In this article, you will find out everything you need to know about carpal tunnel syndrome, the most commonly misdiagnosed symptoms and the best treatment options, including an advanced treatment called Prolotherapy.

Two Conditions That Are Often Misdiagnosed as Carpal Tunnel Syndrome

Table of Contents

• What is Carpal Tunnel Syndrome (CTS)?
• Causes of Hand and Wrist Pain
• Why Misdiagnosis Happens
• Condition 1: Pronator Teres Syndrome
• Condition 2: Cervical Radiculopathy
• Case Study
• Treatments
• Prolotherapy
• Prevention and Early Intervention
• FAQs
• Contact ProHealth Clinic
• Author Bio
• References

What is Carpal Tunnel Syndrome (CTS)?

Carpal Tunnel Syndrome (CTS) is a well-known nerve compression disorder affecting the median nerve at the wrist. Carpal tunnel syndrome affects the median nerve, which primarily affects the thumb, index finger, and middle finger, leading to reduced hand function. The most common symptoms include numbness, tingling, hand pain, and weakness in the hand. Many patients feel symptoms such as fingers tingle—especially in the index finger and middle finger—which can worsen over time. However, some patients with symptoms similar to CTS are actually suffering from entirely different conditions. These overlapping symptoms make the right diagnosis essential for appropriate treatment. Misdiagnosis can lead to ineffective treatments, delayed recovery, and ongoing pain. This article explores two such conditions that are often mistaken for Carpal Tunnel Syndrome and explains how to differentiate them for accurate diagnosis and proper treatment.

Causes of Hand and Wrist Pain

Hand and wrist pain can arise from a wide range of causes, making it essential to understand the underlying issue before starting any treatment. One of the most common culprits is carpal tunnel syndrome, which develops when the median nerve is compressed as it passes through the carpal tunnel—a narrow passageway formed by the carpal bones in the wrist. This compression can lead to classic carpal tunnel syndrome symptoms such as numbness, tingling, and pain, especially in the thumb, index, and middle fingers. However, unlike carpal tunnel syndrome, other conditions can produce similar symptoms and are sometimes misdiagnosed as carpal tunnel.

Rheumatoid arthritis is another frequent cause of wrist pain, particularly in the wrist joint. This autoimmune condition can cause inflammation, stiffness, and swelling, and in its early stages, it may be mistaken for carpal tunnel syndrome. Wrist flexor tendonitis, which involves inflammation of the tendons on the palm side of the wrist, can also mimic carpal tunnel pain, especially when repetitive strain or repetitive movements are involved. Cervical radiculopathy, resulting from nerve compression in the cervical spine, can cause neurological symptoms such as numbness, tingling, and weakness that extend from the neck down to the hand, further complicating the diagnostic process.

Other medical conditions, such as degenerative disc disease, spinal stenosis, and herniated discs in the cervical spine, can also contribute to hand and wrist pain. These conditions may lead to a pinched nerve, resulting in symptoms that overlap with those of tunnel syndrome. Bone spurs and wrist tendonitis are additional factors that can cause discomfort and may be misdiagnosed as carpal tunnel syndrome if not carefully evaluated.

Developing carpal tunnel syndrome is often linked to repetitive strain from activities that involve frequent hand movements, such as typing or assembly line work. Maintaining a neutral position of the wrist, taking regular breaks, and performing stretching exercises can help prevent carpal tunnel syndrome and reduce the risk of other repetitive strain injuries. Accurate diagnosis is crucial, as the right treatment depends on identifying the specific cause of the pain. Non-surgical treatments like wrist splints, physical therapy, and anti-inflammatory medications can provide pain relief for many conditions, while severe cases of carpal tunnel syndrome may require carpal tunnel release surgery. Corticosteroid injections are sometimes used to reduce inflammation and alleviate symptoms.

If you are experiencing pain, numbness, or tingling in your hand or wrist, it is important not to self-diagnose. Left untreated, these symptoms can worsen and lead to long-term discomfort or loss of function. Consulting a healthcare professional ensures an accurate diagnosis and a tailored treatment plan, whether your symptoms are due to carpal tunnel syndrome, arthritis, tendonitis, or another underlying condition. By taking proactive steps to prevent carpal tunnel syndrome and other causes of hand and wrist pain, you can protect your hand health and maintain your ability to perform everyday tasks.

Why Misdiagnosis Happens

Carpal Tunnel Syndrome shares overlapping symptoms with other musculoskeletal and nerve disorders. Many clinicians rely on symptom history alone without further testing, which increases the risk of an incorrect diagnosis. The median nerve’s sensory distribution overlaps with areas affected by other nerves, and certain tendon and joint problems can mimic nerve entrapment. Early and accurate differentiation is vital to avoid unnecessary surgery or prolonged suffering [1].

Condition 1: Pronator Teres Syndrome

Pronator Teres Syndrome (PTS) involves compression of the median nerve as it passes through the forearm near the pronator teres muscle. Like CTS, it can cause tingling, numbness, and weakness in the hand, but the compression occurs further up the arm.

Key Differences from CTS:

• Symptoms often extend further up the forearm.
• Nocturnal symptoms are less common than in CTS.
• Wrist splints, which help CTS, may not relieve PTS symptoms.

Diagnostic Tip: Palpation over the pronator teres muscle may reproduce symptoms, and nerve conduction studies may reveal a different compression site [2].

Condition 2: Cervical Radiculopathy

Cervical Radiculopathy occurs when nerve roots in the cervical spine (neck) are compressed or irritated, often due to disc herniation or osteoarthritis. The resulting nerve pain, numbness, and weakness can mimic CTS symptoms.

Key Differences from CTS:

• Neck pain and stiffness may accompany symptoms.
• Numbness can extend into the arm and shoulder.
• Hand weakness may be more pronounced in certain muscle groups not typically affected by CTS.

Diagnostic Tip: A thorough neurological exam combined with cervical spine imaging (MRI or CT) can confirm the diagnosis [3].

Case Study

Patient: 42-year-old office worker with persistent hand tingling despite months of wrist splint use. Initially diagnosed with CTS, nerve conduction studies revealed normal median nerve conduction at the wrist but slowed conduction in the forearm. Further assessment confirmed Pronator Teres Syndrome. Following targeted physical therapy and ergonomic adjustments, symptoms resolved within three months.

Treatments

Correct diagnosis is the foundation of effective treatment. If symptoms are due to Pronator Teres Syndrome or Cervical Radiculopathy rather than CTS, wrist-focused interventions will likely fail.

For Pronator Teres Syndrome:

• Activity modification to reduce forearm strain.
• Targeted stretching and strengthening of forearm muscles.
• Physical therapy to improve nerve mobility.
• Occasionally, corticosteroid injections or surgical decompression.

For Cervical Radiculopathy:

• Postural correction and ergonomic adjustments.
• Physical therapy to improve neck mobility and reduce nerve compression.
• Anti-inflammatory medications or steroid injections.
• Surgical intervention in severe or persistent cases.

Prolotherapy

In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat carpal tunnel syndrome.

Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.

Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with carpal tunnel syndrome.

As prolotherapy is helping to treat the root cause of carpal tunnel syndrome, it is deemed to be a permanent fix, preventing the symptoms from returning.

Prevention and Early Intervention

Preventing misdiagnosis involves a combination of patient awareness and clinician diligence. Patients should seek medical evaluation early, and providers should perform thorough clinical and diagnostic testing before recommending surgery. Awareness of alternative diagnoses such as Pronator Teres Syndrome and Cervical Radiculopathy is essential to prevent prolonged suffering.

FAQs

How can I tell if my symptoms are from Carpal Tunnel Syndrome or another condition?

CTS symptoms typically involve numbness and tingling in the thumb, index, middle, and half of the ring finger, often worsening at night. If symptoms extend up the arm, involve the neck, or fail to respond to wrist splints, another condition may be responsible.

Can Carpal Tunnel Surgery fix Pronator Teres Syndrome?

No. Pronator Teres Syndrome involves nerve compression in the forearm, so wrist surgery will not resolve symptoms.

What tests help differentiate CTS from Cervical Radiculopathy?

Nerve conduction studies, EMG, and imaging such as MRI can help identify the exact location of nerve compression.

When should I see a specialist?

If symptoms persist beyond a few weeks despite conservative treatment, or if there is weakness, severe pain, or loss of function, see a hand specialist or neurologist promptly.

Contact ProHealth Clinic Today for Your FREE 15-Minute Discovery Call

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Author Bio

Having performed over 10,000 procedures, Mr Eaton is one of the UK’s leading practitioners in the field of treating carpal tunnel syndrome, with patients travelling to see him from across the UK, Europe, and the Middle East. With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with carpal tunnel syndrome and providing effective treatment options to alleviate them. He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany. Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists. LinkedIn profile.

References

1. American Academy of Orthopaedic Surgeons. “Carpal Tunnel Syndrome.” AAOS.org
2. Werner, R. A., & Andary, M. (2011). “Electrodiagnostic evaluation of carpal tunnel syndrome.” Muscle & Nerve, 44(4), 597–607.
3. Carey, J. R., et al. (2007). “Differentiating cervical radiculopathy from upper extremity peripheral nerve entrapment syndromes.” Journal of Hand Therapy, 20(3), 309–319.