Carpal Tunnel And Thyroid Disease
As described, thyroid disease is one of the many conditions known as etiologies of CTS. Despite the number of cases of carpal tunnel syndrome that are associated with underlying thyroid disease, patients complaining of CTS symptoms are not routinely tested for thyroid disease.9
However, CTS may be the presenting symptom or complaint in patients with undiagnosed hypothyroidism. There is increasing evidence for identifying hypothyroid-related CTS and treating the CTS primarily with thyroid hormone.3 Doing so may avoid unnecessary surgical intervention and provide long-term relief or resolution of symptoms. In addition, the efficacy of surgical management may be reduced in patients with untreated hypothyroidism.10
The following discussion will navigate diagnostic and treatment approaches to carpal tunnel syndrome, with a focus on the considerations in hypothyroid-related cases.
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 patients symptoms can be traced down to carpal tunnel syndrome. These physical tests may include pressing down on the patients median nerve, which is found in their wrist. The physician may also bend the patients wrist in certain directions, test the sensitivity of their fingertips, and also try to determine if muscle weakness is present in the patients 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 patients 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 Abnormal Thyroids Cause Pain In Feet
Hypothyroidism can lead to foot pain.
Thyroid disease can refer to any dysfunction of the thyroid gland, a large butterfly-shaped gland in the front of the neck. People who have thyroid disease, especially hypothyroidism, often experience foot pain.
Hypothyroidism occurs when the thyroid gland is underactive and no longer produces all the hormones the body needs. The lack of hormones causes chemical disruptions throughout the rest of the body, including the autoimmune system and metabolism. Fortunately, treatment of hypothyroidism is fairly easy if caught early. Patients with the condition often take hormonal supplements in order to keep their body balanced.
Advanced Foot & Ankle of Wisconsin helps patients with hypothyroidism manage foot pain caused by this condition. Learn more about hypothyroidism including:
- Cold sensitivity
- Muscle pain or stiffness
If you notice many of these symptoms, it is best to see your doctor for a formal diagnosis. Once you have confirmed hypothyroidism as the cause of your pain, it is time to move on to treatment. An untreated underactive thyroid can lead to a fatal condition known as myxedema. Other long term complications include heart problems and depression.
Who Is Most Likely to Develop Hypothyroidism?
A hypothyroidism diagnosis is your first step to treatment.
Finally, if anyone in your family has hypothyroidism your chances of having it increase. Check with your doctor if you have a family history of thyroid disorders.
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Surprising Factors That Can Lead To Carpal Tunnel
When the median nerve that runs from your forearm into the palm of your hand becomes compressed or pinched, you experience pain in your palm and fingers the telltale signs of carpal tunnel syndrome.
You may know that having a job with repetitive hand and wrist activity, such as typing or assembly line work, puts you at risk of developing carpal tunnel syndrome, but you may be unaware of some other factors that can put you at risk. Read on to learn what might be behind the development of this painful and disabling condition.
Could It Be Restless Leg Syndrome
Many people confuse nocturnal leg cramps with another condition known as restless leg syndrome, RLS. Like RLS, leg cramps most often occur at rest. The difference, however, is that leg cramps produce muscle tightening, cramping and pain. With RLS, youll experience a strange and unpleasant urge to move your legs in order to stop a feeling of discomfort, but there isnt usually pain associated with it.
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Research And Possible Risk Factors
Researchers have found that a previous wrist fracture and the use of insulin, metformin, and sulphonylureas are associated with a higher chance of CTS. Smoking, hormone replacement therapy , the combined oral contraceptive pill, and oral corticosteroids did not appear to be not linked to a higher risk of CTS.
One study has suggested that obesity, combined with a square-shaped wrist shape, may increase the likelihood of CTS developing. However, the team concluded that obesity was probably not the cause, because when participants with obesity lost weight, they continued to have CTS.
The same team concluded in other research that the age of women at the menopause might be a factor, and that pregnancy-related hormones may increase the risk of CTS in women at the time of the menopause.
Postmenopausal women who use aromatase inhibitor drugs for breast cancer often experience CTS.
Apart from work-related factors, the main risk for CTS is inflammatory arthritis, but hypothyroidism and diabetes also appear to increase the chance of developing it, according to research published in the Journal of General Internal Medicine.
The National Institute of Neurological Disorders and Stroke says that CTS is three times more likely to occur among people working in assembly operations than in data-entry personnel.
The Canadian Centre for Occupational Health and Safety list the following occupations as risk factors for CTS:
According to the National Library of Medicine, there is
How Is Myxedema Diagnosed
Your symptoms will lead your doctor to suspecting severe hypothyroidism. Blood tests can help your doctor confirm this. A thyroid-stimulating hormone test measures how much TSH your pituitary gland produces. Your pituitary gland will increase TSH production if your thyroid isnt producing enough. In other words, a high level of TSH could mean you have hypothyroidism.
A TSH test is typically checked along with a thyroxine test. This test measures the level of T4, a hormone produced directly by your thyroid. If you have low levels of T4 coupled with a high level of TSH, you have hypothyroidism. Your doctor will likely want to perform more tests to determine your thyroid function and other conditions that may be affecting it.
Myxedema crisis is a medical emergency. Once suspected, TSH and T4 levels will be checked right away. Treatment can begin as soon as possible. The initial diagnosis often relies on the physical examination.
Emergency medical personnel will look out for other features of severe hypothyroidism such as:
- dry skin
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Ruling Out Other Cumulative Trauma Disorders
About 25% of patients with suspected work-related cumulative trauma or repetitive stress disorders have evidence of other conditions that resemble, but are not carpal tunnel syndrome. A definitive diagnosis is often difficult. Most of these disorders require treatments similar to those used for CTS: rest, immobilization, steroid injections, and surgery if conservative treatment is unsuccessful.
Hyperthyroidism: Excess Thyroid Hormone
The opposite problem, hyperthyroidism, or too much thyroid hormone, is far less common, affecting less than 1% of the population. But it, too, can harm the heart.
The classic symptoms include sleeplessness, heat intolerance, excess sweating, weight loss, extreme hunger, and loose bowels. Excess thyroid hormone also causes the heart to beat harder and faster and may trigger abnormal heart rhythms. One is atrial fibrillation, a disorganized rhythm in the hearts upper chambers. A related symptom is palpitations, a sudden awareness of your heartbeat. People with hyperthyroidism may also have high blood pressure. In a person with clogged, stiff heart arteries, the combination of a forceful heartbeat and elevated blood pressure may lead to chest pain or angina.
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Can Smartphones Cause Carpal Tunnel Syndrome
Most of us are guilty of spending too much time on our phones. After a while, all that swiping and scrolling may feel like its taking a toll. Your wrist might ache, or your hand could feel numb or tingly.
Could it be the sign of a greater problem?
Here, Ill explain what you might be experiencing when you have wrist pain after using your phone starting with the question that concerns a lot of people.
Can smartphones cause carpal tunnel syndrome?
From our current understanding of carpal tunnel syndrome, smartphones cannot cause it.
Carpal tunnel syndrome is when theres excessive pressure on the median nerve as it crosses the wrist. The most common reason for carpal tunnel syndrome is idiopathic it just happens and we cannot point to a specific cause.
Carpal tunnel syndrome is associated with other diagnoses such as diabetes or hypothyroidism, but there is limited evidence that any specific physical activity actually causes carpal tunnel syndrome. That being said, certain physical activities may exacerbate symptoms of carpal tunnel syndrome and one such activity is holding a cell phone to your ear. Many patients will note the onset of symptoms of carpal tunnel syndrome as they are talking on their cell phone.
Can smartphones cause other wrist pain?
Phones may also cause whats known as texting thumb, which isnt a diagnosis but refers to wrist, hand or thumb pain associated with a smart device.
How can you prevent smartphone-related wrist pain?
Hypothyroidism Foot Pain Treatment In Wisconsin
Dont live with foot pain from an under active thyroid get treatment!s
The podiatrists of Advanced Foot & Ankle of Wisconsin help local hypothyroidism patients handle their foot pain. Stiffness can be treated with physical therapy exercises determined by our podiatrists. We are able to treat pain in the:
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What Are Symptoms Of Carpal Tunnel Syndrome
It’s important to know what causes carpal tunnel syndrome. But it’s just as important to recognize its signs and symptoms.
Several other conditions canmimiccarpal tunnel syndrome. Most notably, they areflexor tendonitis,rheumatoid arthritis,andthoracic outlet syndrome.Therefore, if you can weed out the other candidate disorders, then you can treat your carpal tunnel syndrome properly.
The hallmark symptoms of carpal tunnel syndrome are pain, numbness, tingling, burning, weakness, loss of dexterity, and loss of temperature sensitivity. The palm of the hand and first three fingers are involved. Sometimes pain or numbness may feel like it’s radiating into the forearm.
Foot Pain And Cramping
Muscle, joint and nerve pains are not usually stressed as primary symptoms of hypothyroidism, but after years of hearing from hypothyroid patients at Hypothyroid Mom, there is one thing that I am certain about. Full thyroid testing should be conducted on every single person that presents with chronic pain or fibromyalgia.
The number of people that write to Hypothyroid Mom about plantar fasciitis, the pain along the bottom of the foot especially the heel that shoots through them especially when they step out of bed in the morning, cant be a mere coincidence. In the case of Hashimotos thyroiditis and Graves disease, the immune system can also attack the joints and muscles frequently in the feet and ankles. Like carpal tunnel syndrome, thyroid patients are also more vulnerable to develop tarsal tunnel syndrome. Add to this the increased risk of developing gout , burning feet from painful neuropathy , and plantar fasciitis , and the incidence of foot pain in thyroid disease becomes very clear.
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Reducing Force From Hand Tools
The force placed on the fingers, hands, and wrists by a repetitive task is an important contributor to CTS. To alleviate the effect of force on the wrist, design tools and tasks so that the wrist position is the same as it would be if the arms dangled relaxed at the sides.
- No task should require the wrist to deviate from side to side or to remain flexed or highly extended for long periods of time.
- The handles of hand tools such as screwdrivers, scrapers, paintbrushes, and buffers should be designed so that the force of the worker’s grip is distributed across the muscle between the base of the thumb and the little finger, not just in the center of the palm.
- People who need to hold tools for long periods of time should grip them as loosely as possible.
- In order to apply force appropriately, the ability to feel an object is extremely important. Tools with textured handles are helpful.
- If possible, people should avoid working at low temperatures, which reduces sensation in the hands and fingers.
- Power tools and machines should be designed to minimize vibrations.
- Wearing thick gloves, when possible, may lessen the shock transmitted to the hands and wrists.
Standard Release Surgical Procedures
CTS surgery can be performed through a standard open release, a mini-open technique, or endoscopy. There is no clear evidence to suggest that one surgical technique is much better than another over the long term.
Open Release Surgery
Traditionally, surgery for CTS has involved an open surgical procedure performed in an outpatient facility. In this procedure, the carpal ligament is cut free from the median nerve. This relieves pressure on the median nerve. The surgery is straightforward.
In treating carpal tunnel syndrome, surgery may be required to release the compressed median nerve. The open release procedure involves simply cutting the transverse carpal ligament.
The Mini-Open Approach
In recent years, more surgeons have adopted a “mini” open — also called short-incision — procedure. This surgery requires only a 1-inch incision, but it still allows a direct view of the area The mini-open approach seems to reduce recovery time, pain, and recurrence rate compared to an open approach. However, over the long term there doesn’t seem to be any significant difference between the mini-open approach and the standard open release.
Endoscopy
Endoscopy for CTS is a less invasive procedure than standard open release.
Endoscopic approaches have a faster return to work outcomes when compared with open approaches.
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Exercises For Carpal Tunnel Syndrome
Wrists
Exercise 1
- Make a loose right fist, palm up, and use your left hand to press gently down against the clenched hand.
- Resist the force with the closed right hand for 5 seconds. Be sure to keep your wrist straight.
- Turn your right fist palm down, and press the knuckles against the left open palm for 5 seconds.
- Finally, turn your right palm so the thumb-side of the fist is up, and press down again for 5 seconds.
- Repeat with your left hand.
Exercise 2
- Hold one hand straight up shoulder-high with your fingers together and palm facing outward.
- With the other hand, bend the hand you are exercising backward with the fingers still held together and hold for 5 seconds.
- Spread your fingers and thumb open while your hand is still bent back and hold for 5 seconds.
- Repeat five times with each hand.
Exercise 3
- Specific physical findings
- Abnormal electrodiagnostic test results
Many people have abnormal electrodiagnostic test results without classic symptoms or any symptoms at all. Furthermore, about 15% of the population has symptoms that are consistent with CTS, but in most of these people, test results do not indicate the disorder.
MRI, CT scans, and other imaging tests are not useful for diagnosing carpal tunnel syndrome.
Carpal Tunnel Syndrome And The Thyroid
Carpal tunnel syndrome is typically diagnosed by a hands-on examination to rule out other conditions, as well as clinical signs of the condition, which can include swelling and discoloration. A practitioner may manipulate the hand to reproduce carpal tunnel syndrome-suggestive hand positions that generate tingling or symptoms. A nerve conduction velocity test may also be conducted to measure the speed of electrical impulses as they pass through the carpal tunnel. A slowdown of the impulse can be a sign of the condition.
However, this method of diagnosis fails to consider the root cause of carpal tunnel. In the case of patients with an underactive thyroid, they often have a fluid retention issue that leads to the experience of increased pressure within the carpal tunnel, irritating the median nerve.
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How Can You Keep Carpal Tunnel Syndrome From Coming Back
To keep carpal tunnel syndrome from coming back, take care of your basic health. Stay at a healthy weight. Don’t smoke. Exercise to stay strong and flexible. If you have a long-term health problem, such as arthritis or diabetes, follow your doctor’s advice for keeping your condition under control.
You can also try to take good care of your wrists and hands:
- Try to keep your wrist in a neutral position.
- Use your whole handnot just your fingersto hold objects.
- When you type, keep your wrists straight, with your hands a little higher than your wrists. Relax your shoulders when your arms are at your sides.
- If you can, switch hands often when you repeat movements.
What Causes Carpal Tunnel Syndrome
Carpal tunnel syndrome can be brought on by one or several factors contributing to increased pressure or swelling within the Carpal tunnel.
- Idiopathic: most cases have no specific cause
- Repetitive trauma: repetitive movements expose the nerve to compression forces and stretching.
- Systemic disorders: diabetes, rheumatoid arthritis, hypothyroidism, amyloidosis.
- Tenosynovitis: thickening of the tendon synovium caused by friction/overuse of the tendons.
- Oedema: increased fluid within the carpal tunnel, eg pregnancy, cardiac failure.
- Abnormal structures protruding into CT canal: eg ganglion, displaced fracture, abnormal muscle belly, and arthritic bony spur.
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