meds soon and that might sort it out. I thought you had told us you'd had this too. I have one resting splint but need to get one made for my left hand as it then keeps me awake while the other is resting! Mind you last night I had to go for a pee so took it off and then forgot to put it back on so that didn't help. Everything is playing up this evening though and I feel like ive been injected with sherbert up and down my body (as well as some RA!). I will try socks tonight and see if that helps me too. TTx

  • Hi Tilda

    I went to OT just over a week ago, it was my first appointment. She asked all the questions but when I told her I get wrist pain she took a hold of my wrist and tapped quite hard then asked if I had a numb sensation and tingling, and if lasted for a few mins.

    She said this is classic signs of carpal tunnel.

    Hope this helps

    Caroline xx

  • Hi - the other thing you could have done is a nerve conduction test. I'd had pins and needles during the night / morning almost since diagnosis and a couple of months ago turned into more numbness of hands and even up my arms during the night and upon waking. The consultant had always sait he thought it was carpal tunnel, but that it didn't seem bad enough for surgery. However eventually had nerve conduction tests, which found absoutely nothing! So still have numb hands and sometimes arms, but no idea what it is as its not carpal tunnel!

  • Thanks I feel none the wiser about what's going on with me but it's interesting to find out all your carpal or non carpal experiences. I will get around to asking GP at some stage. Maybe the numbness is part of RA for some people? I have also been getting classic Reynaulds off and on since all this - perhaps all these things are connected in some way. I suppose each of us our own version of RA and for some it's numbness and for others it's hot and cold sherbert! TTx

  • Actually the neurologist who did my nerve conduction test did comment on my really cold hands and how that can affect nerves etc. He made me soak them in warm water before doing the test as he said cold hands could affect the results, but towards the end of the test my hands were freezing again, so he mentioned Reynaulds...so I also have no idea!!.........

  • My GP did say that Raynaulds can be one of the soft tissue complications of RA - seems unlikely to me that i'd have developed this and carpal tunnel (if I have) entirely independently of the RA - although I have lost a lot of weight in a year and that might account for why I'm feeling the cold so much these days I guess?

  • Well, to throw another possibility in the pool: Before I had surgery on my neck for spinal stenosis, caused by the RA, my prime symptom was numbness and tingling in my arm and hand on the right side, especially when laying down, or looking down, as in reading a book. The nerve conduction study disclosed the source was compressed nerves from deterioration of 3 vertebrae at the base of the skull. Surgery, with insertion of metal plate and screws, cement and maybe evwen twist-ties fixed it :) Amazing what can be done.

    BTW, am about to leave for OT, on my wrist and hand, post op 3+ weeks, today there is an area of pink surrounding the wrist area wher a piortion of the ulnar was removed. I'm going to keep an eye on that. Have wanted to write a blog outlining the whole experience, if this hand will hold up long enough. Or might have to do it in sections :) If I can get my mind to shut up and stop typing long enough!! Later. Lxxx

  • Thanks Loret. It's the Easter weekend and our 23rd wedding anniversary so I'm planning to try my hardest to forget about throbbing wrists, ankles, RA, gloom and doom, weird tingles and prickes. And I'll drink some bubbly, doze a little and embroider leaves for an artwork with a good destination. I hope you have a lovely Easter! Tilda xx

  • hi Tilda just joining in on this.

    I saw a specialist physio who told me about my carpal tunnel, He moved my neck and elbows and wrists and in certain ways it brings on severe pins and needles which i find alarming. Also if i lean forward it comes on badly. However one of the things that apparently show the carpal tunnel apart from the movement tests and the nerve tests is that the pins and needles go down around the hand and all fingers apart from the pinkie !! So i dont know if you have noticed it.

    Then saw the rheumy consultant who said you often need an op to free the nerve which is trapped in the carpal tunnel but that i should hold off cos it might just be the swelling and inflammation causing the nerve to trap at present.

    Ice, hand dangling and wearing hand splints and resting splints helps. Also i would ask about raynauds disease with your finger symptoms, good luck. Axx

  • Thanks Allanah - I think my wrists are probably just good old RA because although my fingers do tingle its not pins and needles. The worst affected of my fingers are both my pinkies - one of which now sticks out permanently and has twisted round so it faces out too. Interstitial that the pinkies are the left out ones then. My wrists aren't agony any more but they aren't right either and most mornings the are very stuff and painful.

    When I do finally get to see the rheumy I will have such a list of questions to work through - he will be made to discuss wrists, dodgy ankle - 3 permanent cranky fingers always swollen and purple at the joints now and my left elbow and shoulder - cant fully stretch or bend my left arm in or out now. Funny the way it's not very symmetrical though although both sides are pretty evenly matched overall?! And yes will try and mention the Raynauds too - fingers are all bright white again as I write this! TTX

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