Carpal tunnel syndrome (CTS) is a condition that occurs when the mobility of the median nerve is restricted as it passes through the wrist, resulting in symptoms including pain, numbness, tingling, and/or weakness in the thumb, index finger, middle finger, and thumb-side of the ring finger. While most often associated with repetitive hand movements—especially in conjunction with heavy forces, vibrations, and non-neutral wrist postures—any health condition that reduces the available space within the carpal tunnel enough to affect the median nerve can contribute to CTS. One such condition that can play a role in the development of CTS is rheumatoid arthritis.
Rheumatoid arthritis is an autoimmune disorder in which the body’s own immune system mistakenly attacks the membranes that line the joints, leading to inflammation. The precise cause of this form of arthritis is unknown, but the current understanding is that some people carry genes associated with a higher risk that may be triggered by unhealthy lifestyle habits (smoking and obesity, for example), environmental pollutants, hormonal changes, and even infections. Due to several factors, including their small size, the joints in the hands are among the first affected by rheumatoid arthritis. In fact, a 2016 systematic review and meta-analysis on the effect of inflammatory arthritis on carpal tunnel syndrome revealed that rheumatoid arthritis nearly doubles an individual’s risk for developing CTS.
The treatment approach for CTS in a patient with rheumatoid arthritis will be multimodal in nature, starting with manual therapies, like mobilization, to help restore normal motion to the affected joints. This may also include activity modifications and the use of a nocturnal splint to avoid exposures that can exacerbate symptoms during the early phase of recovery. A doctor of chiropractic may also employ physiotherapy modalities, instruct the patient on how to perform at-home exercises to reduce pressure on the median nerve, and make nutrition recommendations to help reduce inflammation. If necessary, he or she will work in coordination with the patient’s medical physician or rheumatologist to help achieve a satisfactory outcome.
In the long-term, the patient will be encouraged to adopt a healthier lifestyle not only to reduce the risk for recurrence of their CTS symptoms, but also slow the progress of their rheumatoid arthritis. This may include reducing sedentary time, getting regular exercise, eating a low-inflammatory diet, maintaining a healthy weight, not smoking, spending time in the sun, getting sufficient sleep, and avoiding excessive alcohol intake.
