Hypothyroidism And Carpal Tunnel

Carpal tunnel syndrome is a relatively common condition, estimated to affect approximately 5% of the population, with as much as 90% of patients being female1. The condition has been associated with a number of unpleasant symptoms that can lead to a loss of grip, pain and even possibly disabling complications in the affected patient’s hands.

While not a life-threatening condition, carpal tunnel can cause the patient to find it difficult to partake in their regular day-to-day activities, especially at times when symptoms start to become worse.

Hypothyroidism, a condition that affects the ability of the Thyroid gland to produce enough hormones to support metabolism and other functions in the human body, has been linked to a higher risk of carpal tunnel syndromes. This condition is also known to lead to other aches and pains and is also found mostly in women.

In this article, we will take a look at the possible connection that lies between carpal tunnel syndrome and hypothyroidism, as well as provide useful information that will help patients become aware of the most appropriate techniques they can use to target their symptoms simultaneously.

Symptoms Associated With Carpal Tunnel Syndrome

In the majority of cases, carpal tunnel syndrome tends to develop at a slow rate. The symptoms are usually not of sudden onset, but instead starts out subtly and eventually starts to progress into more noticeable and disrupting symptoms. Since earlier treatment of this condition is known to yield more successful results and potentially also help the patient avoid having to undergo more invasive procedures, individuals are advised to take note of even the more subtle symptoms associated with the condition to ensure a diagnosis can be made during the early stages of the condition.

Common symptoms2 during the earlier stages of this condition may include itchiness in the patient’s palm, as well as their fingers. Tingling or burning sensations may accompany the itchiness. Most patients find that their middle fingers and thumbs are especially affected by these symptoms. A number of patients with carpal tunnel syndrome may also experience a sensation as if their fingers are swollen and more difficult to use, even when no inflammation in their fingers are present.

Most patients find that the symptoms first become noticeable while they sleep – they may start to experience discomfort and pain when they lie down still in bed, as well as when they wake up in the morning.

Without initiating a treatment plan early on, carpal tunnel syndrome may start to become worse. This may lead to additional symptoms developing that may cause further discomfort to the affected patient. While the patient will usually only experience the symptoms primarily at night time during the early stages, as carpal tunnel syndrome progresses, the patient will start to notice that the symptoms become present during the day as well. In addition to the burning, itching and tingling sensations, the patient may also find that their grip strength is reduced significantly, which makes it more difficult to perform certain tasks.

When the patient fails to attend to the condition and leaves it be, muscles that are located at the base of their thumbs can begin to deteriorate. This, in turn, leads to the inability to identify cold and hot temperatures through touch.

Causes Of Carpal Tunnel Syndrome

Even though physicians will usually try to point out a potential cause of carpal tunnel syndrome in a patient that has been diagnosed with the condition, it is important to understand that this is often very difficult – if possible at all. In the majority of cases, no specific cause will be found. The condition will rather be linked to a number of potential risk factors the patient is exposed to.

Numerous risk factors have been associated with the development of carpal tunnel syndrome. Understanding these risk factors will not only help a physician better determine why a patient may be experiencing these symptoms, but may also be helpful in allowing the patient to understand better how they can minimize their risk of carpal tunnel syndrome or reduce the effects of the condition in case they were already diagnosed with the syndrome.

One study3 explains that obesity seems to hold one of the strongest links to the risk of developing carpal tunnel syndrome. Additionally, some occupations are also known to cause a patient to be at a higher risk of this condition due to the particular tasks that the patient need to execute on a daily basis.

Diagnosis And Testing For Carpal Tunnel Syndrome

The diagnosis of carpal tunnel syndrome is only made by following a thorough physical examination, as well as a series of tests. A physician needs first to ensure that the symptoms a patient is complaining about are not caused by another problem, which may require a different approach to treatment.

During a physical examination, a physician will perform certain physical tests4 to help them identify whether the physiology behind the patient’s symptoms can be traced down to carpal tunnel syndrome. These physical tests may include pressing down on the patient’s median nerve, which is found in their wrist. The physician may also bend the patient’s wrist in certain directions, test the sensitivity of their fingertips, and also try to determine if muscle weakness is present in the patient’s thumb.

Different types of tests have also been introduced in the diagnosis of carpal tunnel syndrome to assist with making a more accurate diagnosis, as well as to assess existing damage in the affected patient’s wrist. Electrophysiological tests are the most commonly used options for assisting with the diagnosis of the condition – these tests may consist of an Electromyogram, as well as nerve conduction studies. Physicians may also request ultrasound tests, MRI scans, and X-rays to assist them in their diagnosis, as well as to ensure they can provide the patient with the most effective treatment plan.

How Carpal Tunnel Syndrome Is Treated

Once a patient is diagnosed with carpal tunnel syndrome, an appropriate treatment plan will be compiled by their physician. The treatment plan may include recommendations for either nonsurgical options to help alleviate symptoms, as well as surgical procedures, which may be somewhat invasive, especially in more severe cases of this condition. Nonsurgical treatment options are usually more effective when carpal tunnel syndrome is treated at an early stage before a more significant level of muscle and nerve damage is experienced.

Common nonsurgical options for the management of the condition may include wearing a bracing device and performing nerve gliding exercises. Some patients may find that using over-the-counter anti-inflammatory drugs may also help to reduce inflammation and alleviate pain. Corticosteroids can also be injected directly into the affected wrist to provide a more potent level of inflammatory relief.

Should no improvement be experienced with the use of nonsurgical approaches, or the condition is more severe, then certain surgical options may be recommended to the patient. The surgery used to treat this condition is usually referred to as carpal tunnel release. Two different types of carpal tunnel release techniques may be used, which include open carpal tunnel release and endoscopic carpal tunnel release. While the surgical options have been shown to be effective, it is important for patients to realize that they will not experience relief immediately – it may take as long as 12 months for all symptoms of carpal tunnel syndrome to completely go away.

The Link Between Carpal Tunnel Syndrome And Hypothyroidism

The Thyroid gland is crucial to all parts of the human body since every cell in the body has a receptor that responds to the presence of hormones produced by this gland. When the Thyroid gland becomes underactive, it is unable to produce an adequate supply of the two essential Thyroid hormones, which include Thyroxine and Triiodothyronine, to support all of the functions that depend on the presence of these hormones. This condition has been linked to many diseases and disorders affecting the human body.

One study5 looked at the prevalence of carpal tunnel syndrome among patients previously diagnosed with hypothyroidism and concluded that, among the group of participants, 16.7% of patients with hypothyroidism also had symptoms that would qualify them for a diagnosis with carpal tunnel syndrome. The study notes that they found the increased weight among patient who had been diagnosed with hypothyroidism to be one of the main contributing factors to carpal tunnel syndrome.

Another study6 monitored the efficiency of Thyroid hormone replacement in patients with an underactive Thyroid on wrist function and carpal tunnel syndrome. 73% of the subjects displayed symptoms associated with this syndrome after several tests were performed on them, including the Weber 2-point discrimination test, and the Phalen’s test. A manual compression test was also performed. The most interesting finding of this study was the fact that, even when Thyroid hormone levels returned to normal after being administered Levothyroxine medication, symptoms of carpal tunnel syndrome still persists. This calls for further research, as it seems like Thyroid hormone therapy may not alleviate all symptoms associated with hypothyroidism.

Treatment For Carpal Tunnel Syndrome In Hypothyroidism Patients

Effective treatment solutions are available for both hypothyroidism and carpal tunnel syndrome, but a large number of patients with carpal tunnel syndrome may not be aware that their symptoms may be contributed to by an underactive Thyroid gland. For this reason, patients should obtain thorough examinations and tests to determine if they have healthy Thyroid hormone levels before considering invasive therapies for their carpal tunnel.

On the other hand, it is also important that simply administering Thyroid hormone replacement drugs to the patient when they are also diagnosed with hypothyroidism may not work effectively. Additional lifestyle modifications may be needed to provide improvements in their wrist discomfort, pain and muscle weakness. In patients who are overweight or obese, healthy lifestyle adjustments to assist with weight loss and better weight management becomes essential. Several studies have proven a strong link between obesity in hypothyroidism patients and the developing of carpal tunnel. Additionally, implementing certain types of exercises focused on the wrists may also yield positive results in regards to muscle weakness in the wrist, as well as improve the patient’s grip and help them better cope with the inflammation and pain that often accompanies this syndrome.

Conclusion

Hypothyroidism has been linked to carpal tunnel syndrome, a condition that can cause severe pain in the wrists and hands, leading to potential disabling complications. While numerous treatments are available for the management of carpal tunnel syndrome, some of them tend to be invasive. Patients are advised to consider undergoing Thyroid tests, especially when female and experiencing symptoms like fatigue and weight gain, to help them understand if an underactive Thyroid may be contributing to their wrist pain and discomfort. A more accurate diagnosis can provide the patient with an opportunity to obtain effective treatment without the need for invasive surgical procedures.

References

1 J.O. Sevy andS.C. Dulebohn. Carpal Tunnel Syndrome. StatPearls. 6 October 2017. https://www.ncbi.nlm.nih.gov/books/NBK448179/

2 Carpal Tunnel Syndrome: Symptoms. PubMed Health. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0023119/

3 S. Aroori and R.A. Spence. Carpal tunnel syndrome. U.S. National Library of Medicine. January 2008. https://www.ncbi.nlm.nih.gov/pubmed/18269111

4 Carpal Tunnel Syndrome. OrthoInfo. https://orthoinfo.aaos.org/en/diseases–conditions/carpal-tunnel-syndrome/

5 S.S. Karne and N.S. Bhalerao. Carpal Tunnel Syndrome in Hypothyroidism. U.S. National Library of Medicine. 1 February 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800566/

6 C.F. Palumbo, R.M. Szabo, and S.L. Olmsted. The effects of hypothyroidism and thyroid replacement on the development of carpal tunnel syndrome. U.S. National Library of Medicine. July 2000. https://www.ncbi.nlm.nih.gov/pubmed/10913216

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