Carpal tunnel syndrome as a co-factor in the joint pain and pathogenesis of hand osteoarthritis

Abstract

Purpose: We conducted this study to evaluate the impact of carpal tunnel syndrome (CTS) treatment on symptoms related to hand osteoarthritis (HOA) and show a possible role of neuropathic factors in the development of HOA. Methods: We include patients with the coexistence of HOA and CTS treated between June 2016 and June 2019. Their information was obtained from their clinical records. The diagnosis of OA was based on the American College of Rheumatology criteria. Diagnosis of CTS was based on their symptoms and positivity for Tinel’s and Phalen’s signs, and the results of an electrodiagnostic test (prolonged motor or sensory latencies across the carpal canal of the median nerve). The impact of the treatment (surgical or medical: splint-infiltration) for CTS on the pain associated with symptomatic HOA was evaluated using a Visual Analogue Scale for Pain Intensity (VASPI) (1 to 10), before and three months after the treatment for CTS. A positive response was considered when the reported pain was reduced by at least three points (33%) on the scale as this is the best recommended cut-off point for an acceptable response regarding pain treatment. The results are described as percentage values. Results: Eighteen patients with both HOA and CTS were included. Fourteen patients had bilateral CTS and four had unilateral CTS. A total of 32 hands were therefore treated and assessed. The average age was 52 years. 14 were women. A significant improvement (33% of VASPI score) in pain due to HOA was obtained in 21/28 hands for 14 patients treated for bilateral CTS. All four patients with unilateral TCS show improvement in pain related to HOA. 28 hands received non-surgical treatment (wrist splinting and injection of corticosteroids), and four hands were treated with a surgical approach (two of these had axonal damage and surgical treatment was not successful). Figure 1 shows the four patients with unilateral TCS and the development of more severe ipsilateral HOA. Conclusions: This study indicates that CTS is associated with more painful and progressive HOA and that the treatment of CTS can improve the pain associated with HOA and can probably help to slow its evolution. More studies are needed in order to replicate these findings and to further explore the possible role of CTS in the development of joint damage in HOA.