Arm Pain and Weakness in MS: Is It Carpal Tunnel Syndrome?

Identifying the cause of new symptoms, such as arm pain or weakness, can be challenging if you’re living with multiple sclerosis (MS). Are your tired, achy, tingly arms and hands related to MS or something else entirely, like carpal tunnel syndrome?

Symptoms of carpal tunnel syndrome and MS can overlap, and it’s also possible to have both. But there are ways to tell whether your arm pain and weakness is more likely related to one condition than another. Read on to learn about carpal tunnel syndrome in MS and its causes, symptoms, and the treatment.

What Causes Carpal Tunnel Syndrome?

Carpal tunnel syndrome affects the hand and forearm, causing numbness, tingling, weakness, and pain. This can happen when the median nerve, a primary nerve to the hand, becomes squeezed in a tight space — the carpal tunnel — as it travels through the wrist. The carpal tunnel is made up of bones and a ligament inside the wrist, along with the median nerve and some tendons. When there’s too much pressure on the median nerve, it swells and may cause nerve damage, which can affect the hand function.

Carpal tunnel syndrome is one of the most common nerve conditions, affecting about 3 percent to 6 percent of adults.

Common Symptoms of Carpal Tunnel Syndrome

Symptoms of carpal tunnel syndrome come on gradually and typically get worse over time if not treated. Generally, people first experience tingling and numbness (also a common MS symptom) in their hands or the fingers. The thumb, index, middle, and ring fingers tend to be the most affected, and the pinkie usually is not involved. Since this type of pain is related to problems with the nerves, it’s known as neuropathic pain.

One MyMSTeam member described symptoms in their fingers: “I’m going in for a consultation for my hand for my carpal tunnel. Both of my thumbs lock up, and three-and-a-half out of five fingers go numb to the point of pain.”

Some people also experience electric shock-like feelings that can travel up from the fingers to the wrist, arm, and shoulder. These sensations are often triggered by a motion, such as holding a phone or steering wheel, writing, or typing, and may awaken you during the night. “Terrible carpal tunnel in both arms — didn’t sleep well at all,” wrote one MyMSTeam member.

Sometimes, people simply give their hands a shake to relieve the numbness or tingling, but the sensations can eventually become constant. Hand and arm weakness is common, too, and you might begin to drop objects because of a weak or numb thumb — the median nerve is responsible for the fingers’ pinching motion. Over time, you might have trouble with fine motor movements, such as buttoning a shirt. In severe cases of carpal tunnel syndrome, the thumb can become smaller.

Pinkie Pain? Probably Not Carpal Tunnel Syndrome

Upper-extremity weakness and sensations of numbness, tingling, and pain are all neurological symptoms of MS, too. One clue to telling the conditions apart is that if your pinkie is involved, you can likely rule out carpal tunnel syndrome.

Even health care professionals occasionally mistake MS for carpal tunnel or vice versa. One MyMSTeam member described their misdiagnosis. “So, I went to the ortho because I was diagnosed with carpal tunnel in 2009, and he tells me I don’t have carpal tunnel, but that it was MS masking itself as carpal tunnel,” they said. “So I’ve had MS as far back as 2009.”

Can MS Raise Your Risk of Carpal Tunnel Syndrome?

MS affects the central nervous system (CNS), which includes the brain and spinal cord, whereas carpal tunnel syndrome affects the peripheral nervous system (nerves outside the CNS). Studies looking at carpal tunnel syndrome in people with MS have been few and small, but they show some evidence that carpal tunnel syndrome may be more common in people with MS. One 2018 study of 75 people with MS found that 28 percent of participants also had carpal tunnel syndrome.

Older Age and Use of Mobility Aids

Using mobility aids for MS, such as crutches or canes, increases the risk of developing carpal tunnel syndrome. A small 2020 study found that people with both conditions tended to be older and had lived with MS longer than those who had MS but not carpal tunnel syndrome.

In an earlier study, researchers also suggested that wheelchair and mobility aid use, which involves repetitive (continuous) hand motions, could lead to a high prevalence of carpal tunnel syndrome among people with MS. The findings also linked older age with more severe carpal tunnel syndrome.

More research is necessary to determine if having MS makes you more likely to develop carpal tunnel syndrome, but using mobility aids — common among people with advanced MS — does seem to increase the risk.

Other Risks Factors for Carpal Tunnel Syndrome

There’s no one specific cause of carpal tunnel syndrome, but a variety of factors make you more likely to develop it. Risk factors of carpal tunnel syndrome include the following:

• Repetitive and frequent hand movements, such as typing
• Repetitive and frequent grasping movements used in sports or factory assembly lines
• Hormonal changes in people with thyroid problems or going through menopause
• Fractures or dislocations of the wrist
• Bone or joint diseases, such as osteoarthritis
• Inflammatory autoimmune diseases, such as rheumatoid arthritis
• Blood sugar changes, as seen in type 2 diabetes
• Use of anastrozole (Arimidex), a drug to treat breast cancer
• A higher body weight
• Family history of carpal tunnel syndrome

According to the National Institute of Neurological Disorders and stroke, women are three times more likely than men to have carpal tunnel syndrome. The authors of the 2018 study found that people aged 40 to 60 also are at greater risk.

Treatment of Carpal Tunnel Syndrome

If you’re concerned about numbness, weakness, or pain in your arm, hand, or fingers, it’s important to see your doctor to get the right diagnosis. Early treatment of carpal tunnel syndrome is best, since it’s a condition that gets worse over time. When symptoms first begin, you may be able to manage them by applying ice packs, taking breaks often to rest your hands, and avoiding anything that makes the pain worse. However, if you have numbness, it’s important that you see a neurologist.

Conservative Treatment

If at-home measures like ice and rest don’t provide enough relief, the next step might involve wrist splinting, especially at night, and pain relief medications.

First-line medications for short-term pain relief typically include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), but these over-the-counter medications don’t treat the condition itself. For that, corticosteroids such as cortisone can be injected directly into the carpal tunnel to reduce inflammation of the median nerve, thereby relieving symptoms.

These treatment options are more likely to work if your symptoms are occasional, have lasted less than 10 months, and are mild or moderate.

Surgery

If conservative treatments don’t work or your symptoms are severe, you might consider carpal tunnel surgery. In this procedure, your surgeon relieves pressure on the median nerve by cutting the ligament that’s pushing against it. Two types of surgery are available — endoscopic and open — and both achieve good results and patient satisfaction.

In endoscopic surgery, the surgeon uses a device with a camera attached to look inside the carpal tunnel region. They can then cut the ligament, making small incisions in your wrist or hand. This type of surgery can lead to less pain compared with open surgery.

Open surgery involves a larger incision into the palm of your hand, directly above the carpal tunnel, so the surgeon can access the ligament and reduce pressure on the nerve. Your skin will heal in a few weeks, but internal healing will take several months. You may be given physical therapy during recovery, and your doctor will likely encourage you to gradually return to normal use of your hand.

Talk With Others Who Understand

MyMSTeam is the social network for people with MS and their loved ones. On MyMSTeam, more than 198,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Have you been diagnosed with both carpal tunnel syndrome and MS? What do you do to help relieve the tingling and pain? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References

1. Carpal Tunnel Syndrome — Mayo Clinic
2. Carpal Tunnel Syndrome — OrthoInfo
3. Carpal Tunnel Syndrome — National Institute of Neurological Disorders and Stroke
4. Carpal Tunnel Syndrome –– American College of Rheumatology
5. Carpal Tunnel Syndrome –– American Family Physician
6. Carpal Tunnel Syndrome — Cleveland Clinic
7. Carpal Tunnel Syndrome — Johns Hopkins Medicine
8. Prevalence of Carpal Tunnel Syndrome in Patients With Multiple Sclerosis — Acta Med Croatica
9. Upper Limb Entrapment Neuropathies in Multiple Sclerosis — Multiple Sclerosis Journal — Experimental, Translational and Clinical
10. Numbness — Multiple Sclerosis Association of America
11. Cortisone Shots — Mayo Clinic

MS Symptoms & Signs of MS

• Fatigue
• MS Hug (Dysesthesia)
• Walking (Gait) Difficulties
• Numbness or Tingling
• Spasticity
• Weakness
• Vision Problems
• Vertigo and Dizziness
• Bladder Problems
• Sexual Problems
• Bowel Problems
• Pain & Itching
• Cognitive Changes
• Emotional Changes
• Speech Problems
• Loss of Taste
• Swallowing Problems
• Tremor
• Breathing Problems
• Seizures
• Depression
• Hearing Loss

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Overview

Muscle weakness, which is common in MS, can occur in any part of the body. The first step in managing weakness effectively is to determine what is causing it.

• Deconditioning of muscles results from lack of use. Often in MS, due to fatigue, pain, imbalance, or other symptoms, a person’s overall activity level is reduced. Lack of activity will cause muscles to become weak. For this type of weakness, progressive resistive exercise with weights can be very effective. A physical therapist can recommend a weight-training program that fits abilities.
• Damage to the nerve fibers (demyelination) in the spinal cord and brain that stimulate the muscles can also cause weakness. The muscles are not receiving the nerve impulses they require in order to work effectively – which often results in decreased endurance.  Because the source of this type of weakness is impaired nerve conduction, weight training to strengthen the affected muscles is not effective – and may even increase feelings of weakness and fatigue. The recommended strategy is to maintain the tone of those muscles that are not receiving adequate nerve conduction with regular use, while working to strengthen the surrounding muscles that are receiving adequate conduction. A physical therapist can work with you to identify the sources of your weakness and recommend appropriate strategies to manage them.

Weakness in the legs, ankles and feet can interfere with walking. Management strategies to address walking problems include exercise, assistive devices and medication. Weakness in the upper body and arms can interfere with activities of daily living and self-care. Occupational therapists can recommend appropriate exercises for your arms and hands, as well as tools and devices to assist with activities in the home and at work.  

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Weakness in the hands or when the hands “go numb” in St. Petersburg

State of emergency in Derbyshki Mrs. Patyashina transferred to the category of operation “Dirty hands”

were hospitalized

CHILDREN IN THE BOARDING HOUSE REQUIRED SPECIAL CARE

To date, 6 pupils of the Derbyshkin boarding school for mentally retarded children remain in Kazan hospitals, the rest have been returned to the boarding house in their department. This was announced today at a special briefing by Marina Patyashina – head of the Rospotrebnadzor in the Republic of Tatarstan (it is very strange in itself that Patyashina’s appearance to journalists and the public took place more than two weeks after the emergency)… She stressed that there were no poisonings. Presumably, the infection was introduced by staff into a group of seriously ill children. In total, the diagnosis of “dysentery” was confirmed in 30 children, and a total of 33 pupils were hospitalized.

“Violations of the requirements of sanitary legislation in terms of violation of the regime were revealed, facts of non-compliance with hygiene were revealed, which allowed the spread of intestinal infection. This is due only to the transmission of the infection by contact and household means: through hands, household items, – said Patyashina, answering a question from a BUSINESS Online correspondent. “Taking into account the fact that the children in the boarding school required special care: the participation of staff in feeding, changing clothes, that is, it required especially close contact with the staff, and also the fact that the sanitary literacy of the staff left much to be desired, all this led to what happened. ” .

Rospotrebnadzor specialists exclude the transmission of infection through tap water, as well as the food factor: in the boarding house there is a common catering unit, and children from other departments were not infected.

In addition to the children, 13 employees were hospitalized and are now also subject to discharge after testing twice negative for dysentery.

“Employees were hospitalized because they were diagnosed with the causative agent of dysentery. Now they are in good condition, this disease is not severe. We have about 300 cases of dysentery a year in Tatarstan. This is not a particularly dangerous infection, people may not experience clinics (diarrhea, loose stools), but be carriers of this infection. In order not to pick it up, you must follow a simple rule: wash your hands before eating. A person can be a carrier and infect others if he is in close contact with them, as happened in the boarding house in Derbyshki,” she said.

Now, at the request of the republican prosecutor’s office, inspections have begun in 23 social institutions subordinate to the Ministry of Labor and Employment of Tatarstan, where children are kept around the clock. Details of these checks will be ready by November 1.

Rospotrebnadzor carried out a scheduled inspection in the boarding house in 2010. The following year, an audit was carried out on the execution of previously issued instructions. Recently, an unscheduled inspection was carried out.

Meanwhile, the Investigative Committee continues to investigate the criminal case under the article of the Criminal Code of the Russian Federation “Negligence”. As the assistant to the head of the Investigative Committee of the RF Investigative Committee for the Republic of Tatarstan noted to the newspaper “BUSINESS Online” Andrey Sheptytsky , no new procedural decisions have been made.

Recall that the situation in the Derbyshkin boarding school became one of the main issues of an extraordinary meeting in the Security Council, which on Monday was held in the Kazan Kremlin by President of the Republic of Tatarstan Rustam Minnikhanov . Then he made a remark to the Minister of Labor, Employment and Social Protection of the Republic of Tatarstan Airat Shafigullin . One of the most experienced leaders, the president said, and suddenly such an emergency. Although there are states and resources. Then Minnikhanov demanded to urgently restore order and warned that the perpetrators would be held personally liable.

DIRTY FRUIT, NOT COMPLETELY WASHED DISHES

Lenar Salakhutdinov – director of the Medel Clinic:

– There can be many different sources of intestinal infection in the body. Not necessarily unwashed hands of employees, although, of course, unwashed hands of employees can be considered – this is the most common case. It is possible that these are unwashed food or inadequately washed dishes. Also, very often, an intestinal infection enters the body due to unwashed vegetables, fruits, poor heat treatment. Some products require that they be washed with soapy water instead of plain water.

Intestinal infection is dangerous, even fatal, if started. But at least this is dehydration, weakness and susceptibility to other diseases after it. Main symptoms: abdominal pain, frequent loose stools, weakness. As a rule, antibiotics are used for treatment to clear the E. coli infection from the body.

Azat Fatkhetdinov – chief doctor of the city hospital No. 2 of Naberezhnye Chelny:

– A lot depends on the state of the human body itself. There may be other comorbidities that complement each other. There are exhausted, sick people – an intestinal infection can affect them much worse than healthy people.