Monday, June 4, 2012

Autoimmune Disease and Carpal Tunnel Syndrome

Image found here. 
My friend Shara recently sent me an email which included this question: I did not know that people with autoimmune diseases were susceptible to carpal tunnel, did you?

It also included this comment: You sound like you are back to your sassy self - in your pleasent state. Your critique of that book was a little cranky.

Dang, Shara. I thought I hid my cranky-pants attitude pretty well but I guess you could see right through my efforts....yep. I AM feeling less grumbly these days. Thanks for noticing!

On to the question about autoimmunity and carpal tunnel. CTS, or carpal tunnel syndrome, is described by NIH (National Institute of Neurological Disorders and Stroke):

The carpal tunnel is a narrow passageway of ligament and bones at the base of your hand. It contains nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the nerve to be compressed. Symptoms usually start gradually. As they worsen, grasping objects can become difficult.
     What causes the problem? Some people have smaller carpal tunnels than other people do. Other causes include performing assembly line work, wrist injury, or swelling due to certain diseases, such as rheumatoid arthritis. Women are three times more likely to have carpal tunnel syndrome than men. Treatment includes resting your hand, splints, pain and anti-inflammatory medicines, and surgery.

You can read more about CTS here. CTS has many potential causes including work-related issues, medical conditions, medications, and injuries.

For people with autoimmune disease, carpal tunnel syndrome can be caused by the inflammation which is a result of diseases such as Sjogren's syndrome.  This explanation found via the University of Maryland Medical Medical Center:

     In autoimmune diseases, the body's immune system abnormally attacks its own tissue, causing widespread inflammation, which, in many cases, affects the carpal tunnel of the hand. Such autoimmune diseases include rheumatoid arthritis, systemic lupus erythematosus, and thyroiditis, which can lead to hypothyroidism.. Some experts believe that CTS may actually be one of the first symptoms in a number of these diseases. Studies also suggest that CTS patients with these disorders are more likely to have severe CTS that requires surgery.

An interesting study entitled Carpal tunnel syndrome as a herald of autoimmune rheumatic disorders by Badal Pa,l MD, FRCP was published in the Royal Society of Medicine in April of 1997.  In it, the author theorized that carpal tunnel syndrome may actually be an early indicator of autoimmune disease:

In conclusion, we recommend a high index of suspicion in patients presenting with CTS, even when the condition appears to be idiopathic. Follow-up is desirable, in case the condition is a herald of inflammatory or autoimmune disease.

Great question, Shara.

Readers: Do YOU have CTS? And did your carpal tunnel syndrome precede your autoimmune diagnosis?


Anita Rowe Stafford said...

CTS did precede my other symptoms. It has been problematic for many years now. I have worn the splints, I've had the surgery, and now I'm wearing the splints again on both wrists every night. Doc says I'd better wear them to try to avoid surgery again. Don't think I could open a jar if my life depended on it!

Anonymous said...

Spot on. Great post. Could be a clue to apy attention to. My CTS was the first sign of Sjogrens, which, of course, I had no idea at the time. I wasn't diagnosed with sjogren's for two 1/2 years after the onset of CTS.

Anonymous said...
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Anonymous said...

Yes, to carpal tunnel--a big problem when you're a graphic designer like me. Diagnosis followed by Sjo diagnosis.
A trackball helps!

p.s. Your blog is a blessing! Makes me understand that ALL these symptoms are NOT just in my head. :)

Nicole said...


I've just found your blog and love it! Thanks for sharing your experiences. I have not been diagnosed yet, but am expecting it when I (finally!) get to the rheumy in six more weeks. (Positive blood work and plenty of symptoms.) I developed CTS in late 2008. It's pretty well-controlled with a brace at night and a break from driving once a week.

Anthony said...

I have relatively mild carpal tunnel in only my left hand. My CTS diagnosis preceded the worst of my symptoms by 7 years. CTS preceded my Sjogren's diagnosis by 11 years. My rheumatologist suspects that I have had Sjogren's for around 20 years, though.

Anonymous said...

Thanks for this post. I had some time ago some pains in my hands, and the doctor tought on the carpal tunnel. It seems it was just tiredness, but I have to be carefull.

Cortez Diagnostics Inc. ELISA kit said...

I don't have CTS but my Mom do have. And he did not precede to autoimmune diagnosis, she just don't like it.

Nicole said...


Since I wrote this I've been dx'd with RA. Apparently CTS can be an early symptom, caused by inflammation in the wrist joints. My rheumy said it was certainly possible that my CTS was RA-related. Let's see - that's four years ago now! It has been bothering me this summer, which seems to be an early indication of inflammation in general. For me, at least.

Anonymous said...

Had carpal tunnel surgery years ago AFTER my SS diagnosis. No one made the connection at the time. Now I understand why it happened even though I didn't have a job that stressed my right hand. I also had tendonitis surgery in the same hand.

Anonymous said...

I was diagnosed about six months ago with sjogrens. Now i have cts. If i had the surgery for cts how successful could it be? And would it be worth it?

jtman9200 said...

I have been all over the place looking for a simple explanation of carpal tunnel syndrome. Your graphic is probably the best one I have found. It's good to know that this can been treated with a simple procedure. I think my mother may suffer from this but she has been too stubborn to get it checked out.

Carol Jennings said...

Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Most likely the disorder is due to a congenital predisposition - the carpal tunnel is simply smaller in some people than in others. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; overactivity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal. In some cases no cause can be identified. There is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome. Other disorders such as bursitis and tendonitis have been associated with repeated motions performed in the course of normal work or other activities.. Writer's cramp may also be brought on by repetitive activity.

Ruth said...

Wow. I didn’t have carpal tunnel syndrome, but I did have both thoracic outlet and cubital tunnel syndrome, which are less common. I had them so badly in 1997 that I was on disability for 6 months, lost my job, and continued physical therapy for an additional 10 months. I had chronic pain for a full two years from this. I was tested for Lyme disease and MS, but never other autoimmune disorders. Wish I had a time machine. (Also wrote this on my own blog:

peg said...

I'm a massage therapist with SS so as you can imagine, I have to take care of my wrists (as well as other joints and uh... everything else, sigh.).

I found this self-treatment a while ago and it has helped my wrists (and other areas of nerve entrapment through out the arm). I try to do this every day.

Unknown said...

Hi Peg, I've also found nerve flossing quite good for carpal and cubital tunnel syndrome (less common). this is another great post, thank you! Can definitely think of many of my older clients who have CTS preceeding their -other AI conditions

Lynne Homeopath said...

Yep my Carpal Tunnel preceded Hashimotos though my doctor didnt look passed my TSH which went down from 10 to 3 over three months three yrs ago but inbetween the TSH tests I organised a private advanced thyroid check and as both antibodies were in the 300s I sort help from a private therapist and also treated myself homeopathically and now one antibody is within normal range and the other is close to that state. The best thing I did was to go to a diagnostic kinesiologist to work out what my food intolerances were (common in Hashi's) and after finding out that I had the MTHFR variant I am supplementins with methyl B Vits including Folate and Zinc bathing regularly in epsom salts and now my headaches are much much better and my gut is well under control not to mention my hand and right knee arthritis hardly trouble me at all.
Whats not to like.
Best rgrds