Carpal Tunnel Syndrome in Rheumatoid Arthritis

Summary: Carpal tunnel (CTS) syndrome is the most common compression neuropathy associated with rheumatoid arthritis (RA). Pain and/or paresthesias at night as well as weakness, loss of dexterity, and thenar atrophy can occur. CTS in RA patients is not always obvious, as these symptoms are common complaints in the RA population. Therefore, every patient with RA should be evaluated for CTS. Flexor tenosynovitis (FTS) is the common denominator in patients with CTS and RA. FTS must be treated concomitantly with CTS, and the surgeon should be prepared for the possibility of tendon ruptures and/or exposed bone spurs in the carpal canal. Severe RA wrist destruction with volar subluxation or dislocation of the carpus can result in median nerve compression with CTS symptoms. Median nerve compression also can occur after wrist arthrodesis in RA patients.