Wrist and hand discomfort often leads people to confuse tendonitis and carpal tunnel syndrome. Both conditions cause significant pain and interfere with daily activities in the same general area. While symptoms may overlap, the underlying structures involved are fundamentally different. Understanding the distinction between a musculoskeletal issue and a neurological one is important for seeking the correct treatment.
Anatomical Differences Between Tendonitis and Carpal Tunnel Syndrome
Tendonitis and carpal tunnel syndrome affect distinct biological components within the wrist, which explains their varied symptoms. Tendonitis is primarily a musculoskeletal issue involving the inflammation of a tendon, the thick fibrous tissue connecting muscle to bone. In the wrist, numerous flexor and extensor tendons allow for movement, and any of these can become irritated or inflamed.
Carpal tunnel syndrome (CTS) is a neurological condition centered on the median nerve. This nerve runs from the forearm through the carpal tunnel, a narrow passageway in the wrist that also houses nine flexor tendons. CTS occurs when the median nerve becomes compressed or pinched within this tight space. The fundamental difference is between an inflamed connective tissue (tendonitis) and a compressed nerve (CTS).
How Symptoms Clearly Differ
The primary distinction between the two conditions lies in the type and location of the discomfort experienced. Tendonitis typically presents as localized pain and tenderness directly over the affected tendon, often on the palm side or back of the wrist. The pain is generally described as an ache or sharp pain that worsens significantly with specific movements, such as gripping, lifting, or rotating the wrist.
Physical signs of tendonitis can include localized swelling, stiffness, and sometimes warmth or redness over the area of inflammation. The pain may radiate slightly up the forearm, but the primary sensation is pain, not numbness.
Carpal tunnel syndrome, conversely, is characterized by neurological symptoms that follow the distribution of the median nerve. These sensations include numbness, tingling, or a “pins and needles” feeling, often accompanied by a burning sensation. These symptoms typically affect the thumb, index finger, middle finger, and the thumb-side half of the ring finger, while the pinky finger is usually spared.
A common and distinguishing feature of CTS is the exacerbation of symptoms at night, often waking the person from sleep. The tingling or pain may radiate up the arm toward the shoulder. Weakness in the hand grip can also lead to clumsiness or dropping objects.
Underlying Causes and Common Risk Factors
The origins of these two conditions also differ, reflecting the anatomical structures they involve. Wrist tendonitis most frequently develops from repetitive strain, overuse, or acute injury that leads to micro-tears and subsequent inflammation in the tendon. Activities requiring repetitive gripping, lifting, or forceful wrist rotations, such as certain sports or manual labor, are common instigators. Poor technique or an underlying inflammatory condition like arthritis can also contribute to the development of tendonitis.
Carpal tunnel syndrome results from any factor that reduces the space within the carpal tunnel or increases the volume of the contents passing through it, thereby compressing the median nerve. While repetitive hand and wrist movements are often cited, systemic medical conditions frequently play a significant role. Conditions such as diabetes, rheumatoid arthritis, and thyroid disorders can cause inflammation and swelling that directly compress the nerve.
Other risk factors for CTS include pregnancy, due to temporary fluid retention, and certain anatomical structures, as some people naturally have a smaller carpal tunnel.
Medical Confirmation and Diagnostic Tests
Physicians use specific diagnostic methods to confirm whether the issue is tendonitis or carpal tunnel syndrome. A diagnosis of tendonitis primarily relies on a detailed physical examination, where the doctor looks for localized tenderness upon palpation of the affected tendon. They also assess the range of motion and observe if pain is reproduced by specific movements that stress the tendon. Sometimes, imaging tests such as an ultrasound or Magnetic Resonance Imaging (MRI) may be used to visualize the tendon structure and confirm the presence of inflammation or micro-tears.
For carpal tunnel syndrome, doctors utilize specific clinical tests to provoke the neurological symptoms. Phalen’s maneuver involves holding the wrists in a flexed position, and Tinel’s sign involves lightly tapping over the median nerve at the wrist. A positive result on these tests reproduces the characteristic numbness and tingling in the median nerve distribution.
The most definitive confirmation for CTS comes from electrodiagnostic testing, specifically Nerve Conduction Studies (NCS) and Electromyography (EMG). These tests measure the speed and strength of electrical signals passing through the median nerve, directly assessing the severity of the nerve compression.